Efficacy Of Shockwave Therapy In Postmenopausal Women With Early Metaphase Knee Osteoarthritis

Background: Knee osteoarthritis is one of the important diseases affecting human health. Pain and dysfunction of the severely affected people's life and work, especially for postmenopausal women who have high incidence of a disease, and these patients tend to have different levels of patients with reduced bone mass and osteoporosis, and still no specific effective treatment. Extracorporeal Shock Wave(ESW) as an effective mechanical stimulation can promote bone formation and the subchondral bone remodeling by more and more attention, and applied to the knee osteoarthritis clinical and basic research. Our research group first time applied Extracorporeal Shock Wave for the treatment of postmenopausal women with knee osteoarthritis.Objective: From the pain, functional assessment perspective Extracorporeal Shock Wave Therapy(ESWT) in postmenopausal women efficacy and safety of the knee osteoarthritis, and analyze the ESWT gait in patients with knee osteoarthritis. Provide new ideas and new targets for prevention and control of knee osteoarthritis. Provide a good physical treatment method and guidance for clinical Extracorporeal Shock Wave Therapy treatment of knee osteoarthritis patients.Methods: The August 2014 to June 2015 by X-ray examination was admitted to our department of 2,3(Kellgren-Lawrence installments) 86 cases of postmenopausal women with knee osteoarthritis for this study, detailed demographic data such as patient registration test age, occupation, weight, marital status, height. In this randomized, controlled, single-blind study, prospective clinical study design in patients signed informed consent. the SAS statistical software programming process PROC PLAN generate random numbers randomly divided into two groups according to figures parity: in shockwave treatment group(ESWT group) 44 patients and in the control group in 42 cases. ESWT group patients to determine a cartilage defect in combination with MRI to determine the risk of knee pain and mark specific sites. Pain points when motion was pain points and pain points during passive stretch ligaments. Then use pneumatic ballistic shock wave, pressing the tip to mark the location of the pain points, and accept the impact frequency of 7Hz, energy 1 ~ 2 bar divergent extracorporeal shock wave therapy, the impact of each site 2000 times, 1 times / week, 8 times for a course of shock therapy, not using any anesthetics and sedatives. The control group with the same treatment to the affected joints with false energy shock wave therapy. The patient sitting at course of treatment, knee flexion 90 ° or straight 180 °, the course of treatment to take the initiative avoid important nerves and blood vessels around the knee. Two groups of patients in 0 months(baseline, the day before treatment),1 month(follow-up 1, in the middle of treatment) and 2 months(follow-up 2,at the end of treatment), 3 months(follow-up 3, a month after treatment), and 6 months(follow-up 4,4 months after treatment) by visual analog scale(VAS); pain, function and quality of life in three parts(WOMAC) score of knee function; satisfaction with the treatment; 50 meters' time, gait analysis(walking speed, stride, swing and stance phase period percentage statistical analysis).Results: At 0 months(baseline, the day before treatment), 1 month(follow-up 1, in the middle of treatment) and 2 months(follow-up 2, at the end of treatment), 3 months(follow-up 3, a month after treatment), and 6 months(follow-up 4,4 months after treatment) the results showed: Extracorporeal shock wave therapy group(ESWT group) pain and function were significantly improved relative to the control group(P <0.01) within 3 months.1 The VAS score result: ESWT group average VAS score(2.5 ± 1.0) compared with pre-treatment VAS score(4.3 ± 1.4) and control group VAS score(4.0 ± 1.3)(P <0.01), at 3 months. At 6 months(after 4 months of treatment) ESWT group average VAS score(3.6 ± 1.3) compared with pre-treatment VAS score(4.3 ± 1.4)(P = 0.53) and control group VAS score(4.1 ± 1.2)(P = 0.93).2 The WOMAC score result: The knee score(WOMAC score) in pain scores at 1 months(treatment medium), 2 months(after treatment), 3months(after 1 month of treatment) and get the same result like the VAS score(P <0.01), in scores of stiffness scores did not improve(P> 0.05) in the treatment and follow-up time, the case of knee function and 1 months(mid-term therapy), 2 months(after treatment), 3 months(after treatment months) have been significantly improved(P <0.01).3 The perception of clinical severity: before treatment Control group and ESWT group(difference / medium / well)(7/21/11) and(7/21/10). At 2 months and 3 months, the patient satisfaction ESWT group were(3/22/14) and(4/23/12), The control groups' satisfaction(15/16/7) and(16/15/7) respectively, ESWT group of patient satisfaction was significantly higher than control group patients(P <0.05).4 50 meters' time result: ESWT group patients' 50 meters' time only at two months(35.5 ± 7.0s) than before ESWT group treatment(41.2 ± 7.6s) and the Control group(39.8 ± 7.3s) were significantly different(P <0.05).5 Gait analysis result: Stride Length(cm) within six months follow-up ESWT group than Control group and before treatment has no significant difference P> 0.05, ESWT group Wailing Speed(m / s) only at 2 months(1.25 ± 0.18m) relative to Control group(0.97 ± 0.24m) and before treatment(1.12 ± 0.22m), has significant difference P <0.001. At 2 months, ESWT group standing on the stance [% gait cycle] and the swing phase Swing [% gait cycle] data show significant difference than before treatment and the control P <0.05, but other follow-up time not has statistically significant.6 The correlated result: the patient's subjective feelings positively correlated BMI, patients with a higher BMI after shock wave treatment effect was obvious.Conclusions: By indicators of objective and subjective evaluation of statistical analysis of results of extracorporeal shock wave therapy in postmenopausal women specific populations of knee osteoarthritis is safe and effective, and can effectively relieve pain and improve function in patients, the effect of extracorporeal shock wave therapy is closely relative to the patient's body mass index. To provide new ideas and new targets for prevention and treatment of osteoarthritis of the knee this population, it is one of the effective methods for treating early and mid knee osteoarthritis.