| Knee osteoarthritis(KOA)is the most common arthropathy for osteoarthritis,accounting for approximately 85%of the global osteoarthritis.Influenced by the aging of the global population and increasing obesity and joint damage,this problem is becoming increasingly prevalent.Because of its certain disable-causing,KOA severely affects the employment status and life quality of patients,and has a significant impact on individuals,health care systems and the broader socio-economic costs,which is a major and growing health burden.However,under such a huge burden of disease,there are still a substantial number of KOA patients that have not been well managed and treated.In recent years,with the application and development of the concept of precision medicine and related technologies in KOA treatment,this problem has been improved to a certain extent,but there are still 1)a great quantity of patients with non-surgical treatment of KOA do not carry out good health management,but develop rapidly to the stage of drug control or even joint replacement;2)The measurement error of the lower limb alignment caused by knee flexion deformity or lower limb rotation in patients undergoing surgical treatment affects the precise correction of deformity and surgical effect.Part Ⅰ Establishment and Application Research of Health Management Scheme for KOA Patients with Non-surgical TreatmentObjective1.Investigate the cognition of KOA(prevention knowledge,KOA disease and its risk factors,treatment methods)in patients with knee pain in Yunnan Province,and lay the foundation for health education and management of KOA patients.2.To establish a health management scheme for KOA patients with non-surgical treatment based on WEB platform,and improve the therapeutic effect of KOA patients with non-surgical treatment.Methods1.Researched and designed the KOA cognition questionnaire.A questionnaire survey was administered to 218 patients with knee joint pain in the orthopedic clinic of our hospital from March 2018 to February 2019.Investigated and comprehended the overall cognitive status and weakness of KOA disease(prevention knowledge,KOA and its risk factors,treatment methods)in Yunnan Province.2.Established a health management scheme for KOA based on the WEB platform.Selected from April 2019 to December 2019,154 KOA patients in the orthopedic clinic of our hospital.And randomly assigned to the platform health management group(experimental group)and the traditional health management group(control group).After entering the group,the baseline information was evaluated,and then the patients were followed up for 6 months.Compared and analyzed the WOMAC score,VAS pain visual score and KOA awareness changes in the two groups in 4 weeks,8 weeks and 6 months.Results1.Among 218 patients with knee joint pain in Yunnan Province,83(38.07%)had poor cognition of KOA-correlative knowledge(below 5 points),80(36.70%)had general cognition(6-10 points),and 55(25.23%)had good cognition(score>11 points).The average score of disease and risk factors knowledge was 4.28±2.62,the average score of diagnosis and treatment knowledge was 2.26±1.60,and the score of KOA prevention knowledge was 0.95±0.71.The respondents had a poor understanding of health care education and functional exercise.Only 36.7%of the patients thought that reasonable exercise could treat KOA,and 16.5%thought that health education was a treatment for KOA.2.At the end of the 6-month experiment,27.27%(21/77)of the patients in the experimental group had no improvement in pain,and 2.60%(2/77)of the patients had aggravated pain.In the control group,46.75%(36/77)of patients had no improvement in pain,of which 10.39%(8/77)had increased pain;total score of WOMAC(mean±standard deviation):experimental group(44.71±8.71),control group(55.26±9.05),P<0.001,the average difference of 10.56 points,95%confidence interval(7.72,13.34);KOA cognition score(mean±standard deviation):experimental group(13.81±1.68),control group(10.48±3.03),P<0.001,average difference of 3.32 points,95%confidence interval(2.54,4.11).Conclusions1.The patients with knee joint pain in Yunnan are weak of KOA disease and risk factors knowledge,prevention knowledge,treatment knowledge,We need to strengthen the propaganda and education of KOA related knowledge;2.The improvement effect of platform health management scheme based on WEB technology on pain,knee joint function and disease cognition of KOA patients is superior to that of the traditional scheme.It can effectively improve the non-surgical effect of early KOA patients,control and delay the disease,reduce the operation rate and medical expenses,and realize the precise treatment of KOA patients with non-surgical treatment.Part Ⅱ Precision Measurement and Clinical Application Study in the Lower limb alignmentObjective1.Summarize the affecting factors of accurate measurement in the lower limb alignment.2.Study on the influence of knee flexion deformity and lower limb rotation on the measurement of accuracy in the lower limb alignment.3.Establish a three-dimensional digital measuring method of the lower limb alignment,and evaluate its feasibility and accuracy.4.Study on the application effect of three-dimensional digital measurement of the lower limb alignment in total knee joint arthroplasty.Methods1.Concluded the affecting factors on accurate measurement of the lower limb alignment by literatures review.2.Retrieved the CT data of 35 patients with complete lower limb bone images from September 2017 to June 2018 in our hospital for lower limb angiography.Based on this data,the MIMICS system was used to establish the knee flexion deformity and lower limb rotation model and the three-dimensional digital measurement method of the lower limb.Then,the measurement results of anatomical femor-tibial angle(aFTA),anatomical lateral distal femoral angle(aLDFA),hip and knee ankle angle(HKA),mechanical medial proximal tibial angle(mMPTA)and mechanical lateral distal femoral angle(mLDFA)were used to evaluate the influence of knee flexion or lower limb rotation on the lower limb alignment and the feasibility of the three-dimensional digital measurement method of the lower limb alignment.3.Selected 23 patients(35 sides)with knee osteoarthritis in our department from January 2018 to September 2018.The simulated weight-bearing CT data of all affected limbs was collected using a self-designed simulated weight-bearing device,and the standing full-length films of lower limbs were taken before and after standing.Then the accuracy difference between the three-dimensional digital measurement method in the lower limb alignment based on simulated weight-bearing CT data and the traditional X-ray measurement method was compared and analyzed.4.Choose 80 patients with knee varus deformity who were diagnosed as KOA in our hospital from September 2018 to September 2019 and randomly divided into an experimental group(preoperatively evaluated by three-dimensional digital measurement on the lower limb alignment)and control group(preoperatively evaluated by traditional X-ray measurement on the lower limb alignment),with 40 cases in each group.Compared and analyzed the differences and effect of three-dimensional digital measurement of the lower limb alignment and traditional X-ray measurement in total knee arthroplasty.Results1.The lower limb alignment has obvious individual differences,which are related to race,gender,knee joint degeneration degree(muscle strength,relaxation degree of surrounding ligaments,articular cartilage wear),and lower limb deformity(lexion,rotation).The accurate measurement on the lower limb alignment is closely related to the acquisition method,shooting position and measurement method of the full-length film of lower limbs.2.The increment of 10° flexion of knee joint can cause statistically significant differences in changes except mLDFA(F:1.66,P=0.138),including aFTA(F:83.96,P<0.001),aLDFA(F:3.88,P=0.014),mMPTA(F:61.68,P<0.001,HKA(F:30.79,P<0.001),among which the most influential parameter aFTA has an average difference compared with the neutral position(5.53±0.65).3.The change of the lower limb with 10° rotation as the increment can cause aFTA,aLDFA,HKA,mMPTA,and mLDFA,with statistically significant difference(P<0.001),while the difference in mLDFA between the-30° to+30° groups and the neutral position(0°)group was not statistically significant,P>0.05;The mean values of aFTA,aLDFA,HKA,mMPTA mMPTA and mLDFA groups and the neutral position was less than 2° when the internal rotation was 10° and the external rotation was 10°.4.The paired t-test results of three-dimensional digital measurement on the lower limb alignment based on simulated CT data and traditional X-ray measurement were as follows:aFTA(0.04 ± 4.99,t=-0.001,P=0.99),aLDFA(0.13±1.69,t=-0.63,P=0.053),mLDFA(-0.22±3.35,t=-0.55,P=0.59),and the difference was not statistically significant,mMPTA(2.24±3.04,t=6.17,P=<0.001),HKA(1.26±1.54,t=6.83,P<0.001),and the difference was statistically significant.5.Compared to the operation time of the control group was(83.66 ± 11.63)min,and that of the experimental group was(71.23 ± 9.66)min,the difference was statistically significant(P<0.05).The mean values of PTSA and HKA in the experimental group and the control group after operation were significantly different(t=2.52,P=0.014),and the difference was not statistically significant between the mean values of mMPTA and aMFA in the two groups after the operation(t=-1.002,P=0.319).t=0.583,P=0.514).6.Compared with the baseline,the HSS values of the two groups showed an upward trend at 3M,6M and 12M after an operation,and the HSS values at 3M,6M and 12M after operation were significantly higher than those at baseline(P<0.001).At 3M,6M and 12M after the operation,the HSS values of the control group were lower than those of the experimental group.At 12M after the operation,the HSS score of the experimental group was(81.68±0.98)points,and that of the control group was(76.33±0.98)points.The difference between groups was statistically significant(F=8.65,P=0.004).Conclusions1.Three-dimensional digital measurement on the lower limb alignment can reduce the measurement error caused by knee flexion deformity and rotation factors,and improve the accuracy of measurement on the lower limb alignment.2.Compared with the traditional X-ray measurement method,the three-dimensional digital measurements on the lower limb alignment can improve the surgical effect of total knee arthroplasty.3.The preoperative evaluation in the lower limb alignment by three-dimensional digital measurements on the lower limb alignment can guide total knee arthroplasty.Compared with the traditional X-ray measurement method,it can improve the surgical effect. |
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