经筋针刺联合理筋疗法对膝骨性关节炎的临床应用研究

김효철 인문사회 21 2023 인문사회 21 Vol.14 No.2

The aim of this paper is to provide a summary of the clinical application of meridian acupuncture combined with tendon therapy for knee osteoarthritis, guided by the principles of meridian tendon theory. Additionally, this paper seeks to elucidate the clinical efficacy of this combined approach in treating knee osteoarthritis and to establish a foundation for the clinical application of meridian theory in the treatment of knee osteoarthritis. To achieve these goals, the author conducted a thorough review of relevant literature on the treatment of knee osteoarthritis with acupuncture based on meridian theory, using online data knowledge service platforms such as ‘China Knowledge Network’ and ‘Wanfang’. Keywords such as “meridian”, “acupuncture”, and “meridian tui na” were used to organize and study the relevant literature and compile the current research and relevant results on the treatment of knee osteoarthritis using acupuncture and meridian theory. Furthermore, the current status of research and relevant research results on the treatment of osteoarthritis of the knee based on the theory of meridian tendon were compiled. I found that the pathogenesis of knee osteoarthritis, a common clinical tendon disease, is closely related to the injury of the tendons in the acupuncture system of Chinese medicine. I concluded that knee osteoarthritis can be effectively treated by acupuncture at the focal points of the tendons, based on the effectiveness of acupuncture and tui-na therapy on osteoarthritis of the knee under the guidance of meridian tendon theory. I proposed the optimal treatment plan of “tendon first and then acupuncture”, as combining the two therapies can further improve the therapeutic effect of meridian tendon therapy on osteoarthritis of the knee. The preliminary results of the study showed that the core of knee osteoarthritis is the damage to the meridian tendons. Therefore, the treatment should focus on the release of the local damaged meridian tendon tissue pathological pressure through the meridian tendon massage and tendon manipulation, followed by the use of meridian tendon acupuncture to regulate the meridian tendons. The synergistic effect of the two therapies can restore the structural function of the knee joint, thus providing an optimal clinical treatment plan for the clinical treatment of knee osteoarthritis from the meridian tendon theory.

슬관절(膝關節)의 퇴행성 관절염에 대한 고찰

장준혁,김경호,Jang Jun-Huk,Kim Kyeng-Ho 대한침구의학회 1998 대한침구의학회지 Vol.15 No.2

Osteoarthritis(degenerative joint disease), the most common arthropathy affecting the aged people, is characterized by degeneration of articular cartilage with proliferation and remodeling of subchondral bone. Osteoarthritis of the knee, which probably has greater social cost and more associated disability than osteoarthritis of any other joint, prevalence is known to increase with age, and females have higher rates than males; radiographic abnormalities are present in more than 30% of persons more than 65 years old, with approximately 40% of these persons symptomatic. Though the etiology of osteoarthritis is not entirely understood, much information is available regarding risk factors for the development of knee osteoarthritis that permit some reasonable guideline for preventive strategies. Traumatic damage or occupational or recreational overuse of knee joint may result in osteoarthritis, and obesity also is related to osteoarthritis of the knee. A variety of other possible risk factors for the development of knee osteoarthritis have been proposed, including increased bone mass, smoking, diseases such as diabetes or elevated serum uric acid, and some metabolic factors, but the contribustions of these and other factors such as smoking or race and diseases such as diabetes are as yet undetermined. The usual clinical manifestations include pain, stiffnesss, crepitus and loss of function. In oriental medicine, osteoarthritis of the knee is very similar to diseases such as Bijung(痺症), Haksulpung(鶴膝風), Youkjeolpung(歷節風) in symptoms. The diseases such as Bijung(痺症), Haksuipung(鶴膝風), Youkjeolpung(歷節風) is related to the of function liver(肝) and kidney(腎) and risk factors are regarded as Pung(風), Han(寒), sub(濕). The diagnosis of osteoarthritis of the knee has often been based on radiographic appearance and clinical manifestations. The acupuncture therapy of osteoarthritis of the knee has often been based on Stomach meridian(ST), Spleen meridian(SP), Kidney meridian(KI), Liver meridian(LR).

50세 이상 한국 성인에서 무릎 골관절염의 방사선적 소견에 따른 무릎 통증과 관련된 요인

최은영,김민정 대한임상건강증진학회 2016 Korean Journal of Health Promotion Vol.16 No.3

Background:Discordance between knee pain and radiologic osteoarthritis is well‐known. This study was to investigate factors associated with knee pain with different grades of knee osteoarthritis among Korean adults aged 50 years or more. Methods:Total 5,978 Korean aged 50 years or more who underwent the radiographs of the knees were analyzed from Korean National Nutrition and Health Examination Survey conducted in 2010‐11. Radiographs of the knees were scored for osteoarthritis using the Kellgren‐Lawrence scale. Multivariate logistic regression analysis adjusting for sociodemographic factors, lifestyle factors, comorbidity and health status was used for analysis. Results:The prevalence of knee pain was higher in female compared to that of male (P<0.001), and increased as increasing severity of radiologic knee osteoarthritis. Female was associated with increased risk of knee pain in all of Kellgren‐Lawrence degrees. In most of Kellgren‐Lawrence degrees, depression was associated with increased risk of knee pain, and those with high school diploma or higher were associated with decreased risk of knee pain. A few factors (age, body mass index, and no alcohol drinking) were also associated with increased risk of knee pain for particular grades of radiographic knee osteoarthritis. Conclusions:Knee pain increased as increasing severity of radiologic knee osteoarthritis. Although there were differences of risk factors associated with knee pain with different grades of knee osteoarthritis, female, depression were associated with increased of knee pain, and those with high school diploma or higher were associated with decreased risk of knee pain in most of Kellgren‐Lawrence degrees. 연구배경: 무릎 통증과 무릎 골관절염의 방사선 소견은일치하지 않은 것으로 알려져 있다. 본 연구는 50세 이상한국 성인에서 무릎 골관절염의 방사선적 소견의 정도에따라 무릎 통증에 영향을 주는 요인에 차이가 있는지를 파악하고자 한다. 방법:2010년과 2011년 시행된 국민건강영양조사에서 무릎 방사선 촬영을 시행한 50세 이상의 성인 5,978명 대상으로 하였으며, 무릎 골관절염의 방사선적 소견은 K‐L 등급으로 구분하였다. 모든 통계 분석은 가중치를 고려하였으며, 다중회귀로짓분석을 시행하여 각 등급별로 무릎 통증에 영향을 미치는 인구사회학적인 요인(성별, 연령, 교육, 결혼상태, 직업), 생활습관요인(음주, 흡연, 규칙적인 운동), 동반질환(고혈압, 당뇨병), 건강상태(우울 여부, 체질량지수) 요인에 차이가 있는지를 살펴보았다. 결과: 무릎 통증의 유병률은 여성에서 남성보다 유의하게 유병률이 높았으며(P<0.001), K‐L 등급이 증가함에 따라 증가하였다(Ptrend<0.001). 여성은 무릎 골관절염의 방사선적 소견 모두에서 무릎 통증의 위험을 유의하게 증가시키는 요인이었으며, 우울증은 방사선적 소견 대부분에서무릎 통증의 위험 증가와 고등학교 이상의 교육을 받은 경우는 무릎 통증의 위험 감소와 관련되어 있었다. 무릎 골관절염의 방사선적 소견 등급에 따라 연령, 체질량지수, 비음주 등의 요인도 무릎 통증의 위험 증가와 관련되어 있었다. 결론: 무릎 골관절염의 방사선적 소견이 악화될수록 무릎 통증의 유병률은 증가하였다. 무릎 골관절염의 방사선적 소견에 따라 무릎 통증에 영향을 주는 요인이 다소 차이가 있었으나, 무릎 골관절염의 방사선적 소견 대부분에서여성과 우울증은 무릎 통증의 위험 증가와 관련되어 있었고, 고등학교 이상의 교육을 받은 경우 무릎 통증의 위험감소와 관련되어 있었다

Comparison of Lower-Limb Alignment in Patients with Advanced Knee Osteoarthritis: EOS Biplanar Stereoradiography versus Conventional Scanography

Hyeong-Uk Choi,Du-Han Kim,Si-Wook Lee,Byung-Chan Choi,Ki-Cheor Bae 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.3

Background: Accurate measurement of the lower limb alignment is one of the most crucial factors in advanced knee osteoarthritis patients scheduled for surgery. Recently, EOS biplanar stereoradiography with three-dimensional reconstruction was developed. The purpose of this study was to compare radiographic parameters between conventional scanography and EOS in patients with advanced knee osteoarthritis who need surgical treatment. Methods: A total of 52 consecutive patients (104 knees) with bilateral knee osteoarthritis of advanced stage (Kellgren-Lawrence [KL] grade 3 or 4) were retrospectively reviewed. We measured the hip-knee-ankle angle (HKA) on conventional scanograms. In EOS, we measured HKA, hip-knee-shaft angle, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle. To evaluate sagittal and axial plane alignment, knee flexion angle (KFA), and knee joint rotation (KJR) were also measured. Results: Ninety knees were KL grade 4, and 14 knees were grade 3. The average HKA was 10.14° ± 6.16° on conventional scanograms and 11.26° ± 6.21° in EOS. HKA was greater in EOS than on conventional scanograms, and the difference (1.12°; range, −1.07° to 3.22°) was statistically significant (p < 0.001). Significant correlations were observed on the difference in HKA and mechanical medial proximal tibial angle (r = –0.198, p = 0.044), KFA (r = 0.193, p = 0.049), and KJR (r = 0.290, p = 0.003). In multivariable linear regression analysis, the difference in HKA had significant relationship with KFA (β = 0.286, p = 0.003) and KJR (β = 0.363, p < 0.001). Conclusions: HKA measured on conventional scanograms and in EOS differed significantly and the difference had a significant correlations with KFA, KJR, and medial proximal tibial angle. Surgeons can consider these results before orthopedic surgery in patients who have advanced knee osteoarthritis.

원격재활 운동프로그램이 무릎골관절염 환자의 근 기능과 삶의 질에 미치는 영향

김재윤 ( Jae-yun Kim ),이동우 ( Dong-woo Lee ),정모범 ( Mo-beom Jeong ) 대한물리의학회 2020 대한물리의학회지 Vol.15 No.1

PURPOSE: This study examined the effects of videoconferencing- based telerehabilitation exercise program on the gait, knee function, and quality of life of patients with knee osteoarthritis. METHODS: Forty-eight subjects, who were diagnosed with osteoarthritis of the knee by the radiologic findings, history, and a physical examination, were assigned randomly to a Control group, Experiment group I, and Experiment group Ⅱ. The control group did not perform any exercise program and were educated in understanding and managing the disease of knee osteoarthritis for only one hour. Experimental groups I and Ⅱ were provided with an exercise guidelines book for knee osteoarthritis, and the same exercise programs were conducted by face-to-face visits and non-face-to-face using telerehabilitation for eight weeks, respectively. To verify the effectiveness of each exercise program, the gait speed, knee disability index, and health related quality of life were measured. All assessments were conducted twice before and after the intervention. RESULTS: The participants who underwent both face-toface and telerehabilitation exercise programs showed an improved gait speed, knee function, and health-related quality of life. In particular, there was no significant difference between the telerehabilitation exercise group and the direct face-to-face exercise group in improving the knee joint function and health related quality of life. CONCLUSION: A these findings the telerehabilitation exercise program for patients with knee osteoarthritis can alternate or supplement the face-to-face exercise program. Therefore, the telerehabilitation exercise program should be used not only as a substitute supplement program but also as an intervention for various diseases.

슬관절 골관절염 환자의 슬관절 주위근의 근력비와 Q-각과의 관계

김선엽(Suhn-yeop Kim) 한국전문물리치료학회 2005 한국전문물리치료학회지 Vol.12 No.1

The quadriceps-angle (Q-angle) and the ratio of hamstring/quadriceps (H/Q) are important for the stability of the knee and for protection from excessive stress. The aim of this study was to examine the association between Q-angle and H/Q ratio with and without knee osteoarthritis. We compared knee osteoarthritis patients with symptom-free women. The mean age of the patients in the arthritis group (25 women, osteoarthritis) was 59.7 years. The non-arthritis group consisted of 25 women with a mean age of 55.2 years. of the 25 women with osteoarthritis, 5 had the condition in their left knee, 5 had it in their right knee, and 15 had it on both sides. There was no significant difference in the knee Q-angle of the left and right knees of the arthritis group and the non-arthritis-group (p>.05). The strength of all the muscles around the involved right knee in the arthritis group was significantly weaker than that of the non-arthritis group (p<.05). However, in the left knee, only the strength of the knee extensors and internal rotators was significantly weaker than that of the non-arthritis group (p<.05). The Q-angle was not associated with the H/Q ratio and internal rotators/external rotators ratio of the involved knee in the arthritis group (p>.05). Neither was the Q-angle associated with the pain level of an involved knee in the arthritis group (p>.05). The knee pain was not associated with the H/Q ratio of the involved knee in the arthritis group (p>.05). The Q-angle was not associated with the ratio of H/Q and pain level of the involved knee in the osteoarthritis women.

Transplantation of Gelatin Microspheres Loaded with Wharton's Jelly Derived Mesenchymal Stem Cells Facilitates Cartilage Repair in Mice

Chen Xiaolin,Huang Sunxing,Niu Yongxia,Luo Mingxun,Liu Haiying,Jiao Yiren,Huang Junjiu 한국조직공학과 재생의학회 2024 조직공학과 재생의학 Vol.21 No.1

Background: Knee osteoarthritis (KOA) is a prevalent chronic joint disease caused by various factors. Mesenchymal stem cells (MSCs) therapy is an increasingly promising therapeutic option for osteoarthritis. However, the chronic inflammation of knee joint can severely impede the therapeutic effects of transplanted cells. Gelatin microspheres (GMs) are degradable biomaterial that have various porosities for cell adhesion and cell–cell interaction. Excellent elasticity and deformability of GMs make it an excellent injectable vehicle for cell delivery. Methods: We created Wharton’s jelly derived mesenchymal stem cells (WJMSCs)-GMs complexes and assessed the effects of GMs on cell activity, proliferation and chondrogenesis. Then, WJMSCs loaded in GMs were transplanted in the joint of osteoarthritis mice. After four weeks, joint tissue was collected for histological analysis. Overexpressing-luciferase WJMSCs were performed to explore cell retention in mice. Results: In vitro experiments demonstrated that WJMSCs loaded with GMs maintained cell viability and proliferative potential. Moreover, GMs enhanced the chondrogenesis differentiation of WJMSCs while alleviated cell hypertrophy. In KOA mice model, transplantation of WJMSCs-GMs complexes promoted cartilage regeneration and cartilage matrix formation, contributing to the treatment of KOA. Compared with other groups, in WJMSCs+GMs group, there were fewer cartilage defects and with a more integrated tibia structure. Tracking results of stable-overexpressing luciferase WJMSCs demonstrated that GMs significantly extended the retention time of WJMSCs in knee joint cavity. Conclusion: Our results indicated that GMs facilitate WJMSCs mediated knee osteoarthritis healing in mice by promoting cartilage regeneration and prolonging cell retention. It might potentially provide an optimal strategy for the biomaterial-stem cell based therapy for knee osteoarthritis. Background: Knee osteoarthritis (KOA) is a prevalent chronic joint disease caused by various factors. Mesenchymal stem cells (MSCs) therapy is an increasingly promising therapeutic option for osteoarthritis. However, the chronic inflammation of knee joint can severely impede the therapeutic effects of transplanted cells. Gelatin microspheres (GMs) are degradable biomaterial that have various porosities for cell adhesion and cell–cell interaction. Excellent elasticity and deformability of GMs make it an excellent injectable vehicle for cell delivery. Methods: We created Wharton’s jelly derived mesenchymal stem cells (WJMSCs)-GMs complexes and assessed the effects of GMs on cell activity, proliferation and chondrogenesis. Then, WJMSCs loaded in GMs were transplanted in the joint of osteoarthritis mice. After four weeks, joint tissue was collected for histological analysis. Overexpressing-luciferase WJMSCs were performed to explore cell retention in mice. Results: In vitro experiments demonstrated that WJMSCs loaded with GMs maintained cell viability and proliferative potential. Moreover, GMs enhanced the chondrogenesis differentiation of WJMSCs while alleviated cell hypertrophy. In KOA mice model, transplantation of WJMSCs-GMs complexes promoted cartilage regeneration and cartilage matrix formation, contributing to the treatment of KOA. Compared with other groups, in WJMSCs+GMs group, there were fewer cartilage defects and with a more integrated tibia structure. Tracking results of stable-overexpressing luciferase WJMSCs demonstrated that GMs significantly extended the retention time of WJMSCs in knee joint cavity. Conclusion: Our results indicated that GMs facilitate WJMSCs mediated knee osteoarthritis healing in mice by promoting cartilage regeneration and prolonging cell retention. It might potentially provide an optimal strategy for the biomaterial-stem cell based therapy for knee osteoarthritis.

The Prevalence of Osteoarthritis and Risk Factors in the Korean Population: The Sixth Korea National Health and Nutrition Examination Survey (VI-1, 2013)

Seokhan Lee,권영근,Nojin Lee,Keun-Joo Bae,Jihyun Kim,Seokwon Park,Yang Hyun Kim,Kyung-Hwan Cho 대한가정의학회 2019 Korean Journal of Family Medicine Vol.40 No.3

Background: Knee osteoarthritis is highly prevalent, especially among the elderly. However, its risk factors have not been well identified, especially in the Korean population. This study aimed to assess the epidemiologic characteris-tics and risk factors of knee osteoarthritis in the Korean population.Methods: Data of 2,280 (1,295 women) participants of the 2013 Korea National Health and Nutrition Examination Survey aged ≥50 years who underwent knee radiography were analyzed. According to the American College of Rheumatology clinical/radiographic classification criteria, knee osteoarthritis was defined as knee pain and radio-graphic knee osteoarthritis. The association between risk factors and knee osteoarthritis was analyzed using the chi-square test and binominal logistic regression.Results: The participants had an average age of 62.6 years; 56.8% of them were women. The average body mass in-dex was 24.2 kg/m2, and 296 (13%) participants were diagnosed with knee osteoarthritis. After adjustment for mul-tiple risk factors, age of ≥65 years (adjusted odds ratio [OR], 2.552; 95% confidence interval [CI], 1.868–3.486), fe-male sex (OR, 2.050; 95% CI, 1.275–3.295), obesity (body mass index, ≥25.0 kg/m2; OR, 1.563; 95% CI, 1.191–2.051), hypertension (OR, 1.394; 95% CI, 1.052–1.846), low educational level (lower than or equal to elementary school: OR, 4.761; 95% CI, 2.131–10.635; middle school: OR, 3.184; 95% CI, 1.375–7.369), and low strength exercise frequen-cy (<2 times/wk; OR, 1.829; 95% CI, 1.202–2.784) increased the risk of knee osteoarthritis.Conclusion: Old age, sex, obesity, hypertension, low educational level, and low strength exercise frequency were found to be risk factors for knee osteoarthritis.

Navigated Unicompartmental Knee Arthroplasty: A Different Perspective

Rajesh Malhotra,Saurabh Gupta,Vivek Gupta,Vikrant Manhas 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.4

Background: Anteromedial osteoarthritis is a recognized indication for unicompartmental knee arthroplasty (UKA). Favorable postoperative outcomes largely depend on proper patient selection, correct implant positioning, and limb alignment. Computer navigation has a proven value over conventional systems in reducing mechanical errors in total knee arthroplasty (TKA). However, the lack of strong evidence impedes the universal use of computer navigation technology in UKA. Therefore, this study was proposed to investigate the accuracy of component positioning and limb alignment in computer navigated UKA and to observe the role of navigation in proper patient selection. Methods: A total of 50 knees (38 patients) underwent computer navigated UKA between 2016 and 2018. All operations were performed by the senior surgeon using the same navigation system and implant type. The navigation system was used as a tool to aid patient selection: knees with preoperative residual varus > 5° on valgus stress and hyperextension > 10° were switched to navigated TKA. We measured the accuracy of component placement in sagittal and coronal planes on postoperative radiographs. Functional outcomes were also evaluated at the final follow-up (a minimum of 16 months). Results: Nine patients had tibia vara and 14 patients had preoperative hyperextension deformity. We observed coronal outliers for the tibial component in 12% knees and for the femoral component in 10% knees. We also observed sagittal outliers for the tibial component in 14% knees and for the femoral component in 6% knees. There was a significant improvement in the functional score at the final follow-up. On multiple linear regression, no difference was found in functional scores of knees with or without tibia vara (p = 0.16) and with or without hyperextension (p = 0.25). Conclusions: Our study further validates the role of computer navigation in desirable implant positioning and limb alignment. We encourage use of computer-assisted navigation as a tool for patient selection, as it allows intraoperative dynamic goniometry and provides real-time kinematic behavior of the knee to obviate pitfalls such as significant residual varus angulation and hyperextension that predispose early failure of UKA.

Effect of Joint Mobilization and Kinesio Taping on Pain, Range of Motion, and Knee Function in Patients with Knee Osteoarthritis

( Shin-jun Park ),( Ju-hwan Lee ) 대한물리치료학회 2016 대한물리치료학회지 Vol.28 No.5

Purpose: This study was conducted to investigate the effects of joint mobilization and kinesio taping on pain, range of motion and knee function in patients with knee osteoarthritis. Methods: Thirty subjects were selected and divided into three groups: group 1 was treated with joint mobilization, group 2 was treated with kinesio taping and group 3 was treated with joint mobilization and kinesio taping. Joint mobilization was performed for 20 minutes three times a week for a period of 4 weeks, after which tape was applied for the same period of time and it was not exceeded 24 hours. Pain, range of motion and knee function were then assessed to identify the effectiveness. A visual analog scale (VAS) was used for pain assessment, while active and passive range of motion (AROM, PROM) were assessed using smart phones application, and knee injury and osteoarthritis outcome score (KOOS) was used to assess knee function. Results: After intervention, the joint mobilization group and kinesio taping group showed significant improvements in VAS, AROM, PROM and KOOS (Symptom, Pain, ADL, QOL), whereas no significant difference was found in sport/recreation. The joint mobilization with kinesio taping group showed significant improvements in all items, and a significant increase was found in AROM and PROM compared to the other two groups. Conclusion: We found that joint mobilization and kinesio taping effectively improved pain, range of motion and knee function in patients with knee osteoarthritis, but that application of joint mobilization with kinesio taping was most effective.