Due to the increased life expectancy of the population, 50% of people over 60 years of age have osteoarthritis manifestations on X-ray. Of these, 35% to 50% have clinical manifestations, and 80% of the population over 75% have osteoarthritis symptoms, which can develop in both men and women, with long-term pain and difficulty walking after the onset, seriously affecting people’s daily lives. Osteoarthritis of the knee is a chronic progressive osteoarthrosis that endangers the health of middle-aged and elderly people. Ozone has anti-inflammatory and pain-relieving effects. Treatment of osteoarthritis of the knee has been applied clinically and achieved satisfactory results.1. Etiology: the cause of OA is unknown, and may be related to ageing, genetics, trauma and estrogen levels decline and other multifactorial factors. The nature of osteoarthritis lesions is first cartilage damage, articular cartilage defects, the disease process continues to develop, involving the entire joint, resulting in inflammation of the joint capsule and synovium and muscle atrophy around the joint. 2. Diagnostic criteria: In 1995, the American Rheumatism Association revised the diagnostic criteria for the classification of OA, X-ray examination with obvious signs of OA. Signs and symptoms: (1) Knee pain most of the time 1 month before the visit. (2) There was morning stiffness for <30
(3) Age >40 years, with bone friction sounds. (5) Bony enlargement. Treatment principles: The basic principle of osteoarthritis treatment is to relieve pain, improve joint function, and slow down the progression of the disease, which means to protect the articular cartilage and slow down the process of cartilage destruction, and ultimately to improve the quality of life of patients. 4. Treatment Traditional treatment of osteoarthritis usually involves education, selection of suitable occupations conducive to disease recovery, physiotherapy, weight control, exercise, and application of auxiliary supports. Commonly used medications are: symptom relieving drugs such as acetaminophen, non-steroidal anti-inflammatory analgesics (NSAIDs), etc., and local injections of steroid hormones in the joints for more severe symptoms. In more severe cases, joint debridement or joint replacement is required. These traditional treatments can basically relieve symptoms, improve joint function, and improve quality of life to a certain extent, but these traditional medications somehow exacerbate the destruction of cartilage, because the relief of pain alone can cause patients to blindly increase their activities, which not only fails to delay but also accelerates the disease process. 5. Ozone (O3) therapy: (1) Principle: Ozone (O3) is a strong oxidizer composed of three oxygen atoms, with a half-life of about 20 minutes at room temperature.
O3 is a light blue gas with a special odor. Compared with O2, O3 has a high specific gravity, and the effect is completed instantly without permanent residue. The principle of medical ozone treatment for joint diseases may be that when ozone is injected into the joint cavity, it immediately reacts with biochemical molecules (such as proteins) in the synovial fluid to produce ROS, LOPs (lipid
oxidation
productions), causing the following effects: (1) Inactivation or inhibition of protein hydrolases and inflammatory cytokines, reducing inflammation. (2) Inducing the production of antioxidant enzymes: superoxide dismutase, glutathione superoxide dismutase. Increase synthesis of mesenchymal cells and articular cartilage. Stimulate the proliferation of cartilage and fibrogenic cells and play a role in repair. (3) Inhibit the release of bradykinin and inhibit the synthesis of inflammatory mediators PGs, which can reduce pain (stimulate the release of cytokines to neutralize local inflammatory mediators, such as: IL-1, IL-12, IL-15, TNF to reduce inflammation). (4) Promotes the release of immunosuppressive factors (e.g. TGF-β1, IL-10) and inhibits immune responses. (5) O3 has the effect of oxidation of proteoglycans, proteoglycans with a positive charge can attract a negative charge has the property of increasing the positive charge. (6) Analgesic effect, after injection, it acts directly on the nerve endings and inhibits the release of intermediate neurogen and enkephalins and other substances, so as to achieve the analgesic effect. (2) Procedure: The patient is placed in supine position with the knee joint flexed about 70°~90°, and after routine disinfection, local painful injection is made with 2% lidocaine.
Under local anesthesia, use a No. 7 10 cm long needle with the intersection of the horizontal line of the upper edge of the patella and the vertical line of the outer edge of the patella as the puncture point, enter the joint cavity through the puncture point inward and downward; also through the patellar ligament on either side of the patella immediately below the patella in the direction of the needle, and inject the joint cavity from the medical ozone therapy instrument, which is based on medical pure oxygen as raw material, connect it with the medical oxygen cylinder, adjust the medical pure oxygen output to 4~5
Before injection, adjust the pure oxygen output to 4~5 L/min, adjust the O3 output concentration to 40~50 μg/ml, turn on the power switch for about 15 s to smell the smell of ozone, collect the O3 with a syringe, extract 40~50 μg/ml of medical ozone, and then inject the ozone into the joint.
After the injection, the patient was asked to keep the joint relaxed and rest for about 15 min, and then move the joint slightly, and then inject 20 ml of 40 μg/ml of medical ozone into the joint cavity again after one week for mild cases and one week for severe cases.
If there is joint effusion, the effusion should be aspirated first. Careful medical history should be taken before treatment, and patients with physical or mental abnormalities, ozone allergy, hyperthyroidism and G-6-PD deficiency are contraindications.