Yoshioka Katsuhito, Murakami Hideki, Demura Satoru, Kato Satoshi, Kawashima Hiroki, Sanada Shigeru, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan.
Department of Orthopaedic Surgery, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan.
Spine Surg Relat Res. 2019 Mar 22;3(3):255-260. doi: 10.22603/ssrr.2018-0089. eCollection 2019.
Global spinal balance and its relationship to the pelvis have received much attention, and various formulae have been used to predict postoperative spinopelvic alignment for spinal surgery. However, previous studies had limitations because no consideration was given to the dynamic factor.
Fifteen healthy adults without any lumbar disorder (group A) and 9 L4-spondylolisthesis patients (Group B) volunteered to participate in the study. Sequential images were captured with the subjects in the standing position with maximal forward bending followed by backward bending using a dynamic flat panel detector system. Spinopelvic parameters (LL: lumbar lordosis, SA: sacrofemoral angle, SS: sacral slope, PI: pelvic incidence, DP: distance of the horizontal movement of the pelvis) were evaluated. We also investigated the relationship between LL and SA (lumbar/hip [L/H] ratio) as the spinopelvic rhythm.
In group A, the mean change in LL was 83.2 ± 9.5°; change in SA, 45.4 ± 16.6°; SS, 42.6 ± 8.9°; PI, 43.2 ± 7.7°; DP, 15.7 ± 3.4 cm, and L/H ratio, 3.6 ± 2.7. However, spinopelvic rhythm changed over time, because the change in LL was larger than the change in SA from the middle of the rising motion to the upright position. In group B, the mean change in LL was 50.3 ± 8.0°; SA, 56.9 ± 16.0°; SS, 27.5 ± 13.5°; PI, 47.4 ± 10.4°; DP, 12.7 ± 6.8 cm; and L/H ratio, 1.0 ± 0.5.
When compared with the change in LL, individual differences were largely noted in the change in SA. These results demonstrated that the range of hip joint motion under physiological conditions, unlike anatomical motion, differed substantially between individuals. Therefore, spinopelvic rhythm is dependent on the change in SA.
全球脊柱平衡及其与骨盆的关系备受关注，并且已经使用了各种公式来预测脊柱手术的术后脊柱骨盆对线情况。然而，先前的研究存在局限性，因为没有考虑动态因素。
15名无任何腰椎疾病的健康成年人（A组）和9名L4椎体滑脱患者（B组）自愿参与本研究。使用动态平板探测器系统，在受试者站立位时，先进行最大程度的前屈，然后进行后伸，依次采集图像。评估脊柱骨盆参数（LL：腰椎前凸、SA：骶股角、SS：骶骨斜率、PI：骨盆入射角、DP：骨盆水平移动距离）。我们还研究了作为脊柱骨盆节律的LL与SA之间的关系（腰/髋[L/H]比率）。
在A组中，LL的平均变化为83.2±9.5°；SA的变化为45.4±16.6°；SS为42.6±8.9°；PI为43.2±7.7°；DP为15.7±3.4cm，L/H比率为3.6±2.7。然而，脊柱骨盆节律随时间变化，因为从上升运动的中间位置到直立位，LL的变化大于SA的变化。在B组中，LL的平均变化为50.3±8.0°；SA为56.9±16.0°；SS为27.5±13.5°；PI为47.4±10.4°；DP为12.7±6.8cm；L/H比率为1.0±0.5。
与LL的变化相比，SA的变化存在很大的个体差异。这些结果表明，在生理条件下，髋关节的运动范围与解剖运动不同，个体之间存在显著差异。因此，脊柱骨盆节律取决于SA的变化。
