Clinical Observation And Biomechanical Study Of Knee-Preserving Treatment With HTO Based On The Theory Of "Bone-Strengthening And Tendon-Softening"

Background:Knee osteoarthritis(KOA)is one of the main reasons for the limitation of activity and function in the elderly.It belongs to the category of related diseases in traditional medicine,such as"arthralgia syndrome","acute arthritis","arthroncus of knee","bone arthralgia","knee arthralgia"and so on.The treatment mainly includes conservative and minimally invasive.High tibial osteotomy is in line with the traditional medical concept of"bone strengthening and tendon softening"and is widely used in clinic.Objective:Experiment 1:To observe the clinical efficacy of HTO knee protector in the treatment of KOA based on the theory of"bone strengthening tendon softening".Experiment 2:Study on the biomechanical characteristics of two osteotomy models.Research methods:Experiment 1:56 patients with knee varus deformity who met the inclusion and exclusion criteria in the first affiliated Hospital of Tianjin University of traditional Chinese Medicine,Beijing Rehabilitation Hospital affiliated to Capital Medical University and Tianjin Hospital from March 2018 to June 2019 were collected.The patients were randomly divided into two groups:single-plane osteotomy group and double-plane osteotomy group.The patients in the two groups were evaluated with VAS pain score,osteoarthritis index WOMAC score and HSS knee score before treatment,1 month,3 month and 6 months after operation.MPTA and FTA were measured before and1 months,6 months after operation.All the data were analyzed by SPSS 25.0 software.Experiment 2:Two synthetic tibia were used,one case underwent single-plane osteotomy and fixed with?-shaped plate,and the other case underwent double-plane osteotomy and fixed with T-shaped plate.The dental denture powder was used for embedding and the strain gauge was pasted.The Bose Electro Force~?3510mechanical tester was used to simulate the mechanical environment of compression and torsion.The biomechanical characteristics of the two osteotomy methods and their steel plates were observed.All the data were analyzed by SPSS 25.0 software.Results:Experiment 1:There were 28 cases of biplane osteotomy,including 10 males,18females,16 on the left and 12 on the right.The average age was 56.86±6.598 years old,the oldest was 65 years old and the youngest was 39 years old.There were 28cases of single plane osteotomy,including 6 males and 22 females.There were 11cases on the left side and 17 cases on the right side.The average age was 59.11±5.808 years old,the oldest was 65 years old and the youngest was 47 years old.Sex,age,preoperative VAS,WOMAC,HSS,MPTA and FTA had no statistical significance and were comparable.There was no significant difference in VAS,WOMAC and HSS between the two groups at 1 month,3 months and 6 months after operation(p>0.05),and there was no significant difference in FTA at 1month and 6 months after operation(p>0.05).There was significant difference in MPTA at 1 month and 6 months after operation.The MPTA of single-plane osteotomy group was higher than that of double-plane osteotomy group(MPTA).The analysis of variance of repeated measurements of VAS,WOMAC and HSS showed that the pain symptoms of the two osteotomy methods were gradually relieved at 1 month,3 months and 6 months after operation,the score of WOMAC osteoarthritis index decreased gradually,and the knee joint function was gradually improved,and there was no significant difference between the two groups.The analysis of variance of repeated measurements of FTA and MPTA showed that the degree of FTA of the two osteotomy methods at 1 month and 6 months after operation were lower than those before operation,and there was no significant difference between the two groups.The degrees of MPTA at 1 month and 6 months after operation were significantly higher than those before operation(P<0.0 5).Experiment 2:Under the axial loads of 1000N,1100N,1200N,1300N and 1400N,the axial stiffness of the single-plane osteotomy group was all greater than that of the biplane osteotomy group.The axial stiffness of the two groups under each axial load was all P<0.01 by non-parametric test analysis,which was statistically significant.The stress at the osteotomy broken end of the two groups under each load was all P<0.01 by non-parametric test analysis,which was statistically significant.Under the axial torsional load of 2Nm,4Nm,6Nm and 8Nm,the torsional stiffness of the single-plane osteotomy group was greater than that of the double-plane osteotomy group,and the torsional stiffness of the two groups under each torsional load was all P<0.01 by non-parametric test analysis,which was statistically significant.Conclusion:1.The two methods of high tibial osteotomy based on"bone strengthening tendon softness"theory can improve the function of knee joint,relieve pain and correct deformity.Except that the MPTA single plane osteotomy group was better than the double plane osteotomy group,there was no significant difference in other observation indexes between the two groups.HTO knee preservation in the treatment of knee osteoarthritis is worthy of clinical promotion.2.The axial stiffness and torsional stiffness of single-plane osteotomy combined with?-shaped plate were better than that of double-plane osteotomy combined with T-shaped plate.Single-plane osteotomy combined with?-shaped plate is also better than double-plane osteotomy combined with T-shaped plate in the axial stress of osteotomy surface.