Objective: To evaluate the curative effect of the Traditional Chinese Medicine (TCM) external therapy on knee osteoarthritis patients with different TCM constitutions using musculoskeletal ultrasonography and contrast-enhanced ultrasonography, and to explore the application value of contrast-enhanced ultrasonography in knee joint diseases. Methods: A total of 57 patients diagnosed with knee osteoarthritis in Shaanxi University of Traditional Chinese Medicine from December 2019 to May 2021 were collected, and they were divided into qi stagnation and blood stasis type group (23 cases) and cold-dampness obstruction type group (34 cases) according to the traditional Chinese medicine method. All patients were given acupuncture combined with TCM fumigation and washing. All patients underwent musculoskeletal ultrasonography and contrast-enhanced ultrasonography before and after treatment, observed and recorded relevant data, and compared the treatment effects between the two groups. Results: 85.96% (49/57) of knee osteoarthritis (KOA) patients had suprapatellar bursa effusion, 42.1% (24/57) had iliotibial band bursae effusion, some of which had poor sound transmission, and thickened synovium was seen in most effusions, 33.33% (19/57) had osteophyte formation. Compared with before treatment, the depth of suprapatellar sac effusion in the Qi stagnation and blood stasis type group decreased after treatment (P < 0.05). The protrusion height decreased (P < 0.05), and the infrapatellar and prefermoral fat pad thickness increased (P < 0.05). The contrast-enhanced ultrasonography of the thickened synovial membrane of the knee joint in KOA patients showed different degrees of uniform enhancement, showing slow in and slow out. Compared with the surrounding soft tissue, the arterial phase showed equal enhancement. The enhanced synovium had a clear boundary and a clear boundary with the effusion. In the venous phase, the intensity gradually decreased until clearing. Compared with before treatment, there was no significant difference in contrast-enhanced ultrasound parameters in the qi stagnation and blood stasis type group after treatment (P < 0.05). Conclusion: Musculoskeletal contrast-enhanced ultrasonography was used to quantitatively evaluate the efficacy of TCM external therapy on KOA for different TCM constitutions. Dynamic observation of synovial lesions of knee osteoarthritis provides a valuable imaging method for evaluating the efficacy of traditional Chinese medicine.
Knee Osteoarthritis (KOA) is a common arthropathy in the elderly, with an incidence of 50% [
From December 2019 to May 2021, 57 cases of patients with knee osteoarthritis were collected, 15 cases were male and 42 cases were female, with an average age of 57.53 ± 7.32 years. According to the Chinese medicine Wang Wen Qing qi, the patients were divided into a qi stagnation blood stasis type group (23 cases) and a cold and wet paralysis type group (34 cases), both groups were given acupuncture combined with traditional Chinese medicine (TCM) fumigation treatment. Patients are included according to the following criteria: 1) Patients diagnosed with early KOA according to the criteria of the Guidelines for the Diagnosis and Treatment of Osteoarthritis (2018 Edition) [
The GE E9 ultrasonic diagnostics are equipped with 9 L and 10 L high-frequency linear array probes at frequencies of 7 - 12 MHz. The patient is in the supine position, the knee joint flexion is 120 degrees, and the horizontal, longitudinal, and sliding scans are performed on the patient’s knee joint with a linear array probe to observe the changes in bone and cartilage tissue, surrounding bursal effusion and the thickness of each tendon before and after knee joint treatment, and record the depth of suprapatellar sac effusion, the thickness of the synovial membrane, the thickness of the quadriceps, the thickness of the biceps tendon and patellar tendon, the height of the meniscus protrusion, and the thickness of the infrafemoral fat pad.
Scanning the patient’s knee joint, selecting the more severe lesion on the side of CEUS, switching the CEUS mode after determining the section, rapidly injecting 2 ml of the acoustic novy contrast agent with the vonovirate through the elbow vein, immediately flushing the tube with 5 ml of saline, observing the enhanced mode, and collecting the image. The time-intensity curve is used to record the peak intensity, peak time, average perfusion time, area under the curve, slope, and other parameters. The changes in parameters before and after treatment in the two groups were observed.
Other Information Record the basic information of the patient: gender, height, weight, body mass index (BMI), time of illness; Image data: K-L grading, etc.
The Statistical Product and Service Solutions [
There were no statistically significant differences in gender, age, height, weight, BMI, disease duration, and K-L grading between the qi stagnation and blood stasis type group and the cold-dampness obstruction type group (P > 0.05), as shown in
85.96% (49/57) of KOA patients had suprapatellar sac effusion, 42.1% (24/57) had iliotibial band bursae effusion, part of the sound transmission is poor, and a thickened synovial membrane can be seen in part of the effusion. 33.33% (19/57) of patients had osteophyte formation. Compared with before treatment, the depth of suprapatellar sac effusion in the qi stagnation and blood stasis group decreased after treatment (P < 0.05). The depth of suprapatellar sac effusion decreased in the cold-dampness obstruction type group (P < 0.05). The height of the meniscus protrusion is reduced (P < 0.05), and increased infrapatellar and prefemoral fat pad thick (P < 0.05). See
The contrast-enhanced ultrasonography of the thickened synovial membrane of
| Project | Qi stagnation and blood stasis type group (n = 23) | Cold-dampness obstruction type group (n = 34) | t/x2 | p |
|---|---|---|---|---|
| Gender (eg, male/female) | 8/15 | 7/27 | 1.426 | 0.232 |
| Age (y, x ¯ ± s) | 56.65 ± 7.84 | 58.12 ± 6.7 | −0.735 | 0.406 |
| Height (cm, x ¯ ± s) | 165.83 ± 6.09 | 163.26 ± 6.88 | 1.443 | 0.692 |
| Weight (kg, x ¯ ± s) | 66.64 ± 12.32 | 65.36 ± 9.95 | 0.435 | 0.067 |
| BMI (kg/m2, x ¯ ± s) | 24.05 ± 3.26 | 24.40 ± 3.07 | −0.417 | 0.527 |
| Sick time (y, x ¯ ± s) | 5.37 ± 4.96 | 5.73 ± 7.08 | −0.211 | 0.074 |
| Right knee (%) | 56% (13/23) | 58.8% (20/34) | 0.03 | 0.863 |
| K-L Grading ≥ 2 (%) | 82.4% (19/23) | 79.4% (27/34) | 0.585 | 0.747 |
Note: △: Compared with before treatment P < 0.05.
| Qi stagnation and blood stasis type group (n = 23) | t | P | Cold-dampness obstruction type group (n = 34) | t | P | |||
|---|---|---|---|---|---|---|---|---|
| Before therapy | After treatment | Before therapy | After treatment | |||||
| Suprapatellar sac effusion | 5.11 ± 3.00 | 3.71 ± 2.91△ | 3.052 | 0.007 | 4.54 ± 2.29 | 3.42 ± 2.25△ | 2.731 | 0.011 |
| Synovial thickness | 3.84 ± 2.52 | 3.41 ± 2.55 | 0.756 | 0.457 | 4.16 ± 2.51 | 3.26 ± 3.07 | 1.922 | 0.072 |
| Quadriceps tendon | 6.17 ± 0.94 | 6.55 ± 1.33 | −1.388 | 0.183 | 6.35 ± 1.30 | 6.10 ± 0.96 | 0.810 | 0.426 |
| Biceps femoris tendon | 5.93 ± 0.87 | 5.99 ± 1.29 | −0.221 | 0.828 | 3.79 ± 1.00 | 5.71 ± 1.37 | −0.254 | 0.802 |
| Patellar tendon | 3.55 ± 0.55 | 3.58 ± 0.62 | −0.222 | 0.827 | 3.69 ± 1.17 | 3.35 ± 0.33 | 1.611 | 0.120 |
| Meniscus protrusion height | 2.0 ± 1.78 | 2.47 ± 2.26 | −1.316 | 0.206 | 3.17 ± 2.20 | 2.54 ± 2.25△ | 2.879 | 0.008 |
| Infrapatellar fat pad thickness | 6.85 ± 1.14 | 7.38 ± 1.97 | −0.974 | 0.343 | 6.46 ± 1.42 | 7.34 ± 1.74△ | −2.722 | 0.012 |
| Anterior thigh fat pad thickness | 7.72 ± 2.60 | 7.62 ± 2.14 | −0.069 | 0.945 | 6.90 ± 2.02 | 7.88 ± 2.28△ | −2.655 | 0.014 |
Note: △: Compared with before treatment P < 0.05.
the knee joint in KOA patients showed different degrees of uniform enhancement, showing slow in and slow. In the arterial phase, it is isoenhanced compared with the surrounding soft tissue, and the enhanced synovium has a clear boundary and is clearly demarcated from the effusion. The intensity of the venous phase gradually decreases until washout. Compared with before treatment, there was no significant difference in contrast-enhanced ultrasound parameters between the qi stagnation and blood stasis type group after treatment (P > 0.05). In the cold-dampness paralysis group, the peak intensity decreased and the area under the curve decreased, P < 0.05 (See
KOA is a chronic degenerative bone and joint disease caused by cartilage degeneration and bone hyperplasia of the knee joint. Clinically, it mainly manifests as knee joint pain and different degrees of dysfunction, some joint swelling, and fluid accumulation, which seriously affects the physical and mental health of middle-aged and elderly people. In traditional Chinese medicine, KOA is called “crane knee wind”, or “knee arthralgia”. The dialectical classification of knee arthralgia includes liver and kidney deficiency syndrome, damp-heat arthralgia syndrome, qi and blood deficiency syndrome, cold-damp arthralgia syndrome, and qi stagnation and blood stasis syndrome. This study focuses on the analysis of the most common syndromes of Qi stagnation and blood stasis and cold-dampness obstruction. Both of the above belong to the category of knee arthralgia complex constitution. Qi stagnation and blood stasis are caused by stagnation of blood due to poor Qi movement. Clinical manifestations are dark color, mysterious pulse, chest tightness and sighing, stomach and abdominal pain, belching, introverted personality, melancholy, and narrow-mindedness. Obstruction of cold-dampness is mostly due to the deficiency of qi and blood in the
| Peak intensity (dB) | AUC | Time to peak (s) | Mean perfusion time (s) | Wash in slope (dB/s) | |
|---|---|---|---|---|---|
| Qi stagnation and blood stasis type group (n = 23) | |||||
| Before therapy | 6.37 ± 5.06 | 328.16 ± 239.90 | 27.92 ± 13.90 | 62.14 ± 5.51 | 0.98 ± 0.62 |
| After treatment | 4.44 ± 2.10 | 154.52 ± 77.40 | 32.01 ± 30.53 | 70.40 ± 1.77 | 0.58 ± 0.37 |
| t | −1.095 | −1.461 | 0.000 | 1.826 | −0.73 |
| P | 0.273 | 0.144 | 1.000 | 0.068 | 0.465 |
| Cold-dampness obstruction type group (n = 34) | |||||
| Before therapy | 7.61 ± 4.84 | 287.46 ± 164.09 | 24.07 ± 8.48 | 60.74 ± 10.60 | 0.81 ± 0.53 |
| After treatment | 4.58 ± 5.03△ | 127.36 ± 92.01△ | 32.38 ± 17.63 | 65.97 ± 5.47 | 0.49 ± 0.53 |
| t | 8.39 | 2.804 | 1.273 | −1.370 | 1.092 |
| P | 0.000 | 0.038 | 0.259 | 0.229 | 0.325 |
Note: △: Compared with before treatment P < 0.05.
body, strain, and the evil of cold and dampness invades and obstructs the meridians of the knee, causing the qi and blood to run poorly. The clinical manifestations are: A fat tongue, white and greasy coating, and a pulse that is tight and slow.
At present, the commonly used methods for the treatment of KOA include injection of sodium hyaluronate into the joint cavity of western medicine, acupuncture and moxibustion of traditional Chinese medicine, fumigation and washing of traditional Chinese medicine, and other external treatment methods. External treatment of traditional Chinese medicine has been widely accepted by the majority of middle-aged and elderly patients because of its obvious effect, safety, and no side effects [
CEUS can quantitatively analyze and dynamically observe the changes in the synovial micro-blood flow of the knee joint, effectively diagnose and evaluate the degree of knee joint synovial lesions, and provide accurate imaging information for the evaluation of the efficacy of the knee joint, important clinical application.
The authors declare no conflicts of interest regarding the publication of this paper.
Wen, N. and Xiao, Y.C. (2023) Evaluation of the Therapeutic Effect of Contrast-Enhanced Ultrasound on Different Types of Knee Osteoarthritis in the Elderly. Journal of Biosciences and Medicines, 11, 1-8. https://doi.org/10.4236/jbm.2023.115001