Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.
Melbourne Orthopaedic Group, Melbourne, Australia.
J Arthroplasty. 2019 Nov;34(11):2663-2668. doi: 10.1016/j.arth.2019.06.036. Epub 2019 Jun 22.
Recent research has demonstrated that patients with reduced pelvic mobility from standing to sitting have higher rates of dislocation after total hip arthroplasty (THA). This study evaluates the effect of sagittal spinal deformity, defined by pelvic incidence-lumbar lordosis mismatch (PI-LL), on postural changes in pelvic tilt (PT).
A multicenter database of 1100 preoperative THA patients was queried. Anterior-pelvic-plane tilt (APPt), spinopelvic tilt (SPT), and LL were measured from radiographs of patients in supine, standing, flexed-seated, and stepping-up postures; PI was measured from computed tomography. Patients were separated into 3 groups based on PI-LL (<-10°, -10° to 10°, >10°) and propensity-score matched by PI. Lumbar flatback-deformity was defined as PI-LL > 10°, hyperlordosis: PI-LL < -10°. SPT/APPt, including changes between each posture were compared across PI-LL groups using analysis of variance, with post-hoc Tukey tests. Pearson correlations were reported when testing associations between SPT/APPt change and PI-LL.
After propensity-score matching, 288 patients were analyzed (mean 65 y; 49% F). SPT and APPt change differed across all PI-LL categories from standing to seated, supine, and stepping-up with less SPT/APPt recruitment among hyperlordotic vs flatback patients (all P < .001). Greater PI-LL correlated with greater SPT recruitment from standing to seated (R = 0.294), supine (R = 0.292), and stepping-up (R = 0.207) (all P < .001). Smaller LL changes from standing to seated were associated with greater SPT recruitment (R = 0.372, P < .001).
Postural changes in SPT/APPt are associated with spinopelvic measures in THA candidates. Hyperlordotic patients tend to utilize their spines more compared with flatback patients who were more likely to recruit PT. Increased focus on patients with lumbar flatback and hyperlordosis may help in reducing prosthetic dislocation prevalence following THA.
最近的研究表明，从站立到坐下时骨盆活动度降低的患者在全髋关节置换术后（THA）脱位率更高。本研究评估了由骨盆入射角-腰椎前凸不匹配（PI-LL）定义的矢状位脊柱畸形对骨盆倾斜（PT）姿势变化的影响。
对 1100 例术前 THA 患者的多中心数据库进行了查询。从仰卧位、站立位、屈髋坐立位和跨步站立位的患者 X 线片上测量了骨盆前平面倾斜（APPt）、脊柱骨盆倾斜（SPT）和 LL；从 CT 测量了 PI。根据 PI-LL（<-10°、-10°至 10°、>10°）将患者分为 3 组，并按 PI 进行倾向评分匹配。腰椎后凸畸形定义为 PI-LL > 10°，过度前凸：PI-LL < -10°。使用方差分析比较了 PI-LL 组之间的 SPT/APPt 变化，包括每个姿势之间的变化，并进行了事后 Tukey 检验。当测试 SPT/APPt 变化与 PI-LL 之间的关联时，报告了 Pearson 相关性。
进行倾向评分匹配后，分析了 288 例患者（平均 65 岁；49%为女性）。从站立位到坐位、仰卧位和跨步站立位，所有 PI-LL 类别之间的 SPT 和 APPt 变化均不同，与后凸患者相比，过度前凸患者的 SPT/APPt 募集减少（均 P <.001）。PI-LL 越大，从站立位到坐位时 SPT 的募集越大（R = 0.294），仰卧位（R = 0.292）和跨步站立位（R = 0.207）（均 P <.001）。从站立位到坐位时 LL 变化较小与 SPT 募集增加相关（R = 0.372，P <.001）。
THA 候选者的 SPT/APPt 姿势变化与脊柱骨盆测量值相关。与后凸患者相比，过度前凸患者的 SPT 募集更多，而后凸患者更倾向于募集 PT。更多关注腰椎后凸和过度前凸患者可能有助于降低 THA 后假体脱位的发生率。
