Advantages，Key Issues and Research Strategies of Traditional Chinese Medicine in the Prevention and Treatment of Bone and Joint Degenerative Diseases

doi:10.12114/j.issn.1007-9572.2021.01.032

Abstract

Abstract: The treatment of bone and joint degenerative diseases represented by cervical spondylosis，lumbar degenerative diseases，and knee osteoarthritis is mainly non-surgical treatment，which aredominant diseases of Traditional Chinese Medicine orthopedics. Traditional Chinese Medicine，manipulation，acupuncture，and traditional functional exercises are characteristic therapies commonly used in Chinese Medicine，which can significantly improve the clinical symptoms and signs of patients and prevent disease recurrence. At present，the prevention and treatment of bone and joint degenerative diseases with traditional Chinese Medicine still have many problems such as insufficient clinical efficacy evaluation，insufficient application of clinical Biobanks，insufficient research and development of key traditional Chinese Medicine technology and equipment，lack of multidisciplinary collaborative innovation. In order to solve these problems，it is suggested that traditional Chinese Medicine should follow the principle of “evidence-oriented，Chinese and Western medicine consensus” to carry out clinical research，standardize the collection of Chinese Medicine diagnosis and treatment information，build a clinical biological sample library，integrate modern science and technology to develop key Chinese Medicine technical equipment，integrate advantageous resources to achieve a collaborative research organization model，improve the research evidence of traditional Chinese Medicine in the prevention and treatment of bone and joint degenerative diseases，and further improve the level of clinical diagnosis and treatment.

Key words: Osteoarthritis, Bone and joint degenerative diseases, Intervertebral disc degeneration, TCM therapy, Advantage, Key issue, Strategy

摘要：

以颈椎病、腰椎退行性疾病、膝骨关节炎为代表的骨与关节退行性疾病治疗以非手术治疗为主，是骨伤科临床治疗优势病种。中药、手法、针灸、传统功能锻炼等是中医常用的特色疗法，能够显著改善患者的临床症状、体征，预防疾病复发。目前，中医药防治骨与关节退行性疾病存在临床疗效评价欠规范、临床生物样本库应用不够、中医关键技术装备研发不足、多学科交叉协同创新匮乏等问题。针对上述问题，建议中医药防治该类疾病应遵循“证据为重、中西共识”的原则开展临床研究，规范中医诊疗信息采集并构建临床生物样本库，融合现代科学技术研发中医关键技术装备，整合优势资源实现协同攻关组织模式，完善中医药防治骨与关节退行性疾病的研究证据，进一步提升临床诊疗水平。

关键词: 骨关节炎, 骨与关节退行性疾病, 椎间盘退行性变, 中医疗法, 优势, 关键问题, 策略

WEI Xu,HAN Tao,SUN Kai, et al. Advantages，Key Issues and Research Strategies of Traditional Chinese Medicine in the Prevention and Treatment of Bone and Joint Degenerative Diseases　[J]. Chinese General Practice, 2021, 24(35): 4421-4426. DOI: 10.12114/j.issn.1007-9572.2021.01.032.
魏戌,韩涛,孙凯等. 中医药防治骨与关节退行性疾病的优势、关键问题及研究策略[J]. 中国全科医学, 2021, 24(35): 4421-4426. DOI: 10.12114/j.issn.1007-9572.2021.01.032.

References

［1］IMAGAMA S，ANDO K，KOBAYASHI K，et al. Multivariate analysis of factors related to the absence of musculoskeletal degenerative disease in middle-aged and older people［J］. Geriatr Gerontol Int，2019，19（11）：1141-1146. DOI：10.1111/ggi.13786.
［2］Gbd Disease and Injury Incidence and Prevalence Collaborators. Global，regional，and national incidence，prevalence，and years lived with disability for 354 diseases and injuries for 195 countries and territories，1990-2017：a systematic analysis for the Global Burden of Disease Study 2017［J］. Lancet，2018，392（10159）：1789-1858. DOI：10.1016/S0140-6736（18）32279-7.
［3］REN Y，HU J，TAN J，et al. Incidence and risk factors of symptomatic knee osteoarthritis among the Chinese population：analysis from a nationwide longitudinal study［J］. BMC Public Health，2020，20（1）：1491. DOI：10.1186/s12889-020-09611-7.
［4］ZHU L G，YU C S，ZHANG X F，et al. The treatment of intervertebral disc degeneration using Traditional Chinese Medicine［J］. J Ethnopharmacol，2020，263：113117. DOI：10.1016/j.jep.2020.113117.
［5］TU J F，YANG J W，SHI G X，et al. Efficacy of intensive acupuncture versus sham acupuncture in knee osteoarthritis：a randomized controlled trial［J］. Arthritis Rheumatol，2021，73（3）：448-458. DOI：10.1002/art.41584.
［6］田伟. 脊柱与关节退行性疾病流行病学现状与诊疗发展［J］. 骨科临床与研究杂志，2016，1（1）：1-3. DOI：10.19548/j.2096-269x.2016.01.002.
TIAN W. Epidemiological status and development of diagnosis and treatment of degenerative diseases of spine and joints ［J］. Journal of Clinical Orthopedics and Research，2016，1（1）：1-3. DOI：10.19548/j.2096-269x.2016.01.002.
［7］魏戌，尹逊路，朱立国，等. 骨与关节退行性疾病中医临床研究质量控制［J］. 中医学报，2021，36（5）：998-1001. DOI：10.16368/j.issn.1674-8999.2021.05.212.
WEI X，YIN X L，ZHU L G，et al. Quality control of clinical research of Chinese Medicine for degenerative diseases of bone and joint［J］. Acta Chin Med，2021，36（5）：998-1001. DOI：10.16368/j.issn.1674-8999.2021.05.212.
［8］张明才，石印玉，黄仕荣，等. “骨错缝筋出槽”与颈椎病发病关系的临床研究［J］. 中国骨伤，2013，26（7）：557-560. DOI：10.3969/j.issn.1003-0034.2013.07.007.
ZHANG M C，SHI Y Y，HUANG S R，et al. Study on the correlation between “Gucuofeng and Jinchucao” and cervical spondylosis［J］. China J Orthop Traumatol，2013，26（7）：557-560. DOI：10.3969/j.issn.1003-0034.2013.07.007.
［9］CUI X J，TRINH K，WANG Y J. Chinese Herbal Medicine for chronic neck pain due to cervical degenerative disc disease［J］. Cochrane Database Syst Rev，2010（1）：CD006556. DOI：10.1002/14651858.CD006556.pub2.
［10］DENG Z，WANG K，WANG H H，et al. A finite element study of Traditional Chinese Cervical Manipulation［J］. Eur Spine J，2017，26（9）：2308-2317. DOI：10.1007/s00586-017-5193-5.
［11］HU J H，CHEN F，QIU G X，et al. Jingshu Keli for treating cervical spondylotic radiculopathy：the first multicenter，randomized，controlled clinical trial［J］. J Orthop Translat，2021，27：44-56. DOI：10.1016/j.jot.2020.10.010.
［12］ZHU L G，GAO J H，YU J，et al. Jingtong granule：a Chinese Patent Medicine for cervical radiculopathy［J］. Evid Based Complement Alternat Med，2015，2015：158453. DOI：10.1155/2015/158453.
［13］魏戌，朱立国，高景华，等. 经方治疗神经根型颈椎病的临床应用进展［J］. 世界中西医结合杂志，2017，12（2）：149-152. DOI：10.13935/j.cnki.sjzx.170201.
WEI X，ZHU L G，GAO J H，et al. Clinical application of the classic formulas in the treatment of cervical radiculopathy［J］. World J Integr Tradit West Med，2017，12（2）：149-152. DOI：10.13935/j.cnki.sjzx.170201.
［14］ZHU L G，WEI X，WANG S Q. Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence，and a meta-analysis［J］. Clin Rehabil，2016，30（2）：145-155. DOI：10.1177/0269215515570382.
［15］BLANPIED P R，GROSS A R，ELLIOTT J M，et al. Neck pain：revision 2017 clinical practice guidelines linked to the international classification of functioning，disability and health from the orthopaedic section of the American Physical Therapy Association［J］. J Orthop Sports Phys Ther，2017，47（7）：A1-83. DOI：10.2519/jospt.2017.0302.
［16］于杰，朱立国，洪毅，等. 中医综合疗法治疗神经根型颈椎病的疗效评价与长期随访［J］. 中国中医骨伤科杂志，2016，24（9）：11-13，17.
YU J，ZHU L G，HONG Y，et al. Evaluation the clinical curative effect and result of long time follow-up of combined therapy of traditional Chinese Medicine for radiculopathy type of cervical spondylotic［J］. Chin J Tradit Med Traumatol Orthop，2016，24（9）：11-13，17.
［17］MO Z M，ZHANG R W，CHEN J F，et al. Comparison between oblique pulling spinal manipulation and other treatments for lumbar disc herniation：a systematic review and meta-analysis［J］. J Manipulative Physiol Ther，2018，41（9）：771-779. DOI：10.1016/j.jmpt.2018.04.005.
［18］TANG S J，MO Z M，ZHANG R W. Acupuncture for lumbar disc herniation：a systematic review and meta-analysis［J］. Acupunct Med，2018，36（2）：62-70. DOI：10.1136/acupmed-2016-011332.
［19］MO Z M，LI D，ZHANG R W，et al. Comparisons of the effectiveness and safety of tuina，acupuncture，traction，and Chinese herbs for lumbar disc herniation：a systematic review and network meta-analysis［J］. Evid Based Complement Alternat Med，2019，2019：6821310. DOI：10.1155/2019/6821310.
［20］TU J F，YANG J W，SHI G X，et al. Efficacy of intensive acupuncture versus sham acupuncture in knee osteoarthritis：a randomized controlled trial［J］. Arthritis Rheumatol，2021，73（3）：448-458. DOI：10.1002/art.41584.
［21］LIN L L，TU J F，WANG L Q，et al. Acupuncture of different treatment frequencies in knee osteoarthritis：a pilot randomised controlled trial［J］. Pain，2020，161（11）：2532-2538. DOI：10.1097/j.pain.0000000000001940.
［22］ZHANG W M，WANG S Q，ZHANG R X，et al. Evidence of Chinese herbal medicine Duhuo Jisheng decoction for knee osteoarthritis：a systematic review of randomised clinical trials［J］. BMJ Open，2016，6（1）：e008973. DOI：10.1136/bmjopen-2015-008973.
［23］ZHU L G，YANG S F，WANG S Q，et al. Effectiveness and safety of manufactured Chinese herbal formula for knee osteoarthritis：insights from a systematic review［J］. Evid Based Complement Alternat Med，2015，2015：328642. DOI：10.1155/2015/328642.
［24］LI L，GUO Y，CHEN Z，et al. Epidemiology and the control of disease in China，with emphasis on the Chinese Biobank Study［J］. Public Health，2012，126（3）：210-213. DOI：10.1016/j.puhe.2011.11.012.
［25］朱叶飞，周学迅，朱乃文，等. 江苏省重大传染病研究生物样本库的构建研究［J］. 中国全科医学，2013，16（17）：1566-1568. DOI：10.3969/j.issn.1007-9572.2013.05.035.
ZHU Y F，ZHOU X X，ZHU N W，et al. Establishment of large scale biobank on major infectious diseases in Jiangsu Province［J］. Chin Gen Pract，2013，16（17）：1566-1568. DOI：10.3969/j.issn.1007-9572.2013.05.035.
［26］SUN L L，CLARKE R，BENNETT D，et al. Causal associations of blood lipids with risk of ischemic stroke and intracerebral hemorrhage in Chinese adults［J］. Nat Med，2019，25（4）：569-574. DOI：10.1038/s41591-019-0366-x.
［27］SUN M H，ZHANG Y L，SHEN H，et al. Prevalence of and risk factors for community-based osteoporosis and associated fractures in Beijing：study protocol for a cross-sectional and prospective study［J］. Front Med （Lausanne），2020，7：544697. DOI：10.3389/fmed.2020.544697.
［28］HUANG Y C，LI S，FENG M S，et al. Cervical spine mechanism for reproduction of the biomechanical behaviours of the human neck during rotation-traction manipulation［J］. Appl Bionics Biomech，2017，2017：5829048. DOI：10.1155/2017/5829048.

[1]	BAO Yiru, BAO Shouqian, ZHANG Zhaohui, ZHANG Yinchuan. Tetanus with Low back and Knee Pain, Abdominal Distension and Constipation as Initial Presentations: Report of a Deaf and Mute Case and Literature Review [J]. Chinese General Practice, 2023, 26(24): 3074-3078.
[2]	ZHAO Linlin, SHAO Shuang, LUO Qi, CHEN Xiaolei, DU Juan. Practice Strategy of Treatment-prevention Integration of Family Doctor Team in China [J]. Chinese General Practice, 2023, 26(22): 2715-2719.
[3]	GUO Tianci, CHEN Jixin, YU Weijie, LIU Aifeng. Recent Developments in the Application of Artificial Intelligence in the Diagnosis and Treatment of Osteoarthritis [J]. Chinese General Practice, 2023, 26(19): 2428-2433.
[4]	KAIYISAIER· Abudukelimu, LI Lei, YANG Xiaokai, REN Jun, LIU Shuai. Correlation between Preoperative Cervical CT Values of Hounsfield Units and Height Changes of Adjacent Intervertebral Spaces after Anterior Cervical Discectomy and Fusion [J]. Chinese General Practice, 2023, 26(09): 1125-1130.
[5]	HAN Siyu, LI Duoduo, CAI Meiling, YU Changhe. Comparative Study of the Royal TCM-based Tendon-regulation Manipulation and Joint Mobilization for Knee Osteoarthritis [J]. Chinese General Practice, 2023, 26(02): 210-219.
[6]	CHANG Chun, SUN Yongchang. Global Strategy for Asthma Management and Prevention: Interpretation of the Updates in 2022 [J]. Chinese General Practice, 2022, 25(35): 4355-4362.
[7]	LU Chunjian, LIU Wei, LIN Shaoxia, ZHU Yanxian, PI Min. Efficacy and Safety of the Five Commonly Used External Therapies of TCM Combined with Conventional Western Medicine in Treating Diabetic Peripheral Neuropathy: a Bayesian Network Meta-analysis [J]. Chinese General Practice, 2022, 25(33): 4106-4116.
[8]	Limin MOU, Wenhao ZHANG, Siping ZHANG, Qi QIN, Mingzhan HAN, Wanji CHEN, Jian RAN. Association of Degenerative Knee Osteoarthritis Pain with Sex Hormone and Inflammatory Cytokines in Synovial Fluids in Postmenopausal Women [J]. Chinese General Practice, 2022, 25(29): 3652-3657.
[9]	Qian LIU, Hanzhi ZHANG, Mengsi QIU, Dehua YU. Problems and Addressing Strategies in Community-based Management of Osteoarthritis: a Systematic Review [J]. Chinese General Practice, 2022, 25(25): 3157-3164.
[10]	Mengsi QIU, Qian LIU, Hanzhi ZHANG, Jiupeng TIAN, Lizhi ZHANG, Dehua YU. Healthcare-seeking Perceptions and Behaviors and Behavior-related Factors in Community-living Osteoarthritis Patients: a Mixed-methods Study [J]. Chinese General Practice, 2022, 25(25): 3165-3170.
[11]	Qian LIU, Mengsi QIU, Hanzhi ZHANG, Lizhi ZHANG, Rongan JIANG, Jie QIAN, Zhetun FU, Haiyan YU, Xiaodong LIU, Dehua YU. Construction and Application of an Informatics Based Multidisciplinary Management Model for Osteoarthritis Patients in Community [J]. Chinese General Practice, 2022, 25(25): 3171-3177.
[12]	Qingquan ZHANG, Shijun WANG. Assessment and Surgical Strategies for Lymphatic Metastasis in Cervical Cancer [J]. Chinese General Practice, 2022, 25(18): 2235-2238.
[13]	Yan WANG, Yanjie BAI, Ming ZHANG, Xiaoxiao LI, Yongchuang ZHANG. Moxibustion on Governor Vessel Acupoints Improves the Cognitive Function and TCM Symptoms in Patients with Post-stroke Mild Cognitive Impairment Due to Deficiency of Kidney Essence [J]. Chinese General Practice, 2022, 25(12): 1487-1492,F01.
[14]	Jiachun NI, Zengjin CAI, Qiong JIANG, Haibo LAN, Xiangdong YANG, Wenbin FAN. Progress on Drug Therapy for Opioid-induced Constipation [J]. Chinese General Practice, 2022, 25(12): 1499-1505.
[15]	ZHANG Dongying, YAO Mi, LIU Manling, GUO Fagang, WU Jiang, WANG Baoji, XIAO Baojun, XU Jing, LAI Yanmei, ZHENG Jinping. Analysis and Research on the Characteristics of COVID-19 Epidemic in Urban Village and Its Prevention and Control Strategies in Primary Care Institutions [J]. Chinese General Practice, 2022, 25(11): 1383-1386.