Self-Control Study Based On MRI To Evaluate The Effect Of Massage On Cartilage Metabolism In Patients With Keen Osteoarthritis

Knee osteoarthritis is the joint disease with the highest prevalence rate at present.Its main symptoms include knee swelling,pain,joint bouncing,joint effusion,and joint deformity in severe cases.The above symptoms limit the daily life and work of patients to different degrees,and affect their social activities to different degrees.As the world's population ages,the number of people who are overweight increases,and people who work in offices tend to sit in one sitting position for long periods of time,there is a lack of targeted physical exercise.In addition,with the progress of clinical diagnostic technology,the detection rate of KOA has been increasing,and the incidence of knee osteoarthritis has been increasing year by year.As a result,knee osteoarthritis has attracted more and more attention from all walks of life,especially in the medical field.Objective:Using the technique of evidence-based treatment of TCM knee osteoarthritis massage therapy in the early,mid(K-L class 1-3)knee osteoarthritis,MRI cartilage morphology change(OARSI guidelines recommend 2015)as the main outcome measure,by comparing the knee osteoarthritis were treated by traditional Chinese medicine massage therapy before and after the symptom and cartilage morphological changes,to evaluate the effect of technique in the treatment of knee osteoarthritis and safety and explore whether massage has affected patients with knee osteoarthritis cartilage metabolism,promote cartilage repair.Methods:This study adopts the method of before-and-after itself,since June 2018 to see a doctor in the clinic of Guang 'Anmen Hospital of Chinese Academy of Traditional Chinese medicine,.Dongfang Hospital,Beijing Xuanwu Hospital of Traditional Chinese Medicine,Beijing Municipal Hospital of Traditional Chinese Medicine Oriental hospital orthopedic and massage clinics of patients with knee osteoarthritis,as of January 2020 participants included in early and mid knee osteoarthritis diagnosis standard and included in this study and complete the project follow-up of 60 cases of patients.All patients were given a serial number upon signing the informed consent,and all patients receiving treatment for osteoarthritis of the knee were required to cease all treatment for osteoarthritis of the knee for at least 1 week before the treatment of this protocol was officially started.The treatment plan of massage includes six steps:relaxation technique,acupoint technique,patellar technique,tendon-adjusting technique,joint moving technique,and ending technique.The patient is placed in supine position and asked to relax lower limbs.The doctor is located on the affected side of the patient.(1)Relaxation technique:First,knead the quadriceps muscle with a rhythmic spiral movement(either positive or reverse)from top to bottom,and repeat the operation for 3-5 times;Then,the quadriceps and tibia anterior muscle were pinched vertically and lifted,and then slowly relaxed.The operation was repeated from the proximal end to the distal end for 3 to 5 times.Finally,roll the quadriceps femoris with a frequency of about 120 times/min,from top to bottom,repeated operation 3 to 5 times.(2)Point manipulation:Liangqiu point,Xuehai point,Heding point,Inner and outer Dubi point,Yanglingquan point,Zusanli point and A Shi point were selected around the knee joint of the affected side to exert the force slowly for 5-10 seconds,and point Weizhong point and Chengshan point with the middle finger or forefinger for 5-10 seconds,with the degree of patient's feeling of acid swelling and pain tolerance.(3)Iliac technique:firstly lift the iliac and repeat operation for 3-5 times;Knead the patella to operate again again 5?10 times.(4)Reinforcement manipulation:Tendons were divided on the iliotibial tract,medial collateral ligament and lateral collateral ligament around the knee joint,and they were scraped along the direction of fiber deformation for 3-5 times;Then place the tendons on the medial and lateral head of gastrocnemius muscle and hamstring muscle,and make transverse round trip for 3?5 times.(5)Manipulation of movable joints:flexion,extension,shake and shake the knee joint for 2 to 3 times,and then quickly shake and shake the knee joint.Stretch the tendon to the maximum extent the patient can tolerate and hold for 5-10 seconds.(6)Finishing technique:Finally,knead the quadriceps and tibia muscle repeatedly for 3-5 times to finish.All manipulations should be patient tolerance,with violence in mind.Each manipulation treatment lasted about 10 minutes and was performed twice a week for a total of 10 weeks.Technique treatment before and after one treatment(10 weeks)are completed to visit subjective questionnaire completed and objective index inspection,records the general information,vital signs,university of western Ontario and Manchester osteoarthritis index(WOMAC)scale,TCM syndrome differentiation based on ideas of knee osteoarthritis PRO scale(Chinese scale for knee osteoarthritis CSKO)grade Recht,cartilage,cartilage thickness,T2-mapping value changes of cartilage and carries on the statistical analysis.Results:3.1 Basic data analysisIn this study,a total of 60 patients were included in four sub-centers,including 8 cases of abscission and 52 cases of actual use.Among them,there were 13 male patients and 39 female patients,with an average age of 59.17�9.23 years.The shortest course of disease was 1 day,and the longest was 120 days.The number of female patients was significantly higher than that of male patients,which was consistent with the results of KOA's epidemiology-related studies.The age of the patients all conforms to the normal distribution,among which the age of 50-70 is relatively concentrated.3.2 Analysis of various indexes before and after treatmentThe WOMAC score of the patients before and after treatment,according to the paired T-test,t=-16.674,P=.000,P<0.01,that is,the scores of pain,stiffness and functional activity disorder of the patients after treatment were lower than before,and the changes were extremely significant,indicating that the treatment method in this study could significantly improve the pain,stiffness and functional activity of the knee in patients with knee osteoarthritis.The CSKO scores of the patients before and after treatment were found to be-14.239,P=.000,p<0.01 by paired T-test,and the SCORES of TCM syndromes of the patients after treatment were reduced,with extremely significant difference,indicating that the treatment method in this study could significantly improve many symptoms in the TCM syndromes evaluation scale of the patients with knee osteoarthritis.The Recht scores of the patients before and after treatment and paired T test showed that t=-3.638,P=.001,P<0.01,and the grade of cartilage damage of the patients after treatment was reduced,showing an extremely significant difference.This indicated that the treatment method in this study could significantly improve the score of knee cartilage defect in patients with knee osteoarthritis,and had an obvious repair effect on cartilage.Comparison of the thickness of cartilage in the regions of interest before and after treatment was conducted by paired t-test of the five regions of interest respectively.The results showed that t=-.187,p=.853,p>0.05 on the medial side of femur.Medial tibia t=.989,p=.327,p>0.05;Patellar t=-.472,p=.639,p>0.05;Lateral femur t=4.178,P=.000,P<0.01;The lateral tibia t=.483,p=.632,p>0.05 showed that only the comparative value of the lateral femoral cartilage thickness before and after treatment showed extremely significant difference,and the lateral femoral cartilage thickness was significantly thickened compared with that before treatment.The changes in the remaining four regions showed no statistical significance,which could not indicate that the manipulation treatment for 10 weeks could change the knee cartilage thickness in patients with knee osteoarthritis.Comparison of T2 values of the cartilage in the area of interest before and after treatment and paired T-test of the five areas of interest respectively showed that t=-6.756,p.000,P<0.01 on the medial side of femur.Medial tibia t=-6.414,P=.000,P<0.01;Patellar t=3.711,p=.001,p<0.01;Lateral femur T=-3.078,P=.000,P<0.01;Lateral tibia t=.483,P=.003,P<0.01,it can be seen that after treatment,T2 values of lateral femoral,lateral tibia,patella,medial femoral,medial tibial cartilage were all lower than those before treatment,and there were significant differences.Since T2 reflects the changes in cartilage biochemistry,the decrease of T2 indicates that the content of proteoglycan in articular cartilage increases while the content of water decreases,indicating that this study's manipulation treatment for 10 weeks has significant significance in improving cartilage metabolism.3.3 Safety evaluation and sheddingDuring the treatment,there was a fall in a 59-year-old female patient.The follow-up was caused by an accident when the patient stepped down the stairs at home,which had nothing to do with knee joint disease and treatment.None of the remaining patients showed clinically significant abnormalities associated with treatment,indicating that the manipulation of massage in this regimen was safe for the treatment of knee osteoarthritis.In this study,a total of 8 patients fell off.It was considered that patients' compliance would be affected by high treatment frequency,long treatment cycle and mri discomfort.Conclusion:1.Chinese medicine massage therapy knee osteoarthritis specification technique,the relaxation technique,acupuncture technique and reinforcement technique,patellar technique,class activities joint technique in the treatment of knee osteoarthritis,by WOMAC scores,CSKO score significantly reduced,prove massage to improve patients with knee osteoarthritis of the knee joint pain,stiffness,functional activity have significant curative effect and TCM symptoms of surface;2.Recht score and T2 value of knee cartilage injury were significantly reduced after treatment based on MRI technology,which proved that massage could improve cartilage metabolism and promote cartilage repair.3.Based on the symptoms and MRI imaging changes of patients before and after treatment,it can be seen that massage is safe and effective in the treatment of knee osteoarthritis,which can not only relieve symptoms but also improve cartilage metabolism and promote cartilage repair.