Observe The Specific Tissue Morphology Characteristics Of The Commonly Used Treatment Sites Of Acupotomy With Musculoskeletal Ultrasound

BackgroundKnee osteoarthritis(KOA)is a kind of common chronic joint degeneration disease among the elderly.The patients of KOA suffer knee pain,deformity and the decreased range of motion.At the end-stage of KOA,patients gradually lose of knee joint mobility,which can lead to a poor quality of life.The concept of stepwise treatment principles of KOA emphasizes the importance of early diagnosis and intervention for KOA.Traditional Chinese medicine treatment methods such as acupuncture,acupotomy,massage,are based on tendons lesions theory and combined with modern anatomy theories to treat KOA,have achieved definite curative effect,providing new ideas for the treatment of early and middle KOA.With the development of ultrasound technology,musculoskeletal ultrasound(MSKUS)has become an important method to observe the superficial tissue structure and morphology of the body.Due to its characteristics,musculoskeletal ultrasound can be used in combination with traditional Chinese medicine treatment methods in clinical practice to directly demonstrate the tissue morphology characteristics of the sites treated by traditional Chinese medicine,making it possible to quantitatively define and describe the traditional tendons lesions theory.Purpose1.MSKUS was used to observe the specific tissue morphology characteristics of the commonly used treatment sites of acupotomy,and summarize the pathogenesis rules of the tendons lesions dialectical classification of KOA,to provide references for the selection of traditional Chinese medicine treatment methods2.To investigate the relationship between KOA syndromes,VAS score and imaging changes with the results of MSKUS.To define the role of soft tissue lesions in the course of KOA.MethodsBy using a cross-sectional study method,we investigate twenty patients with KOA who were admitted to china-japan friendship hospital from 2019.8-2020.3 and passed the standard in this study.Basic information,VAS score,HSS score of the patients were,and K-L classification of knee joint on the X-ray of the patients were collected.The knee joint of the patient was examined by doctors,and the specific tendon points and the commonly used points for acupotomy were recorded and marked.MSKUS was performed on the marked knee joint,and the structural manifestations of tendons,ligaments,bursa,effusion and articular cartilage were observed.Results1.General information:20 patients(38 knees)were included in this study,including 9 males(45%)and 11 females(55%),ranging in age from 47 to 84 years old.The oldest patients were 84 years old and the youngest 47 years old,with an average age of 64.63±1 0.270.Among them,18 cases of bilateral knee joint and 2 cases of unilateral knee joint(both right knee)were observed.The average VAS score of the knee was 7.00(6.00,8.00),higher than the normal population.The average HSS score of knee function was 67.74±8.732.All K-L classification of knee joint on the X-ray above stage I.Including stage 11 9 knees,stage ? 13 knees and stage? 16 knees.There was a significant negative correlation between HSS and VAS score(P=0.008<0.01).And there was a significant negative correlation between knee function HSS score and K-L classification(P=0.000<0.01).2.TCM syndrome differentiation:KOA patients with TCM syndrome differentiation,including 3 cases of Cold-dampness syndrome,4 cases of Heat-dampness syndrome,2 cases of Qi stagnation and blood stasis,7 cases of Liver and kidney deficiency,and 4 cases of Qi and blood deficiency.Pearson chi-square test was used to compare the distribution differences of X-ray K-L classification in each TCM syndrome differentiation.The results showed that the difference was not statistically significant.According to the physical examination results,knee joints were divided into three types:Yang Ming tendons meridian,Three Yin tendons meridian,and Shao Yang tendons meridian.Compound syndrome type Yang Ming-San Yin tendons meridian 11 knees,accounting for 28.9%of the total.Pearson chi-square test was used to compare the distribution pattern of K-L classification on the X-ray of all syndrome differentiations,and the results showed that P=0.254>0.05,with no significant difference.3.The relationship between the soft tissue lesion and the HSS score of knee joint function and K-L classification on X-ray imaging:according to the statistical results,the quadriceps tendon(P=0.002<0.05),medial meniscus displacement(P=0.011<0.05).and medial condylar cartilage thickness(P=0.026<0.05)were significantly correlated with the HSS score of knee joint function.According to the statistical analysis results by the method of Logistic regression,the thickness of suprapatellar capsule articular capsule(P=0.041<0.05),articular effusion(P=0.03<0.05),medial condylar cartilage thickness(P=0.006<0.05),intercondylar cartilage thickness(P=0.024<0.024),lateral cartilage thickness(P=0.048<0.05)were significantly correlated with K-L classification of knee joint X-ray.Conclusion1.There is no significant correlation between TCM syndrome differentiation and KOA knee X-ray findings and joint function HSS score,so it cannot be used as a dialectical element in TCM syndrome differentiation.2.In the differentiation of KOA,compound syndrome type Yang Ming-San Yin tendons meridian is the most common one.Hedingci,Chengfeijian,Liaoxijian and Weizhongci were the most common trigger point,which were the distribution of acupotomy.3.MSKUS can clearly evaluate the manifestations of tissue structure lesions.Quadriceps tendon and medial meniscus displacement were risk factors for knee joint function,and medial femoral condylar cartilage thickness was a protective factor for knee joint function.The thickness of the suprapatellar capsule,articular effusion,and articular cartilage of the distal femur was significantly correlated with the development of KOA.