Tcm Syndromes And Radiological Manifestations Of Knee Osteoarthritis-related Research

Objective: Knee osteoarthritis(KOA) was one kind of common chronic degenerative joint disease, and was still unclear in modern medicine. In traditional Chinese medicine, KOA was first cognized in"Huangdi's Canon of Medicine", and more than two thousands years of experiments were accumulated to Chinese doctors. Treatment based on syndrome differentiation was the basic feature of Traditional Chinese Medicine. X-ray was the most common and available diagnosis means of KOA. So in the research of knee osteoarthritis, it is important to explore the rule of pattern of syndrome of TCM and radiologic manifestation. Besides, the correlation of radiologic manifestation and symptom severity was still unclear. Our study is a cross-sectional study, by statistics method, in order to find out the correlation of patterns of syndrome of TCM and radiologic manifestation. At the same time, we attempt to find out which radiologic manifestation could show the severity of KOA .Method: We investigated 80 cases from out-patient clinic of orthopedic of Guang'anmen hospital affiliated to China academy of Chinese medical sciences for a cross-sectional questionnaire survey. Then we collected clinical data,take x-ray pictures of the knees of OA, traditional Chinese medical four diagnostic information and analyze. All data were input to SPSS12.0 database. According to the standards for the differentiation of syndrome in the treatment of KOA defined in Principle of Clinical Research for New Traditional Herbs, the patients were divided into three types: Type I, insufficiency of the liver and kidney, with stagnation of tendons and muscles; Type II, insufficiency of the spleen and kidney, with dampness infusion into bone and joints; Type III, deficiency of the liver and kidney, with inter-obstruction of phlegm and stasis. All data were analyzed by K independent samples nonparametric test in order to find out the correlation of patterns of syndromes of TCM and radiologic manifestation. According to the Lequesne index, cases were divided into two groups to be compared the differences ,and to find out which radiologic manifestation could show the severity of KOA by logistic regression analysis.Results: 78 cases(108 knees) were conform to the study. Age in Type II was the oldest, and severity index in Type II was the greatest. Severity was significantly related to Body Mass Index(BMI).It was shown that after K independent samples nonparametric test about patterns of syndrome of TCM and radiologic manifestation: there were significant differences between three types about lateral patella osteophyte, condyles of tibia osteophyte and Type II was the most serious, Type I was secondary, Type II was the lightest.There were significant differences between group of mild and group of severe about lateral joint space narrow degree of shin and thigh, wall joint space narrow degree of knee cap and thigh, wall tibia osteophytes, wall femur osteophytes, lateral tibia osteophytes, lateral femur osteophyte, wall trochlea osteophytes, lateral knee cap osteophytes, lateral trochlea osteophytes, condyles of tibia space osteophytes.There was significant differences between group of mild and group of severe by evaluated by K-L grade. The results of the logistic regression analysis show that the lateral femur osteophytes are the most sigenificant ridiologic manifestation to evaluating the severity degree of KOA.Conclusion:1. Among three patterns of syndrome of TCM, Type II insufficiency of the spleen and kidney with dampness infusion into bone and joints was the later stage during the development of the disease, with the most serious syndromes.2. There was certain correlation of patterns of syndrome of TCM and radiologic manifestation. There were significant differences between three types about lateral patella osteophyte, condyles of tibia osteophyte and Type II was the most serious, Type I was secondary, Type II was the lightest. It is worth of a further study.3. When evaluating the severity degree of KOA, the joint space and osteophyte were the most important radiologic manifestation which included lateral joint space narrow degree of shin and thigh, wall joint space narrow degree of knee cap and thigh, wall tibia osteophyte, wall femur osteophyte, lateral tibia osteophyte, lateral femur osteophyte, wall trochlea osteophyte, lateral knee cap osteophyte, lateral trochlea osteophyte, condyles of tibia space osteophyte.