Cheng Xiaofei, Zhang Kai, Sun Xiaojiang, Zhao Changqing, Li Hua, Zhao Jie
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Gait Posture. 2017 Jul;56:14-18. doi: 10.1016/j.gaitpost.2017.04.041. Epub 2017 May 1.
The objective was to analyze the compensatory effect of the pelvis and lower extremities on sagittal spinal malalignment in patients with pelvic incidence (PI) and lumbar lordosis (LL) mismatch. A series of parameters including PI, LL, PI-LL, thoracic kyphosis (TK), pelvic tilt (PT), sacral slope (SS), knee flexion angle (KFA), tibial obliquity angle (TOA), femoral obliquity angle (FOA), femur pelvis angle (FPA) and pelvic shift (PS) were measured. Patients with PI-LL mismatch were divided into pelvic retroversion group and pelvic retroposition group based on their PT and PS, and then the parameters were compared within the two groups and with the control group. All variables were significantly different when comparing the pelvic retroversion and retroposition group with the control group except for PI, FOA and PS in the pelvic retroversion group. The pelvic retroposition group had significantly greater value of PI-LL, PI, PT, KFA, FOA and PS and contribution ratio of FOA and PS, and smaller value of LL, TK and FPA and contribution ratio of PT, TOA and FPA compared with the pelvic retroversion group. Patients with lesser PI-LL mismatch rely more on hip extension to increase pelvic retroversion while those with greater PI-LL mismatch tend to add extra femoral obliquity. When compensating for larger PI-LL mismatch, the importance of hip extension is decreased and the effect of the knee and ankle joint becomes more important by providing greater femoral incline and relatively lesser ankle dorsiflexion respectively.
目的是分析骨盆和下肢对骨盆入射角（PI）与腰椎前凸（LL）不匹配患者矢状面脊柱排列不齐的代偿作用。测量了一系列参数，包括PI、LL、PI-LL、胸椎后凸（TK）、骨盆倾斜（PT）、骶骨倾斜度（SS）、膝关节屈曲角度（KFA）、胫骨倾斜角度（TOA）、股骨倾斜角度（FOA）、股骨骨盆角度（FPA）和骨盆移位（PS）。根据PT和PS将PI-LL不匹配的患者分为骨盆后倾组和骨盆后移组，然后比较两组之间以及与对照组的参数。与对照组相比，骨盆后倾组和后移组所有变量均有显著差异，但骨盆后倾组的PI、FOA和PS除外。与骨盆后倾组相比，骨盆后移组的PI-LL、PI、PT、KFA、FOA和PS值以及FOA和PS的贡献率显著更高，而LL、TK和FPA值以及PT、TOA和FPA的贡献率更小。PI-LL不匹配较小的患者更多地依赖髋关节伸展来增加骨盆后倾，而PI-LL不匹配较大的患者则倾向于增加额外的股骨倾斜度。在代偿较大的PI-LL不匹配时，髋关节伸展的重要性降低，膝关节和踝关节的作用变得更加重要，分别通过提供更大的股骨倾斜度和相对较小的踝关节背屈来实现。
