Department of orthopedic and trauma surgery, La Pitié-Salpétrière hospital, 47-83 boulevard de l'Hôpital, Paris, France.
Orthop Traumatol Surg Res. 2013 Feb;99(1 Suppl):S87-103. doi: 10.1016/j.otsr.2012.12.003. Epub 2013 Jan 30.
Trunk balance in upright stance expresses an individual postural strategy found on anatomic and functional parameters. The "pelvic vertebra" is an essential transitional region for the coherence of spinal parameters (notably, lumbar lordosis and thoracic kyphosis) and pelvic parameters (sacral slope, pelvic tilt and incidence). Deterioration of this postural harmony is often associated with spinal aging, maladjusted spinal arthrodeses, or mechanical abnormalities of the hip joints. Spinal surgeons are aware of the importance of detecting and analyzing sagittal imbalance, whether compensated or not. The influence of the hip joint, however, is underestimated and poorly objectified on conventional imaging, as are its interrelations with overall lower-limb posture. Currently, hip surgeons focus basically on the pelvis as bone reference in planning implantation, peroperative adjustment and failure analysis. The antero-posterior (AP) pelvic view is the gold standard, with lateral views being little used. Influenced by the classic anatomic attitude in favor of transverse slices in dorsal decubitus, CT is considered the reference method for "horizontal" assessment of the hip joint. The present study draws attention to a more global vision of the pelvic and subpelvic regions in the sagittal balance of the trunk, relying on the sitting as well as the standing posture, as both involve subtle mechanisms of adaptation governed by the pelvic incidence angle.
直立位躯干平衡反映了个体基于解剖学和功能参数的特定姿势策略。“骨盆椎体”是脊柱参数（尤其是腰椎前凸和胸椎后凸）和骨盆参数（骶骨倾斜度、骨盆倾斜度和入射角）连贯性的重要过渡区域。这种姿势协调性的恶化通常与脊柱老化、脊柱融合术调整不当或髋关节机械异常有关。脊柱外科医生已经意识到检测和分析矢状面失衡的重要性，无论是否代偿。然而，髋关节的影响被低估了，在常规影像学上也没有得到很好的客观化，其与整个下肢姿势的相互关系也是如此。目前，髋关节外科医生基本上将骨盆作为植入物规划、术中调整和失败分析的骨参考。前后位（AP）骨盆视图是金标准，很少使用侧位视图。受经典解剖体位在背侧卧位中有利于横切片的影响，CT 被认为是髋关节“水平”评估的参考方法。本研究提请注意在躯干矢状面平衡中，骨盆和骨盆下区域的更全面的视野，既依赖于坐姿也依赖于站立姿势，因为这两种姿势都涉及由骨盆入射角控制的微妙适应机制。
