| ObjectiveThe subject of clinical research was used the randomized, controlled clinical studies, through the fire needle, electro-acupuncture and moxa needle, observed three different acupuncture treatments to treat knee osteoarthritis, clinical results in order to further explore the acupuncture treatment of this disease optimal therapy and possible mechanism of action for the prevention and treatment of osteoarthritis of the knee to provide the guidance.Methods120cases from the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Foshan City Hospital acupuncture, orthopedic patients, case collection time was from February2013to2014February.40cases as fire needle group,40cases as the EA group,40cases as warm acupuncture group.Western diagnostic criteria referring to the Chinese Medical Association to develop orthopedic branch "osteoarthritis treatment guidelines (2007edition)" in the diagnostic criteria for knee osteoarthritis, with reference to the clinical severity grading standards in1995,"Chinese medicine treatment of osteoarthritis research guidelines "set standards of TCM diagnosis and syndrome type standards are reference2002the Ministry of Health," Chinese medicine clinical research guidelines "in the diagnostic criteria and the State Administration of TCM on knee osteoarthritis1995China implemented People’s Republic of pharmaceutical industry standards,"Chinese disease diagnosis and efficacy standards" bone arthralgia syndrome classification, efficacy evaluation. The time of therapy was three times a week, four weeks for a course, after the end of a course of treatment evaluated. Efficacy of specific projects include:Quality of Life (SF-36quality of life assessment form), WOMAC knee scoring scale, VAS score, knee osteoarthritis treatment criteria (JOA), gait index (plantar each the percentage of time the area affected by the force, the percentage of single foot support of the parameters of time, step angle, the district plantar pressure peaks).Data analysis was performed using SPSS17.0statistical analysis software. Measurement data as mean±standard deviation (x±s), count data ratio (%) expressed constitutes; measurement data groups were compared using F test (heterogeneity of variance using the Kruskal-Wallis H rank sum test), comparison between the two groups LSD test, their before and after using paired t test or Wilcoxon paired rank sum test. Segment information between groups were compared using x test was used to compare data sets between grade Kruskal-Wallis H rank sum test.ResultsBefore treatment, fire needle group and EA group, warm acupuncture group sex, age, duration, type of TCM, SF-36quality of life assessment form, knee WOMAC Rating Scale, VAS score, JOA knee score, knee joint inflammation in patients with gait index (the percentage of time the force plantar regions, the percentage of time the parameters of a single foot support, step angle, the district plantar pressure peaks) score was not statistically significant analysis shows the baseline clinical data among the three groups comparable.①The quality of life comparison among three groups after treatmentSF-36quality of life assessment form study showed that somatic role function (RP), the EA group, Wen acupuncture group than in the fire needle group improved more significant (P<0.05); overall healthy feeling (GH) aspects of fire needle group score improved magnitude larger, warm acupuncture group compared with the electro-acupuncture group, the difference was statistically significant (P<0.05); mental Health (MH), the electro-acupuncture group and warm acupuncture group, fire needle group, the difference was statistically significant (P<0.05); comprehensive integration in terms of the EA group, the situation warm acupuncture group improved significantly compared with compared with fire needle group, the difference was statistically significant (P<0.05). Overall, the comprehensive integration of the three groups after treatment than before treatment were different degrees of improvement (P <0.05), EA group, warm needle acupuncture group relative to the group role in body function (RP), mental health (MH) conditions improve more significant aspects. (2)The clinical symptoms and signs comparison among three groups after treatmentWOMAC knee osteoarthritis assessment results showed that after treatment WOMAC osteoarthritis comparative assessment scores between the three groups, pain scores, the fire needle group, electroacupuncture group compared with the temperature after acupuncture treatment group was significantly lower than the scores (P<0.05); electro-acupuncture group, stiff situation warm fire needle acupuncture group than in the group to improve more obvious difference was statistically significant (P<0.05); physiological function, no statistically significant difference between the three groups after treatment group (P>0.05); while in terms of comprehensive integration, no significant difference (P>0.05) among the three groups groups. For the improvement of pain in patients with osteoarthritis of the knee to fire needle, the efficacy of acupuncture is better, and relieve stiffness symptoms, then effect of the EA, the warm acupuncture is better.Results of VAS scores showed that the three groups of VAS score after treatment compared with pre-treatment score, score varying degrees decrease (P<0.05), but no statistical significance between the two groups, indicating that fire needle, acupuncture, warm acupuncture for knee osteoarthritis patients relieve their pain conditions have a certain effect, and the effect is quite.Results of VAS scores showed that the three groups of VAS score after treatment compared with pre-treatment score, score varying degrees decrease (P<0.05), but no statistical significance between the two groups, indicating that fire needle, acupuncture, warm acupuncture for knee osteoarthritis patients relieve their pain conditions have a certain effect, and the effect is quite.Knee JOA score results showed that the three groups of knee JOA score score compared walking areas, fire needle group, warm acupuncture group compared with the EA group, scores improved significantly different (P<0.05); the downstairs areas, groups among the three groups was not statistically significant (P>0.05); on improving the situation in the knee flexion, needle set fire to the efficacy of the most significant, compared with the warm acupuncture group, statistically significant improvement (P<0.05); swelling, the fire needle group, Wen acupuncture group better than EA group effect (P <0.05). It is suggested that to improve walking in patients with osteoarthritis of the knee, swelling to fire needle, the efficacy of acupuncture obvious temperature, poor EA efficacy; improve buckling case, the superior electrical fire needle acupuncture needles and warm.(3)The gait indexes comparison among three groups after treatmentGait Indexes findings show that three groups in a few gait temperature indicators, such as the inside heel HM forces the percentage of time, there is a certain aspect of step angle improved, but did not reach normal, especially foot districts by the end of the percentage of time each time distribution and support of the force. It is possible to observe a short time, may also be caused by the disease itself or refractory patients walking posture. Meanwhile, abnormal gait index also shows that the disease still exists and is likely to continue to develop. In this study, the treatment of osteoarthritis of the knee using different stitches, even though it can have an impact on the disease process, but for improving the efficacy of gait index in patients with osteoarthritis of the knee is still not ideal.(3)The gait indexes comparison among three groups after treatmentGait Indexes findings show that three groups in a few gait temperature indicators, such as the inside heel HM forces the percentage of time, there is a certain aspect of step angle improved, but did not reach normal, especially foot districts by the end of the percentage of time each time distribution and support of the force. It is possible to observe a short time, may also be caused by the disease itself or refractory patients walking posture. Meanwhile, abnormal gait index also shows that the disease still exists and is likely to continue to develop. In this study, the treatment of osteoarthritis of the knee using different stitches, even though it can have an impact on the disease process, but for improving the efficacy of gait index in patients with osteoarthritis of the knee is still not ideal.④The clinical effects comparison among three groups after treatmentThe overall effect of the three groups Kruskal Wallis H rank sum test, H=6.28, P=0.14, not statistically significant (P>0.05), which was markedly effective fire needle group65.79%, total effective rate was78.95%; EA group markedly effective rate was56.41%, total effective rate74.36%; warm acupuncture group markedly effective rate was63.16%, the total effective rate was76.32%; it suggested that statistically, the total efficiency of the three groups had no significant difference, P>0.05, indicating no significant difference in fire needle, EA, warm acupuncture treatment of knee osteoarthritis treatment.ConclusionsBased on the above findings, the fire needle group, EA group and warm needle group have a significant effect to patients with osteoarthritis of the knee, can significantly improve the WOMAC knee osteoarthritis assessment (pain, stiffness, physical function) patients, VAS score and walk down the stairs, buckling, swelling and other indicators; knee osteoarthritis patients with clinical symptoms and quality of life have a benign effect adjustment; but for patients with osteoarthritis of the knee gait index percentage force time (plantar regions affected, poor enough to support a single parameter of the percentage of time, step angle, the district plantar pressure peaks) effect. In contrast to the three aspects of therapy, electro-acupuncture group, warm needle acupuncture group relative to the group role in body function (RP), to improve the mental health (MH) aspects of the situation is more notable for; to improve walking in patients with osteoarthritis of the knee, swelling to fire needle, warm acupuncture were obvious, EA group with poor efficacy; improve buckling case, the superior electrical fire needle acupuncture needles and warm. No significant difference in clinical efficacy assessment of efficacy among the fire needle, EA, warm needle to treat knee osteoarthritis. |
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