| Background:Degenerative arthritis of the knee is clinically characterized by knee joint pain, swelling, stiffness, deformity, dysfunction. With the arrival of aging society,the incidence of knee osteoarthritis in China has obvious upward tendency increasing with age. Knee osteoarthritis has become a common disease and frequently encountered disease in the elderly, made a serious negative impact on the patients’ lives or work and been one of the leading causes of knee joint dysfunction and disability. Sodium hyaluronate which is the main component of synovial joints and plays a role of lubrication, barrier and scavenging free radicals in the joint cavity is one of effective method in treating knee osteoarthritis. Arthroscopic debridement is a minimally invasive technique to clean the knee joint synovial membrane, repair or form meniscus, grind osteophytes and flush joint cavity by arthroscopy in the knee which is widely used in clinical and the commonly used treatment of degenerative knee arthritis. Traditional Chinese medicine decoction is one of commonly used traditional Chinese medicine external treatment therapies by improving of traditional Chinese medicine fumigation with the characteristics of simple operation, safe and effective.Objectives:The fact is that there is no a treatment which has a remarkable curative effect and easily accepted by patients, though there are many methods of treatment of degenerative osteoarthritis of the knee. This study analyses clinical effect of sodium hyaluronate, Arthroscopic debridement and Traditional Chinese medicine decoction in treatment of degenerative arthritis of the knee to clear their clinical effect and provide theoretical basis on treatment of degenerative arthritis of the knee.Research objects and methods:All cases are outpatients and inpatients with degenerative arthritis of the knee from March 2013 to February 2015 in Liaocheng Chinese Medicine Hospital. According to case accepting criteria and the patients’ intend,all cases are divided into three groups which are sodium hyaluronate group (99 cases which are treated by sodium hyaluronate), arthroscopic debridement group (100 cases which are treated by arthroscopic debridement), and traditional Chinese medicine decoction(101 cases which are treated by traditional Chinese medicine decoction). Sodium hyaluronate group was treated by injecting sodium hyaluronate 2 ml every time, once a week, five times in four weeks as one course. Arthroscopy group was treated by knee joint cavity cleaning operation, cleaning up the hyperplasia of the synovial tissue, or removing osteophyte for patients whose activity was affected by osteophyte, or arthroscopic meniscoplasty for patients whose meniscus was damaged, and applied to a large number of physiological saline flush joint cavity. Traditional Chinese medicine decoction group is treated by puting No.1 pack bag after soaking in decoction for restoration and heating up to 40 to 42℃ under the knee, and TDP irradiation for heating application,30 minutes each time,2 times a day,1 week for one course. According to the HSS scale score, each observation items and body mass index in the table are analyzed by descriptive statistics analysis, single factor analysis and multi-factor analysis.Results:1. Demographic characteristics between different treatment groupsComparing the distribution of different demographic characteristics between the treatment groups, using one-way anova and t-test analysis to analyze quantitative variables (age, body mass index) and using chi-square test to analyze classification variables (gender, profession), age (P<0.05) and gender (P<0.01) between different groups were with statistical significance. Traditional Chinese medicine decoction group is the oldest and has more female than male. Arthroscopy group is the youngest and has more male than female.2. Pathogenic conditions before treatment between different treatment groupsComparing other pathogenic conditions before treatment between different treatment groups, using one-way anova and t-test analysis to analyze quantitative variables (course of disease) and using chi-square test to analyze classification variables (location, meniscus injury), age (P<0.05) and gender (P<0.01). Traditional Chinese medicine decoction group has more both sides knee injured patients and arthroscopy group has more meniscus injured patients.Comparing HSS knee baseline scores between different treatment groups and using one-way anova to analyze the total HSS knee scores and the scores in every term, total scores and pain, function, Pain, function, ability of up and down the stairs, flexion deformity, activity and stability between different groups were with statistical significance (P﹤0.05). Sodium hyaluronate group had a highest total score, pain scores and arthroscopy group is lowest. Function score was highest in traditional Chinese medicine (TCM) collapse stains and highest in sodium hyaluronate group. Flexion deformity was highest in sodium hyaluronate group and lowest in Chinese medicine stains group. Up and down the stairs, activity, stability score were highest in sodium hyaluronate group and lowest in arthroscopy group. The difference was statistically significant (P<0.01).3. HSS knee scores in different time points between different treatment groups3.1 HSS knee scores in one week between different treatment groupsComparing HSS knee scores in one week between different treatment groups and using one-way anova to analyze the total HSS knee scores and the score in every term, Total score and pain scores had improved most significantly in arthroscopy group, not significantly in Chinese medicine stains group. Activity score had improved most significantly in arthroscope group, not significantly in sodium hyaluronate group. Function, reduce component scores had improved most significantly in sodium hyaluronate group, not significantly in Chinese medicine stains group. Activity score and up and down score had improved most significantly in arthroscope group, not significantly in sodium hyaluronate group. Flexion deformity points had improved most significantly in sodium hyaluronate group, not significantly in Chinese medicine stains group. The difference was statistically significant (P<0.05).3.2 HSS knee scores in one month between different treatment groupsComparing HSS knee scores in one week between different treatment groups and using one-way anova to analyze the total HSS knee scores and the score in every term, Total scores, pain, function and deduction project had improved most significantly in arthroscopy group, not significantly in Chinese medicine stains group. Ability of up and down the stairs scores and flexion deformity scores had improved most significantly in arthroscope group, not significantly in sodium hyaluronate group. Myodynamia had improved most significantly in sodium hyaluronate group, not significantly in Chinese medicine stains group. The difference was statistically significant (P<0.05).3.3 HSS knee scores in three months between different treatment groupsComparing HSS knee scores in one week between different treatment groups and using one-way anova to analyze the total HSS knee scores and the score in every term, Total scores, pain scores, function scores and deduction project scores had improved most significantly in arthroscopy group, not significantly in Chinese medicine stains group. Ability of up and down the stairs scores, activity scores and stability scores had improved most significantly in arthroscope group, not significantly in sodium hyaluronate group. Myodynamia had improved most significantly in sodium hyaluronate group, not significantly in Chinese medicine stains group. The difference was statistically significant (P<0.05).4. HSS knee scores in different time points in the same treatment group4.1 Sodium hyaluronate groupUsing one-way anova to analyze the total HSS knee scores in the same treatment group, we found that total score, pain score, function score and myodynamia were increased by 8.76 points,8.76 points,2.44 points,0.28 points in 1 week later and then gradually rising. And they were increased by 12.00 points,6.52 points,3.29 points and 6.52 points in 3 months later. We found that points project and activbity score were increased by 1.03 points and 0.55 points in 1 week later and then gradually rising. They were increased by 1.05 points and 0.77 points and then gradually declining. They were increased by 0.87 points and 0.74 points respectively in 3 months later. The difference was statistically significant (P<0.05).4.2 Arthroscopy groupUsing one-way anova to analyze the total HSS knee scores in the same treatment group, we found that total score, pain score, function score, points project score, activbity score and stability were increased by 8.63 points,4.50 points,1.90 points, 0.40 points,1.65 points and 0.24 points in 1 week later and then gradually rising. And they were increased by 19.98 points,8.65 points,5.46 points,1.39 points,2.46 points and 0.34 points in 3 months later. We found that up and down the stairs scores and walking scores were increased by 0.24 points and 0.12 points in 1 week later and then gradually rising. They were increased by 0.75 points and 0.34 points respectively in 1 months later and maintained the improvement at this level. The difference was statistically significant (P<0.05).4.3 Traditional Chinese medicine decoction groupUsing one-way anova to analyze the total HSS knee scores in the same treatment group, we found that total score, pain score and activbity score were increased by 8.04 points,4.11 points and 0.77 points in 1 week later and then gradually rising. And they were increased by 8.70 points,4.46 points and 0.99 points, in 3 months later. We found that function scores and points project scores were increased by 2.30 points and 0.58 points in 1 week later and then gradually declining. They were increased by 1.68 points and 0.40 points respectively in 3 months later. The difference was statistically significant (P<0.05). We found that scores of myodynamia, up and down the stairs, flexion deformity,walking and stability were not significant (P>0.05) between different observation time point.5. Clinical effect in different treatment groupsResults analysed by generalized estimating equations (GEE) about total HSS score and scores of each term between different treatment group:taking the total HSS score and score of each term during the observation as the dependent variable respectively, and taking the corresponding knee scores effecing factors which were siginificant in the single factor analysis (p<0.10) and in the group’s distribution is not balanced between variables as a covariate. Variables were put into generalized estimating equations to compare total HSS score and scores of each term between different treatment group.5.1 Total HSS knee scores in different treatment groupsTaking traditional Chinese medicine decoction group as control group, the sodium hyaluronate group was 0.41 points higher than Chinese medicine decoction group and the change was not significant; the arthroscopic group was 2.80 points higher than Chinese medicine decoction group and the change was significant(P<0.01).5.2 Pain scores in different treatment groupsTaking traditional Chinese medicine decoction group as control group, the sodium hyaluronate group was 0.65 points lower than Chinese medicine decoction group and the change was not significant(P>0.01).; the arthroscopic group was 0.96 points higher than Chinese medicine decoction group and the change was significant(P﹤0.01).5.3 Function scores in different treatment groupsTaking traditional Chinese medicine decoction group as control group, the sodium hyaluronate group was 0.42 points lower than Chinese medicine decoction group and the change was not significant(P>0.01); the arthroscopic group was 0.79 points higher than Chinese medicine decoction group and the change was significant(P<0.01).5.4 Myodynamia scores in different treatment groupsTaking traditional Chinese medicine decoction group as control group, the sodium hyaluronate group was 0.36 points higher than Chinese medicine decoction group; the arthroscopic group was 0.20 points higher than Chinese medicine decoction group and the change was significant(P<0.01).5.5 Up and down stairs scores in different treatment groupsTaking traditional Chinese medicine decoction group as control group, the sodium hyaluronate group was 0.15 points higher than Chinese medicine decoction group; the arthroscopic group was 0.32 points higher than Chinese medicine decoction group and the change was significant(P<0.01).5.6 Flexion deformity scores in different treatment groupsTaking traditional Chinese medicine decoction group as control group, the sodium hyaluronate group was 0.11 points higher than Chinese medicine decoction group and the change was not significant(P﹥0.01); the arthroscopic group was 0.08 points higher than Chinese medicine decoction group and the change was significant(P<0.01).5.7 Deduction project scores in different treatment groupsTaking traditional Chinese medicine decoction group as control group, the sodium hyaluronate group was 0.46 points higher than Chinese medicine decoction group; the arthroscopic group was 0.36 points higher than Chinese medicine decoction group and the change was significant(P<0.01).5.8 Walking scores in different treatment groupsTaking traditional Chinese medicine decoction group as control group, the sodium hyaluronate group was 0.01 points higher than Chinese medicine decoction group and the change was not significant(P>0.01); the arthroscopic group was 0.08 points higher than Chinese medicine decoction group and the change was significant(P<0.01).5.9 Activity scores in different time treatment groupsTaking traditional Chinese medicine decoction group as control group, the sodium hyaluronate group was 0.28 points lower than Chinese medicine decoction group; the arthroscopic group was 0.33 points higher than Chinese medicine decoction group and the change was significant(P<0.01).5.10 Stability scores in different treatment groupsTaking traditional Chinese medicine decoction group as control group, the sodium hyaluronate group was 0.09 points higher than Chinese medicine decoction group; the arthroscopic group was 0.14 points higher than Chinese medicine decoction group and the change was significant(P﹤0.01).Conclusions:1.Three treatment methods of degenerative arthritis of the knee both have therapeutic effect. Long-term clinical effect of arthroscopic group was obviously better than sodium hyaluronate group and traditional Chinese medicine decoction group.2.In the arthroscopic group, pain, function, walking ability, stability and mobility have improved most significantly. In Sodium hyaluronate group, pain, function, myodynamia and deduction project have significantly improved; and myodynamia and deduction project have improved most significantly. In traditional Chinese medicine decoction, pain, function and mobility have improved more significantly. |
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