Fukushima Kensuke, Miyagi Masayuki, Inoue Gen, Shirasawa Eiki, Uchiyama Katsufumi, Takahira Naonobu, Takaso Masashi
Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
Arch Orthop Trauma Surg. 2018 Nov;138(11):1495-1499. doi: 10.1007/s00402-018-2992-z. Epub 2018 Jul 3.
The significance of the relationship between the spine and hip joints has been frequently discussed. However, the relationship between acetabular coverage and spinal sagittal alignment has not been fully elucidated as previous studies did not adequately control for factors that might affect the spinopelvic alignment. The aim of this study was to elucidate the impact of acetabular coverage on spinal sagittal alignment by comparing patient groups matched on sex, age, and the presence of hip and anterior impingement pain.
We prospectively enrolled 30 women undergoing periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH) and 30 women undergoing hip arthroscopic surgery (HAS) for labral tears. The lateral centre edge angle was measured on hip radiographs. In addition, the sagittal vertical axis, pelvic tilt, pelvic incidence, sacral slope (SS), and lumbar lordosis (LL) were measured on preoperative plain radiographs of the whole spine to assess the sagittal spinal alignment. Clinical and radiologic data were compared between the two groups (PAO vs. HAS).
The patient groups did not differ in age and body mass index. The mean SS was significantly greater in the PAO group (41.6° ± 1.6°) than in the HAS group (35.3° ± 1.5°; P = 0.0039). Additionally, the mean LL was significantly greater in the PAO group (54.5° ± 2.0°) than in the HAS group (45.1° ± 1.9°; P = 0.0015).
The SS and LL were greater in patients with DDH than in patients with hip pain, but without DDH. Patients with DDH might show lumbar hyperlordosis to rotate the pelvis anteriorly, increasing the anterosuperior acetabular coverage.
脊柱与髋关节之间关系的重要性已被频繁讨论。然而，髋臼覆盖与脊柱矢状位对线之间的关系尚未完全阐明，因为先前的研究没有充分控制可能影响脊柱骨盆对线的因素。本研究的目的是通过比较在性别、年龄以及是否存在髋关节和前方撞击痛方面相匹配的患者组，来阐明髋臼覆盖对脊柱矢状位对线的影响。
我们前瞻性纳入了30例因发育性髋关节发育不良（DDH）接受髋臼周围截骨术（PAO）的女性和30例因盂唇撕裂接受髋关节镜手术（HAS）的女性。在髋关节X线片上测量外侧中心边缘角。此外，在全脊柱术前平片上测量矢状垂直轴、骨盆倾斜度、骨盆入射角、骶骨倾斜度（SS）和腰椎前凸（LL），以评估脊柱矢状位对线。比较两组（PAO组与HAS组）的临床和放射学数据。
两组患者在年龄和体重指数方面无差异。PAO组的平均SS（41.6°±1.6°）显著高于HAS组（35.3°±1.5°；P = 0.0039）。此外，PAO组的平均LL（54.5°±2.0°）显著高于HAS组（45.1°±1.9°；P = 0.0015）。
DDH患者的SS和LL大于无DDH但有髋关节疼痛的患者。DDH患者可能表现出腰椎前凸增加，以使骨盆向前旋转，从而增加髋臼前上覆盖。
