| Object:To contrast needle knife with intra-articular injection of sodium hyaluronate injection for knee osteoarthritis in the efficacy of joint function, clinical symptoms and joint space, this study analyze differences of the efficacy between the two treatments, and explore the potential mechanisms of needle knife on knee osteoarthritis in biomechanical level.Methods:1、120 patients were randomly divided into two groups, treatment group(60 cases) and control group (60 cases). There were 53 patients of treatment group and 52 patients of control group left when the final treatment plan completed. The treatment group were treated by needle knife. Select xuehai point, liangqiu point, yinlingquan point, yanglingquan point, heding point and tender points around patellar ligament,medial and lateral collateral ligament for treating once a week. The control group used with intra-articular injection of sodium hyaluronate injection therapy once a week. According to the treatment plan for treatment, we considered 5 weeks as a course of treatment to compare their joint function and clinical symptoms after treatment with data before treatment.2、Respectively selected 10 cases of patients with X-ray II grade level from two groups of patients. According to the knee MRI, compare changes of joint space between treated and untreated.3、After a set of consecutive transectional MRI images of normal male knee joint processing by the computer, they were divided into 1716 nodes and 1215 units according to the principle of three-dimensional finite element. Then through the Super—Sap finite element calculation procedure, respectively established in the control group (patellar ligament and tendon fibronectin), the simulation of needle knife group 1 (needle knife peel patellar ligament adhesion), the simulation of needle knife group 2 (needle knife dredge tendon fibronectin), the simulation of needle knife group 3 (needle knife peel patellar ligament and tendon fibronectin). Appropriate pressure mimicking the virtual magnitude and orientation of load was applied to the different treatments model, to calculate the stress values of all nodes and units of each model.Results:1、Comparison of scores of knee movement function:Following treatment, the scores of knee movement function were significantly increased in both groups((P<0.01).Comparing with the same stage in the control group, the increase of knee movement function scores was significantly higher in stage I and II in the treatment group(P<0.01). There was no significant differences in stage III between two groups(P>0.05).2、Comparison of symptom scores of KOA:Following treatment, the symptom scores of KOA were significantly reduced in both group (P<0.01).Comparing with the same stage in the control group, the decrease of symptom scores of KOA was significantly higher in stage Ⅰ and Ⅱ in the treatment group(P<0.01), while those of stage III were not significantly changed (P>0.05).3、Comparison of joint space:Following treatment, Comparing with the control group, the decrease of joint space was significantly higher in the treatment group(P<0.01).4、Three-dimensional finite element analysis of knee joint:Comparing with the control group, the mises stress of patellar ligament、lateral and medial meniscus、cartilage were both decreased in the simulation of needle knife group 1,2,3. The medial side of cartilage and meniscus destruction were easier than the opposite. Conclusions:1、Needle knife therapy for knee osteoarthritis in the efficacy of joint motor function, clinical symptoms and joint space were better than intra-articular injection of sodium hyaluronate injection.2、The possible mechanism of needle knife therapy for knee osteoarthritis is that needle knife can loosen adhesions and improve joint internal mechanical environment, thus delay the articular cartilage degeneration and improve clinical symptoms.3、Needle knife therapy can peel patellar ligament and contracture, improve knee biomechanics to restore the balance of knee biomechanics. |
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