Osteoarthritis of the knee is a common chronic degenerative osteoarthropathy, also known as proliferative knee osteoarthritis and age-related knee osteoarthritis. The clinical onset is most common in middle-aged and elderly people, with more women than men. The etiology of this disease is not well understood, but is closely related to age, gender, occupation, metabolism, and injury. The pathological change is a joint lesion caused by degenerative changes in articular cartilage, mainly osteophytes, and the inflammation of synovial membrane is a secondary lesion. According to Chinese medicine, this disease is caused by chronic strain, cold or minor trauma, or by old age and weakness, liver and kidney deficiency and lack of qi and blood.
Clinical manifestations
1. Slow onset, mostly seen in middle-aged and elderly obese women, often with a history of exertion.
2. The pain is aggravated by knee joint activities, characterized by paroxysmal pain at first, then persistent pain, more so at night and during exertion, and obvious pain when going up and down stairs.
3. The knee joint activity is limited, or even limping. Very few patients may develop interlocking phenomenon or knee joint effusion.
4. There may be popping and grinding sounds when the joint moves, and some patients have swollen joints.
Physical signs
1. There is obvious pressure pain at the knee patella, and atrophy of the quadriceps muscle can be seen.
2.X-ray film shows hyperplasia of the inner and outer condyles of the tibia and femur, intercondylar spine and calcification of the patellar ligament.
3.Patellar grinding test was positive.
4. Laboratory tests: blood and urine routine were normal, blood sedimentation was normal, anti-“O” and rheumatoid factor were negative, and joint fluid was non-inflammatory.
Diagnosis
1.History of repeated strain or trauma.
2, mostly in middle-aged and elderly people, the symptoms are mostly gradually aggravated, and can be suddenly aggravated by exertion and trauma. Exclude rheumatism, rheumatoid arthritis, severe trauma to the knee joint (such as fracture, meniscal injury, etc.), lower limb deformity and joint infection.
3. There are typical symptoms of knee pain with limited joint movement. The pain in going up and down stairs and the pain in the knee in a semi-squatting position are aggravated.
4.There are the following typical signs: swelling of the knee joint, sometimes there is pressure pain or percussion pain in the medial and lateral joint space; joint activity popping and grinding sound; joint contracture or quadriceps atrophy.
5. On X-ray, there is hyperplasia of the bony joint edges, narrowing of the joint space, calcification of the ligaments, sharpness of the intercondylar spine of the tibia, and sometimes osteoporosis is seen.
Differential diagnosis
1, chondromalacia patellae: the greater the activity of the knee joint, the more obvious the pain, and there is hyperextension pain and walking weakness. There is pressure pain on the anterior, inferior, medial, lateral and N fossa of the knee. When the knee is extended with pressure on the patella, friction and pain can be palpated. Patellar grinding test is positive.
2. Lateral collateral ligament injury of the knee: there is fixed pressure pain at the site of ligament injury, often at the upper and lower attachment points of the ligament or in the middle. The knee joint is in a semi-flexed position, with limited movement of the joint. Positive lateral squeeze test.
3, knee meniscal injury: history of trauma, post-injury joint pain, swelling, popping and interlocking phenomenon, pressure pain in the internal and external space of the knee. In the chronic phase, the quadriceps muscle atrophy is especially obvious in the medial quadriceps. The McDonald’s sign and grinding test are positive.
4. Subpatellar fat pad injury: history of trauma, strain or cold in the knee. The pain in the knee joint, especially in stairs, is aggravated by knee hyperextension, the pressure pain in the infrapatellar fat pad is obvious, the knee hyperextension test is positive, the patellar tendon relaxation pressure pain test is positive. x-ray lateral knee film, the texture of the fat pad brace can be seen thickened, a few can be seen fat pad calcification shadow.
Treatment
1.Non-steroidal analgesic and anti-inflammatory drugs: mainly play an analgesic and anti-inflammatory role, which can effectively relieve pain.
2.Glucosamine: Glucosamine is the most important monosaccharide that constitutes polyglucosamine (GS) and proteoglycan in articular cartilage matrix. Normal people can synthesize GS by amination of glucose, but in osteoarthritis, the synthesis of GS in chondrocytes is blocked or insufficient, resulting in softening of cartilage matrix and loss of elasticity, destruction of collagen fiber structure, and increase of cartilage surface lumen to make bone wear and tear. Glucosamine can block the pathogenesis of osteoarthritis, promote the synthesis of proteoglycans with normal structure in chondrocytes, and inhibit the production of enzymes (such as collagenase and phospholipase A2) that damage tissue and cartilage, reduce damage to chondrocytes, improve joint movement, relieve joint pain, and delay the course of osteoarthritis. Oral 250-500mg once, 3 times a day, best taken with meals.
3, sodium hyaluronate knee joint cavity injection: sodium hyaluronate is the main component of the synovial fluid of the joint cavity, one of the components of the cartilage matrix, which plays a lubricating role in the joint and reduces friction between tissues. The injection in the joint cavity can significantly improve the inflammatory response of the synovial tissue, enhance the viscosity and lubricating function of the joint fluid, protect the joint cartilage, promote the healing and regeneration of the joint cartilage, relieve pain and increase the joint Mobility. It is often injected intra-articularly, 20mg once, once a week for 5 weeks, with strict aseptic operation.
4.Pain point block and small acupuncture treatment, acupuncture and physiotherapy, etc.
5.Knee joint replacement: for long-term non-surgical treatment is ineffective, serious deformation of the joint, and affect the life of reliable knee joint replacement!
Treatment experience
For OA patients, first identify whether it is resting pain or weight-bearing pain, and whether there is joint redness and swelling, and fluid accumulation.
If it is resting pain, acupuncture and infrared physiotherapy should be used. If there is also fluid accumulation, use acupuncture to stimulate the blood sea point and magnesium sulfate wet compress. Acupuncture points: calvarium, knee eye, Yanglingquan, foot three li, hedgehog, Liangqiu, A-Yi (medial joint suture).
In case of weight-bearing pain: joint cavity sodium glass acid injection + pain point block + acupuncture