| Objective:Based on literature research and expert investigation,the shear wave elastography technology and common by muscle tenderness meter observation of patients with knee osteoarthritis focal point of the degree of hardness and tenderness,to knee osteoarthritis palpation of the traditional by jin focal point to carry out the objective research,to provide new ideas for the reinforcement of traditional Chinese medicine diagnosis,for the early diagnosis of knee osteoarthritis and to provide basis for accurate treatment in TCM.Methods:By setting the name of the disease related to the meridian tendon and knee osteoarthritis as the search term,the KOA clinical literature of January 1,2000 solstice,January 1,2020 was retrieved from CNKI,Weipu and Wanfang database.According to the inclusion and exclusion criteria,the use of the focus points of the meridian tendon was statistically analyzed,and the quality of the clinical trial literature was evaluated;According to the result of literature analysis and expert interview,comprehensive frequency and high frequency in the focal point,the preparation of KOA common reinforcement focal point expert questionnaire,questionnaire survey to the related domestic experts,the expert opinion each round the degree of concentration and coordination with mean,not important percentage,grade and evaluate the coefficient of variation,The focal points with low expert concentration and coordination degree were deleted.After two rounds of questionnaires,the common transtendonal focal points of KOA were finally screened out;Patients with knee osteoarthritis and healthy volunteers who were enrolled in the Department of Traditional Chinese Medicine,Pain Department,Orthopedics and Traumatology Department,Neck,Shshoulder,Laohe-leg Pain Department of Zibo Central Hospital on November 14,2020 and January 18,2021 were selected.According to the criteria,41 cases of knee osteoarthritis observation group and 40 cases of normal control group were included.The basic information was recorded in detail.The patients were divided into grade I,II,III and IV according to the K-L grade of X-ray.Eight common tendons in the KOA group and the corresponding tendons in the control group were marked by palpation with both hands.Ultrasonographic detection and tenderness measurement were performed,and the elastic modulus of shear wave and tenderness threshold were recorded.The elastic modulus,tenderness threshold and the difference between groups were observed in each group,and the relationship between the elastic modulus and tenderness threshold in the KOA group was compared by correlation analysis method.Results:1.KOA the focal points of clinical literature mainly divided into two classes,the reinforcement focal points of clinical screening research literature 41 clinical common focal points and frequency in the top 15 for patellar,tibial condyle inside,patellar down under,wei Yang,Chengshan outside,Chengshan inside,Yin ling,liao liao,outside,knee patellar clearance time,bearing steel,Yang,cranes under inside,outside the patellar,end time,tibial condyle;In the literature of transtendon focal point treatment,there are 43 common transtendon focal points,and the top 15 with the highest frequency are intrapatellar,medial condyle of tibia,subpatellar,intrapatellar,Weiyang,Kuguan,extrapatellar,small head of fibula,Yin lingshang,liao liao,weizhong,yinguu,osteogenic,external condyle of tibia,and heyang.There were 56 RCTs and11 Jadad scores of > 3 in therapeutic literatures.There were 7 CCTs and 3 Minors scale scores ranging from 9 to 16.2.Through two rounds of expert questionnaire survey,the common meridional focal points on 4 surfaces of knee joint were determined.The anterior side of the knee and foot Yangming transtendinous medial inferior iliac,medial condyle of the tibia,medial iliac and medial inferior iliac respectively;The outer side of the foot shaoming jin into the fibular,osteogenesis,fibular small head,Yangling times;The back side of the foot sun through tendons Wei Yang,Wei Zhong,He Yang,Yin Gu times;The inner side of foot three Yin through the fascia sea times,liao liao times,ququan times,liao knee,knee guan times,Yin ling.3.(1)Compared with the tendon nodes of the normal control group,the elastic modulus values of the focal points of the tendon in the KOA observation group were all increased(P < 0.001),except for the decrease of the subtenderness threshold in the middle of the Ko A observation group(P < 0.001).(2)Compared with the tendon nodes of the normal control group,the elastic modulus values of the focal points of the tendons in the X-ray grade I group were all increased(P < 0.001),except for the decrease of the subtenderness threshold in the middle of the patient(P < 0.001).(3)The comparison of elastic modulus values among patients with different grades(I,II,III and IV)showed that Yangling times in the IV group were higher than those in the I group,the II group and the III group(P < 0.05),the intrapatellar inferior(P < 0.05)and the extrapatellar inferior(P < 0.05)in the II group were higher than those in the I group(P < 0.05).The midgrade of grade III group was higher than that of grade II group(P < 0.05).Compared with the threshold of tenderness,only grade III group was higher than grade I group(P < 0.05).(4)There was a significant negative correlation between the elastic modulus and the tenderness threshold in the intrapatellar inferior,chengfibular,Yangling,Weizhong,and Heyang patients with Ko A,and the correlation coefficients were R=-0.377,R=-0.485,R=-0.561,R=-0.439,R=-0.414,respectively(P<0.05).Conclusion:1.The common transtendinal focal points of KOA are mainly distributed near the knee joint,located at the starting and ending points of ligaments and tendons,and a few of them are located in the middle part of the ligament,fascia,and synovial sac,with the characteristics of distribution of meridional tendons and aggregation around the joint.2.The shear wave elastography technology can quantify the hardness characteristics of tendon focal points,and objectively reflects the difference and significant increase in hardness between the focal points of KOA patients and the tendon nodes of normal people,which can provide objective indicators for clinical palpation and provide a new idea for TCM tendon diagnosis.3.The tenderness meter can quantify the subjective pain of KOA patients during palpation of the focal points,which objectively reflects the difference and significant decrease of the tenderness threshold between the focal points of the tendon of KOA patients and the tendon nodes of normal people.4.Elastic modulus measurement and tenderness threshold measurement can effectively distinguish normal people from patients with KOA and normal people from patients in the early stage of KOA,which can be used as objective indicators for the early clinical diagnosis of KOA,and have certain significance for the early diagnosis of disease and the evaluation of curative effect. |
PDF Full Text Request