Knee and goose foot bursitis is a common clinical disease, mostly seen in middle-aged and elderly people, mainly manifested as pain in the medial side of the knee joint, and the pain is aggravated when moving, especially when the knee joint is flexed, externally rotated and abducted. At present, the common treatment methods are tui-na manipulation therapy, closure therapy, acupuncture treatment, etc.
1.1 Diagnostic criteria of Chinese medicine
The criteria were formulated in accordance with the Diagnostic Efficacy Criteria for Chinese Medical Evidence promulgated by the State Administration of Traditional Chinese Medicine and the Ministry of Health’s Guidelines for Clinical Research on New Chinese Medicines, and with reference to relevant literature reports. ①History of trauma or chronic injury, preferably in middle-aged and elderly patients. ② Pain, swelling and pressure pain at the medial goose foot bursa of the knee joint are obvious. (③The knee joint activity is limited when the pain is severe.
1.2 Treatment methods
1.2.1 Small needle knife treatment group: The patient lies supine with the affected knee slightly flexed and externally rotated with the medial side facing upward, and the pressure and pain point is found on the medial side of the knee joint and marked with a marker. The operator wore sterile gloves, routinely disinfected, spread the towel, and did local infiltration anesthesia with about 1.5 ml of 2% Lidocaine plus 3.5 ml of saline at the localization point. The incision line is parallel to the longitudinal axis of the limb, and the needle is inserted vertically, reaching the bone surface of the medial tibial condyle, cutting longitudinally for 3-5 times, with a sense of breakthrough when the bursa wall is cut, then the needle body is tilted at 45 degrees, and the needle is discharged after 2-3 times of lateral spatula stripping. After the treatment, a sterile dressing was applied. The patient was instructed not to expose the affected knee to water within 3 days to avoid infection.
1.2.2 Local injection treatment group: Positioning, positioning, disinfection and towel laying methods are the same as above, 2% Lidocaine about 1.5ml plus Trimethoprim 10mg, saline 7.5ml stabbed vertically into the bursa at the positioning point. If there was fluid in the bursa, the fluid was first extracted and then injected locally, and a sterile dressing was applied after treatment. The patient was also instructed not to expose the affected knee to water for 3 days to avoid infection.
2.Efficacy evaluation method
2.1 Patient pain scoring method
VAS scoring method (Visual analogue scale) was used to reflect the efficacy of the treatment according to the patients’ complaints of pain relief. A scale of “0” indicates no pain, and a scale of “1O” indicates absolutely intolerable pain. After the patient understood the meaning of the ruler, he or she was asked to mark the corresponding position of the pain level he or she felt on the ruler. The location can be marked to the millimeter level. The difference between the patient’s position before and after treatment is used as a score to assess the patient’s effectiveness. Recording time: once before treatment and again 2 weeks after the end of treatment.
2.2 Clinical efficacy assessment method
The efficacy evaluation standard was divided into four levels: clinical control, apparent efficacy, effective and ineffective. Specifically as follows: ① clinical control: VAS score was 0 or VAS score remission rate >75% after treatment; ② efficacy: VAS score remission rate 50%-70% after treatment; ③ effective: VAS score remission rate 25%-50% after treatment; ④ ineffective: VAS score remission rate <25% or no remission. (Remission rate %=100-(VAS1-VAS2/VAS1)xlO0. VAS1 is the pre-treatment score value and VAS2 is the post-treatment score value).
2.3 Statistical treatment: SPSS 17.0 statistical software was used for analysis. Paired t-test was used for comparison between groups before and after treatment itself, and paired t-test was used for comparison between groups. The cardinality test was used for the count data.
3. Results
3.1 Comparison of the VAS scores of the two groups before and after treatment: The VAS scores of both groups were significantly reduced after treatment, and compared with those before treatment, there was a highly significant difference by statistical treatment (p<0.01), and there was a highly significant difference between the acupuncture treatment group and the local injection treatment group (p<0.01), indicating that the improvement of pain in the acupuncture treatment group was significantly better than that in the local injection treatment group.
3.2 Comparison of clinical efficacy of the two groups: clinical control rate: the difference between the acupuncture group and the local injection group was highly significant (p<0.o1); total effective rate: the difference between the acupuncture group and the local injection group was significant (p<0.o5).
4.Case example
Patient Li, female, 54 years old, farmer. She presented to the clinic on July 12, 2012 with “recurrent pain in the right medial knee for 4 months, aggravated for 3 days”. The patient had been engaged in agricultural work for a long time and initially felt soreness and pain in the right knee whenever she exerted herself, which could be relieved after rest, but gradually the pain became more intolerable and was not significantly relieved after rest. Examination: right knee goose foot stop pressure pain (++), swelling (+), right knee mobility: 90 degrees of flexion, -5 degrees of hyperextension; VAS score: 8 points. Plain radiographs of both knees:knee degeneration, no significant narrowing of the joint space was seen. Diagnosis: right knee goose foot bursitis. Treatment: Acupuncture treatment was given once to release the goose foot bursa. After treatment, the patient’s local pain, swelling and joint mobility improved significantly. The patient was advised to take rest and was re-examined after 2 weeks, VAS score: 1. The patient was followed up for 2 months afterwards and no recurrence was observed.
5. Discussion
5.1 Physiological anatomy of goose foot bursitis
The goose foot is a joint tendon membrane composed of suture muscle, femoral muscle and semitendinosus muscle on the medial side of the knee joint, and together they form a tendon-like tissue, which resembles a goose foot in shape, hence the name “goose foot”. It stabilizes the knee joint and has the effect of inwardly closing and internally rotating the calf. Small trauma, prolonged squatting, and exposure to cold can also trigger a series of physical changes in the tendons attached to the bones, such as congestion, exudation, edema, and mechanization, leading to inflammation of the goose foot bursa, and repeated attacks can affect the activities of the knee joint.
The bursa of the goose foot is located between the joint tendon stop of the suture, femoralis and semitendinosus muscles and the medial tibial collateral ligament and serves to lubricate the muscles and tendons in areas of repetitive motion. The synovial membrane covering these bursae is distributed with a network of blood vessels that secrete bursal fluid. Inflammation of the bursa can lead to increased secretion of bursal fluid, which manifests as swelling of the bursa. The chance of inflammation is greatly increased in the elderly because of joint degeneration and bone growth.
5.2 Pathogenesis of goose foot bursitis.
In ancestral medicine, goose foot bursitis belongs to the category of “paralysis, tendon injury”, etc. It is generally believed that the disease is due to accumulated strain, fall and fall injury, feeling wind, cold and dampness. The pathogenic mechanism is the dysfunction of the viscera and blood, local blood stagnation, meridians and collaterals.
Modern medical research on the pathogenesis of goose foot bursitis: ① composed of goose foot suture muscle, thin femoral muscle and semitendinosus muscle common stop at the formation of a strong stress concentration point, in a direct blow, or flexion and extension twisting, or repeated friction strain on the knee and other factors easily cause stress injury; ② due to the large range of knee joint activities, tendons between each other friction prone to injury, bending knee squatting tendons and bursa vulnerable to extrusion; ③. The innervation of each muscle is different (suture muscle is innervated by femoral nerve, thin femoral muscle is innervated by closed foraminal nerve, and semitendinosus muscle is innervated by tibial nerve) which may cause injury due to uncontrolled strain coordination in the instantaneous complex movement.
5.3 Mechanisms of acupuncture for goose foot bursitis.
Through efficacy observation, small needle knife treatment efficacy is better than local injection treatment, small needle knife will Chinese medicine acupuncture concept and Western medicine scalpel function into one, the lesion tissue for direct loosening, stripping, shoveling and other techniques, reduce the inflammation area tissue internal pressure, block the malignant stimulation of nerve vessels, improve blood circulation, facilitate the inflammation subside, absorption, improve tissue metabolism, accelerate repair, play the dredging meridians, The effect of supporting the righteousness and eliminating the evil, adjusting the yin and yang. It improves the cure rate and efficiency of goose foot bursitis, while effectively reducing the recurrence rate. In this retrospective study, two patients who did not show significant improvement after local injection therapy were treated with acupuncture and achieved satisfactory results. Therefore, small needle knife treatment as one of the treatment modalities for goose foot bursitis has satisfactory efficacy and is worthy of clinical promotion.