Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, Ottawa, Ontario, Canada.
Department of Orthopaedics and Trauma Surgery, University of Heidelberg, Heidelberg, Germany.
Bone Joint J. 2019 Aug;101-B(8):902-909. doi: 10.1302/0301-620X.101B8.BJJ-2019-0106.R1.
This study of patients with osteoarthritis (OA) of the hip aimed to: 1) characterize the contribution of the hip, spinopelvic complex, and lumbar spine when moving from the standing to the sitting position; 2) assess whether abnormal spinopelvic mobility is associated with worse symptoms; and 3) identify whether spinopelvic mobility can be predicted from static anatomical radiological parameters.
A total of 122 patients with end-stage OA of the hip awaiting total hip arthroplasty (THA) were prospectively studied. Patient-reported outcome measures (PROMs; Oxford Hip Score, Oswestry Disability Index, and Veterans RAND 12-Item Health Survey Score) and clinical data were collected. Sagittal spinopelvic mobility was calculated as the change from the standing to sitting position using the lumbar lordosis angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic-femoral angle (PFA), and acetabular anteinclination (AI) from lateral radiographs. The interaction of the different parameters was assessed. PROMs were compared between patients with normal spinopelvic mobility (10° ≤ ∆PT ≤ 30°) or abnormal spinopelvic mobility (stiff: ∆PT < ± 10°; hypermobile: ∆PT > ± 30°). Multiple regression and receiver operating characteristic (ROC) curve analyses were used to test for possible predictors of spinopelvic mobility.
Standing to sitting, the hip flexed by a mean of 57° (sd 17°), the pelvis tilted backwards by a mean of 20° (sd 12°), and the lumbar spine flexed by a mean of 20° (sd 14°); strong correlations were detected. There was no difference in PROMs between patients in the different spinopelvic mobility groups. Maximum hip flexion, standing PT, and standing AI were independent predictors of spinopelvic mobility (R = 0.42). The combined thresholds for standing was PT ≥ 13° and hip flexion ≥ 88° in the clinical examination, and had 90% sensitivity and 63% specificity of predicting spinopelvic stiffness, while SS ≥ 42° had 84% sensitivity and 67% specificity of predicting spinopelvic hypermobility.
The hip, on average, accounts for three-quarters of the standing-to-sitting movement, but there is great variation. Abnormal spinopelvic mobility cannot be screened with PROMs. However, clinical and standing radiological features can predict spinopelvic mobility with good enough accuracy, allowing them to be used as reliable screening tools. Cite this article: 2019;101-B:902-909.
本项针对髋关节骨关节炎（OA）患者的研究旨在：1）描述从站立位到坐位时髋关节、脊柱骨盆复合体和腰椎的贡献；2）评估脊柱骨盆活动度异常是否与更严重的症状相关；3）确定脊柱骨盆活动度是否可以通过静态解剖放射学参数预测。
前瞻性研究了 122 例终末期髋关节 OA 患者，这些患者均等待全髋关节置换术（THA）。收集患者报告的结果测量值（PROMS；牛津髋关节评分、Oswestry 残疾指数和退伍军人 RAND 12 项健康调查评分）和临床数据。通过从侧位 X 射线获取的腰椎前凸角（LL）、骶骨倾斜度（SS）、骨盆倾斜度（PT）、骨盆股骨角（PFA）和髋臼前倾角（AI），计算从站立位到坐位时的矢状面脊柱骨盆活动度。评估了不同参数之间的相互作用。将 PROMS 与脊柱骨盆活动度正常（10°≤∆PT≤30°）或异常（僵硬：∆PT＜±10°；过度活动：∆PT＞±30°）的患者进行比较。使用多元回归和受试者工作特征（ROC）曲线分析来测试脊柱骨盆活动度的可能预测因素。
从站立位到坐位，髋关节平均屈曲 57°（标准差 17°），骨盆向后倾斜平均 20°（标准差 12°），腰椎平均前屈 20°（标准差 14°）；发现这些运动之间具有很强的相关性。在不同脊柱骨盆活动度组的患者中，PROMS 无差异。最大髋关节屈曲、站立位 PT 和站立位 AI 是脊柱骨盆活动度的独立预测因子（R=0.42）。在临床检查中，站立位 PT≥13°和髋关节屈曲≥88°的联合阈值，预测脊柱骨盆僵硬的敏感性为 90%，特异性为 63%，而 SS≥42°预测脊柱骨盆过度活动的敏感性为 84%，特异性为 67%。
髋关节平均占从站立位到坐位运动的四分之三，但存在很大差异。PROMS 无法筛查异常的脊柱骨盆活动度。然而，临床和站立位影像学特征可以很好地预测脊柱骨盆活动度，可作为可靠的筛查工具。
2019；101-B：902-909.
