| ??Objective:Needle knife and circular needling are both traditional Chinese medicine external treatment.In this experiment,circular needling intervention was used as the control group to compare the curative effect of needle knife treatment.To study the characteristics of knee soft tissue inflammation in patients with koa,and further explore the mechanism of acupotomy in the treatment of KOA.Our team has shown that NF-?B inflammatory pathway,synovium and cartilage expression activation play an important role in the process of KOA degeneration through animal experiments.Through the experimental study of clinical musculoskeletal ultrasound,the characteristics of KOA soft tissue inflammation are summarized,which is consistent with the theory of tendon injury in traditional Chinese medicine.Therefore,in this study,based on the previous research,based on the theory of tendon injury and the theory of reconciliation,we carried out animal experiments and clinical research to elaborate the mechanism of Yuanli acupuncture and needle scalpel treatment of KOA.A needle knife has a blade,but a round sharp needle does not.With this operation method,we believe it is more accurate to compare the difference between the "needle" of round sharp needle and the "knife" of needle knife,and further explore the possible mechanism of needle knife treatment and knee osteoarthritis.Both needle knife and Yuanli acupuncture treatment are traditional Chinese medicine external treatment methods.In this experiment,Yuanli needle intervention therapy was used as a control group to compare the efficacy of needle knife therapy.To study the characteristics of musculoskeletal ultrasound of knee soft tissue inflammation in patients with KOA,and further explore the mechanism of acupuncture treatment of KOA.The research team's early animal experiments showed that the NF-?B inflammation pathway and synovium,and cartilage tissue expression activation,played an important regulatory role in the degeneration of KOA.It has also passed the clinical musculoskeletal ultrasound experimental study,summarized and summarized the characteristics of KOA soft tissue inflammation,which is consistent with the theory of traditional Chinese medicine tendon injury.Therefore,in this study,on the basis of previous research,based on the theory of tendon injury and unraveling,through animal experiments and clinical research,we elaborated the mechanism of action of Yuanli needle therapy versus needle knife therapy of KOA.The needle knife has a blade,but the round needle does not.Using this method of operation,I believe it is more accurate,compare the difference between the "needle" of a rounded needle and the "knife" of a needle knife,and further explore the possible mechanism of needle knife treatment and knee osteoarthritis.In terms of biomechanics:1.The maximum stress results show that compared with the normal group,the Yuanli needle group,the manufacturing module and the needle knife group all have a significant downward trend(P<0.01,P>0.05);and the modeling Compared with the group,the needle knife group and the Yuanli needle group had a significantly increasing trend(P<0.01,P>0.05);compared with,the needle knife group,the Yuanli needle group had a decreasing trend(P<0.05).2.The maximum strain results show that compared with the normal group,the model group and the round needle group have a significant downward trend(P<0.01,P>0.05),and the needle knife group has an upward trend(P>0.05);and Compared with the model,the needle knife group and the Yuanli needle group had an upward trend(P<0.05);compared with the needle knife group,the Yuanli needle group had a downward trend(P>0.05).3.The results of the maximum displacement show that the needle knife group,the Yuanli needle group,and the manufacturing module have a downward trend(P<0.05),compared with the normal group;compared with the model group,the needle knife group,the Yuanli needle group have The increasing trend(P<0.05,P>0.05);the Yuanli needle group had a decreasing trend(P>0.05),compared with the needle knife group.4.The elastic modulus results show that the needle knife group,the Yuanli needle group and the model have a decreasing trend(P<0.05),compared with the normal group;the needle knife group and the Yuanli needle group have a significantly increasing trend(P<0.01,P<0.05),compared with the model;Yuanli needle group has a decreasing trend(P<0.05),compared with the needle knife group.??Methods:(?)In clinical research:57 patients with KOA were included in the case screening criteria of diagnosis and treatment guidelines for osteoarthritis(2018 version)formulated by bone science branch of Chinese Medical Association.The patients were randomly divided into two groups:needle knife test group and Yuanli targeted group.The needle knife test group was treated with the muscle bone ultrasound guided needle knife,while the round benefit group was treated with the muscle bone ultrasound guided round benefit needle,and the needle knife technique with the same diameter as the needle knife group was used.In both groups,internal and external knee acupoints were selected.In terms of the difference of safety,the improvement of symptoms before and after treatment,and the correlation with KOA symptoms,the specific role of needle knife and round needle in the process of puncture treatment was analyzed and observed.To evaluate the manifestations of inflammation of the soft tissue around the knee joint,analyze the manifestations of inflammation of the knee joint and the surrounding soft tissue,and examine them with muscle bone ultrasound.And from the clinical point of view,to explore the specific mechanism of needle knife and round needling in the treatment of KOA.(?)Animal experiment:Test 1:40 Wistar rats of 8 weeks old were selected and randomly divided into normal group,model group,needle knife group,and round needle group,10 rats in each group.Among them,the normal group was fed normally during the same period without any treatment.The modeling module,the needle knife group,and the Yuanli needle group all use the papain method to model the KOA model rats.The modeling module does not do any intervention treatment and is kept at the same time as the other groups.Needle knife group:After successful modeling,needle knife intervention is performed once a week for four weeks.After successful modeling,the Yuanli needle group uses the same diameter as the needle knife.The Yuanli needle is used for needle knife operation once a week for a total of four weeks.Both the needle knife group and the Yuanli needle group selected the inner and outer knee eye points.Rats in each group were selected after the intervention treatment,and the knee joint cartilage,synovium and patellar ligament tissues of the rats were taken to observe the inflammation and hyperplasia of synovium.The Mankin standard was used to evaluate the degree of cartilage destruction in each group.Cartilage tissue was fixed,sliced,and stained under a light microscope.Explore the interventional therapy of Yuanli acupuncture,compared with the treatment of KOA with acupuncture,inhibit the degeneration of cartilage and improve the mechanism of biomechanics,from the perspective of tissue morphology and biomechanics.Test 2:In synovial tissue,the expression levels of NF-?BP65,IKB-amRNA and protein,the key components of the NF-?B inflammation pathway,were statistically significantly different in each group(P<0.01).The NF-?Bp65mRNA in the needle knife group And protein expressions were significantly higher than the Yuanli needle group and the model(P<0.01),and the expression of IKB-?mRNA and protein in the needle knife group was higher than the Yuanli needle group and the model(P<0.05).Serum inflammatory factors IL-1?,TNF-?,MMP-13,PGE2 in the needle knife group and Yuanli needle were significantly higher than the normal group,and the content of the needle knife group was significantly lower than that in the Yuanli needle group.The results of the enkephalin test showed that the needle knife group was significantly higher than the Yuanli needle group.(?)Results:Western blot and real-time PCR were used to detect the expression levels of NF-?B inflammatory pathway,key elements NF-?Bp65 and IKB-a in synovium and cartilage of rats in each group,and enzyme-linked immunosorbent assay(ELISA)was used to detect the contents of TNF-?,IL-1?,MMP-13 and prostaglandin E2,?-endorphin in serum of rats in each group.In the second experiment,KOA rats were used in the same way.From the perspective of molecular biology,to explore and analyze the specific mechanism of Yuanli acupuncture intervention,treatment and needle knife treatment of KOA.??In conclusion:(?)In clinical research:KOA symptoms,the comparison between the two groups showed that the VAS pain score and Lysholm knee function score were significantly improved in the first and second follow-up(P<0.01).The improvement of vas in the second follow-up was significantly better in the Acupotomy group than in the Yuanli group(P<0.05).In the first follow-up,the improvement of Lysholm score of knee joint in Acupotomy group was better than that in Yuanli group(P<0.05).In the aspect of musculoskeletal ultrasound:the comparison between the two groups showed that after treatment,the thickness of synovium and the depth of joint effusion were significantly improved.(?)Animal experiment 1:The scores of normal group and model group were statistically significant.There was no significant difference between the acupotomorphic group,Yuanli group and the model group,and the scores of the model group,the acupotomorphic group and Yuanli group were significantly higher than those of the normal group.There were statistical differences in Mankin scores among the groups.There was no statistical difference between the needle knife group and the round needling group.The model group,the needle knife group and the round needling group were significantly higher than the normal group,and the needle knife group and the round needling group were significantly lower than the model group.Biomechanics:1?the results of the maximum stress showed that compared with the normal group,the circular needling group,the making model group and the needle knife group had a significant downward trend(P<0.01,P>0.05);compared with the making model,the circular needling group and the needle knife group had a significant upward trend(P<0.01,P>0.05);compared with the needle knife group,the circular needling group had a downward trend(P<0.05).2?The results of maximum strain showed that compared with the normal group,there was a significant decreasing trend in the group of making model and circular needling(P<0.01,P>0.05),and an increasing trend in the group of needle knife(P>0.05);compared with the group of making model,there was an increasing trend in the group of needle knife and circular needling(P<0.05);compared with the group of needle knife,there was a decreasing trend in the group of circular needling(P>0.05).3?The results of the maximum displacement showed that the needle knife group,the round needle group and the model group had a downward trend(P<0.05),compared with the normal group;compared with the model group,the needle knife group and the round needle group had an upward trend(P<0.05,P>0.05);the round needle group had a downward trend(P>0.05),compared with the needle knife group.4?The results of elastic modulus showed that the needle knife group,the round needling group and the model group had a decreasing trend(P<0.05),compared with the normal group;the needle knife group and the round needling group had a significant increasing trend(P<0.01,P<0.05),compared with the model group;the round needling group had a decreasing trend(P<0.05),compared with the needle knife group(?)Animal experiment 2:In synovium,the expression levels of NF-?Bp65,IKB-? mRNA and protein,the key elements of NF-?B inflammatory pathway,were significantly different in each group(P<0.01),the expression of NF-?Bp65 mRNA and protein in needle knife group was significantly higher than that in round needle group and model group(P<0.01),and the expression of IKB-? mRNA and protein in needle knife group was higher than that in round needle group and model group(P<0.05).The levels of IL-1?,TNF-?,MMP-13 and PGE2 in the serum of acupotomotor group,Yuanli group were significantly higher than those of the normal group,and the levels of IL-1?,TNF-?,MMP-13 and PGE2 in the acupotomotor group were significantly lower than those of Yuanli group,while the levels of ?-endorphin in the acupotomotor group were significantly higher than those of Yuanli group.??Conclusion(—)The safety and efficacy of both needle scalpel and round needling in the treatment of KOA were improved by using ultrasound guided technique.And from the clinical point of view to observe the specific mechanism of how to effectively treat KOA through loosening and relieving.(?)Compared with the intervention of circular needling,the needle knife release method can release the adhesion and contracture of the soft tissue around the knee more effectively through cutting and stripping.In terms of inhibiting the destruction of synovium and cartilage morphology,promoting animal behavior,and improving the biomechanical recovery of patellar ligament,acupotomolysis is better than round needling,so as to alleviate the symptoms of KOA.(?)Both acupotomy and Yuanli acupuncture can inhibit the activation and expression of NF-?B signal pathway in the synovium and cartilage of KOA model rats.However,the levels of TNF-?,MMP13,IL-1?,and prostaglandin E2 in the serum were significantly lower in the treatment of acupotomy than in the treatment of circular acupuncture.And increase the content of ?-endorphin,so as to inhibit joint degeneration and relieve symptoms. |
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