Clinical Study On The Effect Of DTT-HTO Knee Preservation Treatment On Patellofemoral Joint Based On The Theory Of "treating Tendons And Bones Together

The first one Objective:Through prospective clinical observation,to explore the degeneration and stability changes of patellofemoral joint before and after the treatment of moderate-to-severe varus KOA with DTT-HTO,and to provide theoretical and practical basis for the application of the operation of moderate-to-severe varus KOA.Method:A prospective analysis was performed on 36 patients with moderate-to-severe KOA with minimally invasive arthrosis in the Third Affiliated Hospital of Beijing University of Chinese Medicine who received DTT-HTO from January 2022 to January 2023.Caton-Deschamps Index(CDI)and Blackburne-Peel Index(Blackburne-Peel Index,)were measured before and after 30°lateral knee X-rays.BPI),Weight-Bearing Line Ratio of lower limb(WBLR)on full-length x-rays of lower limb loading posterior tibial slope(PTS)at 30° lateral x-rays of knee.Results:Compared with preoperative,postoperative WBLR increased significantly,and the difference was statistically significant(P<0.01);Compared with preoperative,postoperative CDI,BPI and PTS showed no significant changes,and the differences were not statistically significant(P<0.05).Conclusion:DTT-HTO can change the lower limb force line,transfer the lower limb force line from the medial cavity of knee joint to the lateral cavity,relieve the compressive stress of the medial cavity of knee joint,and restore the mechanical balance of knee joint.Patella position and knee stability in sagittal position were not changed,patella height and posterior inclination of tibia were not changed.The second one Objective:To explore the degeneration and stability of patellofemoral joint before and after DTT-HTO surgery through prospective clinical observation,and to provide theoretical and practical basis for the application of varus type moderate to severe KOA surgery.Methods:A prospective analysis was performed on patients who received DTT-HTO in our hospital from January 2022 to January 2023 in moderate-to-severe KOA with minimally invasive arthroplasty department varus.CDI was measured before and 6 months after surgery to reverify that there was no change in patellar height before and after surgery.Sulcus angle(SA),angle of congruence(CA),patellar tilt angle(PTA)and lateral patellofemoral angle,LPFA)were used to explore the stability of patellofemoral joint before and after surgery.The Ahlback grading and the Altman score were calculated to explore the degeneration of patellofemoral joint before and after surgery.The visual analogue scale(VAS),hospital for special surgery knee score(hospital for special surgery knee score,HSS)and range of motion(ROM)were used to compare surgery effect before and after surgery.The postoperative complications and adverse reactions were recorded.Results:Compared with preoperative results,CDI,SA,CA,PTA,LPFA,the Ahlback grading and Altman score had no significant changes 6 months after operation,and the difference was not statistically significant(P>0.05).Compared with the preoperative results,VAS scores decreased gradually at 3 days,1 month,3 months and 6 months after surgery,and the difference was statistically significant(P<0.01).Compared with the preoperative results,HSS score decreased briefly 1 month after surgery due to the influence of rehabilitation factors,and gradually increased 3 months and 6 months after surgery,the difference was statistically significant(P<0.01).Compared with the preoperative results,the ROM decreased briefly in 1 month and gradually increased in 3 months and 6 months after the operation due to the influence of rehabilitation factors,the difference was statistically significant(P<0.01).Conclusions:DTT-HTO has no significant effect on patellar height and patellofemoral joint stability in the short and medium term,and does not cause patellofemoral joint degeneration.It can significantly reduce knee pain,improve knee function and increase knee motion.It is one of the safe repair methods for the treatment of moderate-to-severe varus knee osteoarthritis,and has achieved good clinical results.