Osteoarthrosis of the knee
Osteoarthrosis of the knee is a non-bacterial inflammatory disease that occurs in middle-aged and elderly people, and is more common in women and obese people. With the aging of our population, the incidence of this disease is increasing year by year. The disease has a certain impact on both work and physical health
Etiology and pathogenesis
Osteoarthrosis of the knee is characterized by primary or secondary degenerative changes in the knee cartilage, as well as the formation of new bone – osteoid – at the edges of the joint, with the rate of degeneration exceeding the rate of repair and regeneration. As the endocrine system of the middle-aged and elderly declines, the osteoarticular system gradually declines, resulting in a decrease in the secretion of synovial fluid that nourishes the joints, a gradual change in the chemical composition of the joints, loss of muscle strength, ligamentous loosening, loss of joint stability, and a series of other physiological and protective degenerative changes. The knee joint is one of the most complex joints in the human body and bears the greatest amount of gravity. In middle age, degenerative changes gradually occur, and painful symptoms gradually appear due to biomechanical changes in the surrounding soft tissues and the corresponding strain. After degeneration of the knee joint, the elasticity of the patellofemoral cartilage surface decreases, joint stability decreases, and pressure on the infrapatellar fat pad increases, resulting in strain injury. With the development of the disease, there may be increased intra-articular exudate, increased intra-articular pressure, and changes in the intra-articular environment, which leads to changes in the synovial membrane and cartilage metabolism in the joint, resulting in pathological changes with the simultaneous presence of bone, cartilage, and synovial membrane. All the above-mentioned lesions lead to reactive cartilage hyperplasia on the cartilage surface and formation of bone spurs through ossification. Therefore, the disease is an aseptic inflammatory change.
According to traditional Chinese medicine, this disease is due to the deficiency of liver and kidney and the irregularity of meridians. The kidney is the master of bone and produces marrow, while the liver is the master of tendons and produces blood. Therefore, if the kidney is deficient, there is little marrow to fill the bones and the bones are not firm; if the liver is deficient, there is little blood to nourish the tendons and the qi and blood run unfavorably, thus making the tendons and bones painful.
Clinical manifestations
Pain and swelling of the knee joint, aggravated by exertion and relieved by rest. Inflexibility of joint movement (especially in the morning), audible or palpable friction sounds when moving, increased pain when squatting, standing up or going up or down stairs, limited walking activities, and the phenomenon of limp legs. X-rays may show lip-like hyperplasia of the inner and outer tibial and femoral condyles, sharpness of the intercondylar ridge of the tibia, hyperplasia of the upper and lower patellar margins, and narrowing or asymmetry of the knee gap. Laboratory tests: anti-“0” <500 units, blood sedimentation <30 mm/H, negative rheumatoid factor.
Treatment methods
1.Knee arthroscopy: It is an advanced technology commonly used in minimally invasive surgery, which is widely used in the diagnosis and treatment of knee disorders because of its low trauma, low cost, low pain and fast recovery.
2, joint puncture injection of sodium hyaluronate: Hyaluronic acid is an acidic mucopolysaccharide, and almost all the mucopolysaccharides contained in the joint fluid of the knee joint are hyaluronic acid, which plays an important role in the lubrication of the joint. In degenerative osteoarthrosis, the degradation of hyaluronic acid molecules and the decrease in the lubricating function of the joint fluid are caused by various reasons, thus losing the protection of joint cartilage and further causing degeneration of joint cartilage. Intra-articular injection of sodium hyaluronate can increase joint lubrication, relieve joint swelling, eliminate pain-causing substances to reduce pain, improve joint function, and achieve the goal of reducing joint inflammation or hindering the progression of inflammation. In addition, supplementation of hyaluronic acid gel covering the surface of joint cartilage protects joint cartilage, inhibits joint cartilage degeneration, prevents joint contracture, and restores the normal biochemical composition of joint fluid. Each joint is usually injected once a week with 2ml each time. 5 times is a course of treatment. Each course of treatment can have one injection together with Depo-Provera to strengthen the anti-inflammatory and pain-relieving effect.
3.Acupuncture treatment: Acupuncture medicine believes so we believe that the important cause of knee osteoarthritis is due to the imbalance of force within the joint. Knee osteoarthritis is due to trauma and excessive weight bearing and other factors, resulting in chronic injury to the tissues around the knee joint, forming local scars, adhesions, muscle spasm, making the force balance between tendons, ligaments, fat pads, fascia, etc. out of balance. Due to the change in biomechanics of the knee joint, the normal load-bearing force line changes slightly, the effective load-bearing area of the articular cartilage surface decreases, the pressure on the bone trabeculae per unit area increases, causing microfractures and gradually forming bone collapse, along with the phenomenon of sclerosis of the subchondral bone. The vascular proliferation under the destroyed cartilage area, the healing of subchondral microfractures, and the stasis of intraosseous veins increase the pressure on the bone and lead to the proliferation of perichondrium around the destroyed cartilage area. Therefore, the treatment is to grasp the essence of the lesion of “imbalance of force” in the joint, and use the unique effect of small needle knife closed surgery to perform longitudinal and transverse sparing, shoveling and cutting techniques on the painful area around the knee joint, in order to loosen tissue adhesions, relieve muscle spasm and cut scar tissue, so as to loosen the joint and adjust the mechanical balance of the knee joint. At the same time, we use the acupuncture effect of small needle knife to unblock the meridians and harmonize the qi and blood, so as to achieve the purpose of “no pain if you pass”.
4.Manipulation treatment: mainly focus on pointing and tendon sparing. The purpose of acupuncture is to tonify the liver and kidney, activate blood circulation, and press the points of Kidney Yu, Zhi Mou, Cheng Fu, Yin Men, Wei Zhong, Cheng Shan, Calvary, Blood Sea, Knee Pass, Yang Ling Quan and Kun Lun. The effect of sparing the tendons is to relax the muscles and restore the strength of muscle tone. Because knee joint damage affects weight bearing, the muscles around the knee joint are under increased tension and muscle tension occurs to maintain the stability of the knee joint, while continued muscle tension can induce strain on the peri-knee muscles. If this soft tissue damage is not treated in a timely and correct manner, it can lead to increased pressure in the joint cavity and increased wear and tear on the articular cartilage. The use of manual pointing and plucking treatment can improve the pressure imbalance in the joint caused by the abnormal contraction of the muscles and ligaments around the knee joint, so that the muscle tension gradually tends to normalize and the moment of force on the whole lower limb is adjusted, thus the symptoms are improved and disappear. In addition, manipulation treatment also increases blood circulation in the knee and improves knee joint movement.
5.Medication
(1) Chinese herbal soup: According to the patient’s specific condition, herbal medicine is decocted according to the disease.
(2) Traditional Chinese medicine: For patients with liver and kidney deficiency, we apply Bone Spur Ning Capsule, Anti-Bone Growth Capsule, Kidney Bone Capsule, Duluxu Yisheng Capsule, etc. For patients with irregular meridians, we apply Qili Capsule, Blood Activation and Pain Relief Capsule, Blood Activation Main Power Pill, Blood Nourishing and Glory Tendon Pill, etc.
(3) Topical medicine: there are traditional ointment developed by our department, acupuncture point paste inflammation and pain self-heating paste, orthopedic tengxian medicine, also the department adopts oral Chinese medicine soup used in the Chinese medicine residue applied externally to the knee. Lixu gel, Futalin emulsion can also be used to apply topically to the knee.
(4) Western medicine: mainly for pain relief. Such as oral fotarine tablets, aminoglycoside, tincturemethonium, chimantin, fenbid, etc.
6.Surgical treatment: Our hospital mainly adopts joint cleaning and joint replacement.
7.Functional exercise: perform static contraction of quadriceps and resistance exercise of knee extension in prone position and resistance exercise of straight leg raising.
8. Precautions: Minimize the load on the knee joint, such as going up and down stairs, climbing and other activities. It is recommended that they use a cane or crutches to reduce the pressure of their body weight on the knee joint. Patients who are too obese should pay attention to weight loss.
To sum up, in the treatment of osteoarthrosis of the knee joint, our department is mainly based on Chinese medicine treatment, using a combination of Chinese and Western medicine, with the aim of reducing the patient’s pain, focusing on the treatment of both the knee lesion and the surrounding soft tissue lesion, which complement each other to improve the efficacy.