Clinical Studies On Treatment Of Osteoarthritis Of The Knee Joint Sequential Method

Background Osteoarthritis is typically with onset during middle or old age that is characterized by degenerative and sometimes hypertrophic changes in the bone and cartilage of one or more joints, it marked symptomatically especially by pain, swell, deformity and stiffness. The knee joint is usually one of the affected joints. It is reported a higher incidence of osteoarthritis of the knees in old females than in old males. Osteoarthritis may be classified into two types: primary and secondary. As the increase of old people, the morbidity of osteoarthritis is also increasing yearly. The treatment proved to be difficult, because of complex anatomic structuresand long course of illness in the knee joint. There are lots of managements of most patients, generally subjective symptoms appear to be improved at short-term follow-up, but long-term responses are still unsatisfactory. The patients with OA admitted at in-patient orthopaedic department of Hubei TCM hospital from September 2005 to October 2006, were divided into two groups randomly. GroupⅠtreated with debridement under arthroscopy, HA injection by arthrocentesis and guided TCM herbal ions in order. GroupⅡtreated with debridement under arthroscopy and HA injection. Before and after treatment, referring to ISOA scoring system, evaluate and compare the clinical effects between the two therapeutic methods on 4 weeks and 6 months.Objective The aim of the clinical study is to compare the clinical effects and ISOA scores between the two groups after the treatment on 4 weeks and 6 months follow-up. Estimate the safety.Methods Patients with knee joint OA admitted at in- patient orthopaedic department of Hubei TCM hospital from September 2005 to October 2006, there were 40 cases. According to the admit time, the cases were divided into two groups randomly. GroupⅠtreated with debridement under arthroscopy, HA injection by arthrocentesis and guided TCM herbal ions in order. GroupⅡtreated with debridement under arthroscopy and HA injection. Before the therapy, estimate the scores of ISOA, laboratory tests were also carried out including Blood-Rt, Urine-Rt, Stool-Rt, liver function, renal function. ECG is checked too. X-ray films of AP view and lateral view of the knee joint were taken. On 4 weeks and 6 months after the therapeutic procedures, ISOA and clinical effects were estimated again and analyzed statistically. Excellent: symptoms of pain, swell etc vanish, the function of knee joint normal, the scores of ISOA decrease more than 90%; good: symptoms of pain, swell etc vanish, the function of knee joint normal, the scores of ISOA decrease more than 70%; fair: symptoms of pain, swell etc vanish, the function of knee joint limited, the scores of ISOA decrease more than 30%. Poor: symptoms of pain, swell etc basically same as before, the scores of ISOA decrease less than 30%. [formula: (ISOA scores before treatment-ISOA scores after treatment)÷ISOA scores before treatment×100%]Results1. Follow-up after treatment on 4 weeks:The scores of ISOA before treatment: groupⅠ20 cases, (?)±s=10.25±2.27, groupⅡ20 cases, (?)±s=10.15±1.82. Follow-up on 4 weeks after treatment, the scores of ISOA: groupI20cases, (?)±s=3.025±1.74, groupⅡ20 cases, (?)±s=2.95±1.67. The scores of two groups ISOA after treatment on 4 weeks follow-up comparing with the scores before treatment were significant difference statistically, P＜0.01. The scores of groupⅠand groupⅡafter treatment on 4 weeks follow-up were no significant difference statistically, P＞0.01. The clinical effects after treatment on 4 weeks follow-up: groupⅠ20 cases, 5 cases were evaluated as excellent, 14 as good, 1 as fair and 0 as poor, the rate of excellent and good results was 95%; groupⅡ20 cases, 4 cases were evaluated as excellent, 14 as good, 2 as fair and 0 as poor, the rate of excellent and good was 90%. There was no significant difference statistically between the two groups, P＞0.01.2. Follow-up on 6 months after treatment:2.1 GroupⅠ20 cases, the scores of ISOA: (?)±s=2.95±1.79, there was significant difference statistically comparing with the scores before treatment, P＜0.01. Clinical effects: 4 cases were evaluated as excellent, 14 as good, 2 as fair and 0 as poor, the rate of excellent and good was 90%, there was no significant difference statistically comparing with the clinical results after treatment on 4 weeks follow-up, P＞0.05.2.2 GroupⅡ20 cases, the scores of ISOA: (?)±s=5.05±1.36, there was significant difference statistically comparing with the scores before treatment, P＜0.01. Clinical effects: 4 cases were evaluated as excellent, 12 as good, 3 as fair and 1 as poor, the rate of excellent and good was 80%, there was significant difference statistically comparing with the clinical results after treatment on 4 weeks follow-up, P＜0.05.2.3 The scores of ISOA and clinical effects between groupⅠand groupⅡafter treatment on 6 months follow-up were significant different statistically, P＜0.05.Conclusion1. Follow-up after therapeutic procedures on 4 weeks and 6 months, ISOA scores and clinical effects were significant different statistically comparing with the treatment before, P＜0.01. Results show the treatment with debridement under arthroscopy and HA injection by arthrocentesis had good clinical responses.2. Follow-up after therapeutic procedures on 6 months, ISOA scores and clinical effects between the two groups were significant different statistically, P＜0.05. Clinical study proved that combined therapy in order had good clinical effects and long-term responses in treating OA of knee joint.3. The clinical study show that combined therapy in order is an effective, long-term lasting treatment. The guided TCM herbal ions play an important role.4. There were no abnormal reactions and allergy.