Osteoarthritis is a common clinical disease, which threatens the normal activities of about13 adults around the world. With the aging of society, the incidence of osteoarthritis will increase, so accurate diagnosis and reasonable treatment are very important.
The etiology of osteoarthritis, especially knee osteoarthritis, is not very clear. The stress changes of articular cartilage and subchondral bone, biochemical changes of articular cartilage and synovium and genetic factors may play an important role in the occurrence of osteoarthritis.
At present, there is no satisfactory cure for osteoarthritis, which is usually symptomatic treatment, that is, relieving joint pain, improving joint mobility and reducing joint dysfunction. From 65438 to 0998, the American Rheumatology Association conducted an evidence-based medical analysis on the treatment of osteoarthritis and formulated guidelines. At the same time, it is pointed out that individualized treatment must be taken according to the patient's condition. Because of the different national conditions, it is more appropriate to adopt ladder therapy for osteoarthritis in China at this stage.
First, non-drug therapy
There are many non-drug treatments, including health education, self-training, weight loss, aerobic exercise, joint mobility training, muscle strength training, the use of walkers, knee varus wedge insoles, occupational therapy and joint protection, and auxiliary facilities for daily life. A considerable number of patients in Europe and America can alleviate symptoms and return to normal life and work through the above treatment. China's investment in this area and the concept of medical staff are still relatively weak, and medical staff at all levels should pay attention to strengthening this work in the future.
Patients with knee osteoarthritis often suffer from weakness of quadriceps femoris muscle strength, which used to be thought to be caused by disuse atrophy. However, recent studies abroad believe that quadriceps femoris muscle weakness is not entirely caused by osteoarthritis, but may be one of the risk factors of knee osteoarthritis. Due to the weakening of quadriceps femoris muscle strength, the stability of knee joint is affected, and the buffering capacity of normal muscles is reduced. Therefore, strengthening muscle strength training and aerobic training of quadriceps femoris is beneficial to patients with osteoarthritis.
Second, medication.
For most patients with osteoarthritis, mild to moderate pain can be controlled by taking analgesic drugs. These drugs mainly include various non-steroidal anti-inflammatory drugs (NSAIDs), such as selective Cox-2 inhibitors (nabumetone, etodolac, etc. ) and central analgesic drugs such as tramadol hydrochloride. In drug treatment, we must pay attention to the gastrointestinal side effects of some drugs, such as upper gastrointestinal bleeding, ulcer, perforation and so on. And drugs can cause side effects such as inhibition of platelet aggregation.
Glucosamine and chondroitin sulfate are commonly used to treat osteoarthritis in clinic. These two drugs can inhibit the production of superoxide radicals by damaged cells, enhance the absorption of nutrients by articular cartilage and maintain the toughness and elasticity of joints. However, these effects are slow, and due to the lack of perfect clinical experimental data and evidence, they can not be effective drugs for osteoarthritis at present. Third, intra-articular injection therapy.
This is also a treatment that can relieve joint symptoms. Commonly used drugs are hyaluronic acid preparation and glucocorticoid. The former has been used clinically in China for some time and has a certain curative effect. The mechanism of action is mainly to inhibit inflammatory mediators, such as cytokines and prostaglandin; Stimulate cartilage matrix synthesis and inhibit cartilage degradation; However, the analgesic effect appears slowly. The analgesic effect of glucocorticoid appears soon. It is worth noting that intra-articular injection therapy is an invasive operation. In order to avoid iatrogenic intra-articular infection, the application of glucocorticoid should be cautious.
Fourth, surgical treatment.
If the symptoms of osteoarthritis are very serious, drug treatment is ineffective and affects the daily life of patients, surgical intervention should be considered. For knee osteoarthritis, some people advocate arthroscopic joint dissection first. This kind of operation has a certain effect on some patients in the near future, but the long-term effect is not necessarily. For most patients with osteoarthritis, femoral head necrosis and rheumatoid arthritis, joint replacement surgery has a significant effect in relieving pain and restoring joint function. However, due to some short-term and long-term complications of joint replacement surgery, such as loosening and wear of components and osteolysis, these complications can not be completely solved at present. Therefore, it is very important to strictly grasp the surgical indications of joint replacement. Strictly speaking, surgical indications include: ① radiological evidence of joint injury; ② Moderate or severe persistent pain or disability; (3) For all kinds of patients who are ineffective in non-surgical treatment.
Because the effect of artificial joint replacement is closely related to the length of operation, the doctor's experience, the patient's preoperative physical condition, perioperative management, rehabilitation training and so on. Therefore, a good joint surgeon should have all kinds of knowledge, be well-trained and skilled, and be competent for artificial joint replacement independently.
The task of treating osteoarthritis is still arduous for a long time, which requires not only the unremitting pursuit of clinicians, but also the joint efforts of the whole society. I believe that as long as we continue to explore and work hard, we will certainly catch up with the developed countries' level and make our country lead the world in the treatment of osteoarthritis.
Interviewee: wyunlong 2 18- Scholar II 10-25 20:39.
-
Do you think the best answer is good? There are currently 1 comments.
100% ( 1)
0% (0)
Other answers *** 2
Treatment of osteoarthritis with traditional Chinese medicine
CCTV International (June 27, 2005 13:52)
Hao Jun, chief physician, director of the Department of Osteoarthropathy, Luoyang Orthopedic Hospital, Henan Province, has been a doctor for more than 20 years and studied in Japan. He is good at treating knee osteoarthritis with conservative and surgical methods, and puts forward the theory that "tendons are used for bones". On this basis, he focused on improving soft tissue and developing traditional Chinese medicine treatment methods to develop early, middle and late osteoarthritis. (Left)
Chang is the deputy chief physician of the Department of Osteoarthropathy, Luoyang Orthopedic Hospital, Henan Province. He has in-depth research on osteoarthropathy and soft tissue injury diseases, engaged in clinical teaching and research of orthopedics in 16, and has in-depth research on conservative treatment and surgical treatment of osteoarthropathy, cervical spondylosis and lumbar disc herniation in traditional Chinese medicine. Published professional papers, monographs and scientific research achievements 10. (right)
Moderator: Hello, audience, this is the live broadcast of Healthy Road. Welcome to watch and participate in our program. As the saying goes, people get old first, so which part of this leg first enters retirement age? Today, we invite a Chinese doctor to learn about this part for us and also want to talk about how to treat it with Chinese medicine. The two experts who came to the scene today are Hao Jun and Chang, the attending physicians of Luoyang Orthopedic Hospital in Henan Province. Welcome to visit.
The knee joint may be the first place where a person's legs get old. So what changes have taken place in the knee?
The change of knee on the leg is called osteoarthritis, also called degenerative osteoarthritis, sometimes called spur and hyperosteogeny, but the root cause is mainly cartilage degeneration, which causes some proliferative changes around the joint.
Cartilage, how did it change?
Cartilage is a special layer of tissue attached to joints, which usually plays a role in lubrication and reduces joint friction. But after this cartilage is worn, the bone is exposed, which means that the upper cartilage is worn away and the bone is exposed. This cartilage is disposable, and it can't be regenerated after being worn off. Bone can regenerate because of blood circulation, so in this case, if cartilage is worn and bone can regenerate, then bone spurs will gradually form.
What causes joint swelling and hyperplasia?
There are many kinds of swelling and hyperplasia of knee joint. As far as osteoarthritis is concerned, it can be divided into primary and secondary The second type is congenital, also known as "bowlegged". Secondary means that there is nothing wrong with the leg at ordinary times, but a large piece of cartilage is destroyed after trauma.
Principles of TCM treatment
There are two principles for Chinese medicine to see a doctor, one is the overall concept, and the other is the treatment based on syndrome differentiation. The whole concept means that a certain part of the patient is sick, but it is a whole for him personally, that is to say, local diseases can affect the whole body, and systemic diseases can also affect this place. The second dialectical treatment, it should be said that although people and people's diseases are the same, but everyone has their own specificity, this will give different people dialectical treatment.
How to understand "tendons are used for bones, and tendons can bind bones"
"Strengthening muscles and bones" is one of the main treatment methods in our hospital. When we treat fractures or intra-articular fractures in the early stage, the first thing we put forward is the combination of motion and static. That is to say, it is not simply to let bones grow, but also to pay attention to the recovery of peripheral muscle function and joints while growing bones. "Tendons can bind bones" refers to the restraint function, and the functions of lower limbs are mainly two, one is standing and the other is walking. With these two functions, people can almost complete their daily life. But standing needs a stability, which is mainly achieved by tendons and ligaments. Just like a house, I have a roof and a floor, but there must be a beam in the middle. This rib is the beam function of the house. What is the function of exercise? The function of exercise is to coordinate muscles and tendons and make joints move.
When arthritis occurs, this ligament is like a tug-of-war on our knees. Maybe a little stronger, and less fighting. So we must strike a balance. Then some of the early manifestations were that I felt pain in my knee. What else?
Apart from knee pain, it is often difficult to stand up after squatting. At this time, everyone usually goes to the hospital to take a film. In this film, we can see that the patella leans slightly outward, and the top of the bone is often concave.
So like these patients, what kind of Chinese medicine treatment do they face?
Every day, I have to receive Chinese medicine fumigation, oral Chinese medicine and massage with Zhanjin Dan. Its main function is to promote blood circulation, relieve pain and dredge meridians. At the end of the course of treatment, it is necessary to carry out a large-scale tendon manipulation treatment. Kneading tendons in a large scale can not only promote blood circulation and remove blood stasis, but also relax muscles and relieve muscle tension. For patients with patellar displacement, it can also be released with a small sharp knife.
Smoked and washed, what does this smoke mean?
Fumigation, according to physical therapy, is the function of dredging collaterals and warming up. This fumigation is a drug that our hospital treats itself, and it is a painkiller. Put this medicine in, then the patient lies on the bed and puts his joints in a heated place. Through local infiltration, it plays the role of promoting blood circulation, removing blood stasis and dredging meridians.
So is the massage part relaxing the meridians and activating the collaterals?
Massage is a traditional therapy of Chinese medicine. It seems simple, but the truth is quite profound. In other words, through some simple manipulations and specific rolling, massage and straightening on certain acupoints and meridians, the functions of dredging meridians and activating qi and blood can be achieved.
For early patients, is there any difference in medication for later severe patients?
Orthopedics department should advocate three-stage medication, that is, early rupture, middle and late supplement.
What is the difference between metaphase osteoarthritis and early osteoarthritis?
Mid-term clinical manifestations, mainly knee pain between legs, pain is more obvious when going up and down stairs, with leg bending and noise.
What is the difference in the treatment of patients in the middle term?
One is traction and the other is insole. Traction seems to be a very common method. Generally speaking, traction is pulling, which can make the link tense. Another function is to straighten some joints directly. Insole, although it acts on the feet, the lower limbs are a whole. Insole can also act on the inside of the knee joint, which makes the gap inside the knee joint slightly wider, that is, it can alleviate the bending of the leg.
What are the symptoms in the late stage?
After the development of osteoarthritis to the advanced stage, there may be difficulty in walking, leg deformation, and even pain at night, so you can't travel far. What's more serious is that you are in a wheelchair, your muscles are atrophied and you can't take care of yourself.
Some patients are afraid of surgery and want conservative treatment. As we said before, Chinese medicine can treat this conservatively and take medicine, so it is peaceful in the medium term and tonic in the later period. How should his patients be "harmonious" and "compensated" in the middle and late stages?
In the middle stage, it mainly focuses on dredging meridians, mainly regulating qi and blood and dredging meridians. In the later stage, the liver and kidney are supplemented, because the liver is the main muscle and the kidney is the main bone, so in the middle stage of treatment, we just use the concept of land preparation in traditional Chinese medicine. In the process of treating the leg, we should nourish the liver and kidney to make it strong, because the kidney has capital empowerment, then the bones and muscles will become strong. This is a fact.
Can the principle of "tonifying kidney and liver, strengthening tendons and bones" be applied to ordinary people? To avoid the early occurrence of osteoarthritis.
Chinese medicine has a syndrome differentiation treatment, which means that although the whole process of this disease is like this, everyone has their own specificity. I can't say that I bought this medicine for eating. We have to treat it according to syndrome differentiation and see if you are suitable for taking this medicine. There are also general treatments, such as physical therapy for muscle balance and traction.
Moderator: For the elderly, it is very likely that osteoarthritis is looking for a knee. If you don't want to have surgery, you can really consider treating it with Chinese medicine. In tomorrow's program, we will focus on the brain. What happens if there is a cloud mountain fog cover in the brain? It sounds romantic because the patient has some vascular problems in his brain. What if there is smoke in my head? Is treatment dangerous? Welcome to our program and thank the two experts again.
Tel: (0379) 63546715 63546713.
References:
/program/jkzl/2005 06 27/ 10 1362 . shtml