Ochi Hironori, Baba Tomonori, Homma Yasuhiro, Matsumoto Mikio, Nojiri Hidetoshi, Kaneko Kazuo
Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Department of Orthopedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, Japan.
Eur Spine J. 2016 Nov;25(11):3699-3706. doi: 10.1007/s00586-015-4217-2. Epub 2015 Sep 2.
Dislocation after total hip arthroplasty (THA) is a major postoperative complication. Even if the cup is in the safe zone, dislocation caused by implant impingement may occur during postural changes. The aim of the present study was to investigate the spinopelvic factors that influence pelvic inclination changes from standing to sitting in patients with hip diseases who were candidates for THA.
74 patients who underwent primary THA were included according to our criteria. The analysis of the sagittal balance of the spinopelvic complex was performed on standing and sitting lateral radiographs. Pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis angle (LLA), thoracic kyphosis angle (TK), and sagittal vertical axis (SVA) were measured. The differences between the standing and sitting positions regarding the spinal and pelvic parameters were analyzed. Correlations between the variables of the spinopelvic parameters were examined using Spearman's rank correlation coefficient.
The changes in SVA, TK, LLA, SS, PT, and PI from the standing to sitting positions, respectively, were -3.9 ± 48.2 mm, -0.1° ± 6.4°, 21.4° ± 17.7°, 22.2° ± 12.2°, -22.3° ± 13.2°, and 0.4° ± 6.9°. The lumbar lordosis was reduced and pelvic rotation was extended from the standing to the sitting position. The correlation coefficient between the change in the SS and that in the LLA was 0.72 (p < 0.0001). The correlation coefficient between the change in PT and that in the LLA was -0.68 (p < 0.0001).
The change in pelvic inclination from standing to sitting is strongly related to the mobility of the lumbar spine in patients with hip diseases.
全髋关节置换术（THA）后脱位是一种主要的术后并发症。即使髋臼处于安全区域，在体位改变时仍可能因植入物撞击而发生脱位。本研究的目的是调查影响拟行THA的髋部疾病患者从站立位到坐位时骨盆倾斜度变化的脊柱 - 骨盆因素。
根据我们的标准纳入74例行初次THA的患者。对站立位和坐位的侧位X线片进行脊柱 - 骨盆复合体矢状面平衡分析。测量骨盆入射角（PI）、骶骨倾斜角（SS）、骨盆倾斜角（PT）、腰椎前凸角（LLA）、胸椎后凸角（TK）和矢状垂直轴（SVA）。分析脊柱和骨盆参数在站立位和坐位之间的差异。使用Spearman等级相关系数检验脊柱 - 骨盆参数变量之间的相关性。
从站立位到坐位，SVA、TK、LLA、SS、PT和PI的变化分别为-3.9±48.2mm、-0.1°±6.4°、21.4°±17.7°、22.2°±12.2°、-22.3°±13.2°和0.4°±6.9°。从站立位到坐位，腰椎前凸减小，骨盆旋转增加。SS变化与LLA变化之间的相关系数为0.72（p<0.0001）。PT变化与LLA变化之间的相关系数为-0.68（p<0.0001）。
髋部疾病患者从站立位到坐位时骨盆倾斜度的变化与腰椎的活动度密切相关。
