Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
Arthroscopy. 2019 Apr;35(4):1092-1098. doi: 10.1016/j.arthro.2018.10.147. Epub 2019 Mar 8.
To evaluate postoperative coronal/sagittal spinal plane and spinopelvic parameters in patients undergoing gluteus medius repair and to identify associations between outcomes and the aforementioned spinopelvic variables.
Patients who underwent gluteus medius/minimus repair by a single surgeon between January 20, 2012, and November 25, 2015, were retrospectively identified from a prospectively collected database. Radiographic measurements included Cobb angle, lumbar lordosis, sagittal vertical axis (SVA), pelvic tilt, sacral slope, and pelvic incidence. Patient-reported outcomes (PROs) were obtained at baseline and a minimum of 22 months after surgery. Bivariate correlation determined effects of spinopelvic measurements on PROs. Scoliosis and nonscoliosis groups were compared using independent samples t-test, and multivariate analysis determined whether the preoperative variables affected outcomes.
Thirty-eight (80.9%) of 47 consecutive patients were radiographically evaluated with a scoliosis series. All patients demonstrated significant improvements in all PROs and pain (P < .001 for all), as well as at an average 28.2 ± 7.8 (range, 22-51) months after surgery. There were significant negative relationships between SVA and Hip Outcome Score-Activities of Daily Living (r = -0.405, P = .026) and Hip Outcome Score-Sports Specific (r = -0.492, P = .011) scores. Patients with a positive SVA (>0 cm) had significantly worse patient-reported outcomes than their counterparts with negative (≤0 cm) SVA. Also, patients with positive sagittal plane deformity (SVA >5 cm) had significantly worse HOS-SS than patients without positive sagittal plane deformity (SVA <5 cm) (47.0 ± 35.3, 73.2 ± 24.0; P = .04). Independent sample t-testing for the patients with scoliosis (n = 18) versus no scoliosis (n = 20) demonstrates a significantly worse postoperative International Hip Outcome Tool (short version) score in the patients with scoliosis (77.4 ± 15.1, 53.8 ± 37.1; P = .043).
Patients with scoliosis presented with lower rates of symptom improvement and ability to return to an active lifestyle in patients with hip disorders. In addition, patients with positive sagittal plane deformity experienced lower hip-related sport-specific outcome scores. Although the direct relationship between the spine and the hip in patients after gluteus medius/minimus repair remains unclear, this study shows an association between these postoperative outcomes and spinopelvic parameters.
Level IV, case series.
评估臀中肌修复术后患者的冠状/矢状脊柱平面和骨盆矢状参数，并确定这些结果与上述骨盆矢状参数之间的关系。
从 2012 年 1 月 20 日至 2015 年 11 月 25 日期间接受单一外科医生臀中肌/小肌修复术的患者中，从前瞻性收集的数据库中回顾性确定患者。影像学测量包括 Cobb 角、腰椎前凸、矢状垂直轴（SVA）、骨盆倾斜、骶骨倾斜和骨盆入射角。在基线和术后至少 22 个月时获得患者报告的结果（PRO）。双变量相关确定了骨盆矢状参数对 PRO 的影响。使用独立样本 t 检验比较脊柱侧凸组和非脊柱侧凸组，多元分析确定术前变量是否影响结果。
47 例连续患者中有 38 例（80.9%）进行了脊柱侧凸系列的影像学评估。所有患者的所有 PRO 和疼痛均有显著改善（所有 P <.001），平均在术后 28.2 ± 7.8（范围为 22-51）个月。SVA 与髋关节评分-日常活动（r = -0.405，P =.026）和髋关节评分-专项运动（r = -0.492，P =.011）评分之间存在显著的负相关。SVA 为正（>0cm）的患者的患者报告结果明显比 SVA 为负（≤0cm）的患者差。此外，SVA 为正（>5cm）的患者的髋关节特定结局评分（HOS-SS）明显低于 SVA 为正（<5cm）的患者（47.0 ± 35.3，73.2 ± 24.0；P =.04）。对脊柱侧凸（n = 18）与无脊柱侧凸（n = 20）患者的独立样本 t 检验表明，脊柱侧凸患者的国际髋关节结果工具（短版）评分术后明显更差（77.4 ± 15.1，53.8 ± 37.1；P =.043）。
患有脊柱侧凸的患者在患有髋关节疾病的患者中，症状改善率和恢复积极生活方式的能力较低。此外，SVA 为正的患者的髋关节相关专项运动结局评分较低。尽管臀中肌/小肌修复术后患者脊柱与髋关节之间的直接关系仍不清楚，但本研究显示了这些术后结果与骨盆矢状参数之间的关联。
IV 级，病例系列。
