Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaa, Suita, Osaka, 565-0871, Japan.
J Orthop Res. 2020 Mar;38(3):578-587. doi: 10.1002/jor.24484. Epub 2019 Oct 9.
Pelvic sagittal inclination (PSI) significantly affects the femoral head coverage by the acetabulum in patients with developmental dysplasia of the hip (DDH), while no reports have quantified PSI in DDH patients in the supine and standing positions. Furthermore, little is known about how PSI changes after periacetabular osteotomies. Herein, PSI in the supine and standing positions was quantified in DDH patients preoperatively and postoperatively. Twenty-five patients with DDH who had undergone periacetabular osteotomies were analyzed. The preoperative PSI and the PSI 2 years after surgery were measured in the supine and standing positions using the image registration technique between radiographs and computed tomographic images. The percentage of patients who showed PSI changes of more than 10° from the supine to the standing position was quantified. PSI changed 8.2 ± 5.0° posteriorly from the supine to the standing position during the preoperative period. Posterior pelvic tilt of more than 10° was found in nine cases (36%). Two years after periacetabular osteotomies, the postural PSI change was 7.1 ± 3.9° posteriorly. When the preoperative and postoperative PSI values were compared, PSI in the standing position did not differ (p = 0.20). Similarly, the amount of PSI change from the supine to standing position was not significantly different (p = 0.26). In conclusion, posterior pelvic tilt in the standing position was found preoperatively in symptomatic DDH patients, and it remained for 2 years after periacetabular osteotomies. This postural change in PSI does not seem to influence the outcome of periacetabular osteotomy. However, during preoperative planning, surgeons should recognize that acetabular anteversion or anterior acetabular coverage differs between the supine and standing positions in some patients with DDH. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:578-587, 2020.
骨盆矢状倾斜度（PSI）在发育性髋关节发育不良（DDH）患者中显著影响股骨头对髋臼的覆盖，而目前尚无报道对仰卧位和站立位 DDH 患者的 PSI 进行定量评估。此外，对于髋臼周围截骨术后 PSI 的变化知之甚少。本文旨在定量评估 DDH 患者术前和术后仰卧位和站立位的 PSI。分析了 25 例行髋臼周围截骨术的 DDH 患者。使用 X 线片和 CT 图像之间的图像配准技术，测量了患者术前和术后 2 年仰卧位和站立位的 PSI。定量评估了仰卧位到站立位 PSI 变化超过 10°的患者比例。术前，仰卧位到站立位 PSI 向后变化 8.2±5.0°。9 例（36%）患者出现超过 10°的骨盆后倾。髋臼周围截骨术后 2 年，站立位后向 PSI 变化 7.1±3.9°。与术前相比，站立位 PSI 无差异（p=0.20）。同样，仰卧位到站立位 PSI 变化量也无显著差异（p=0.26）。综上所述，术前有症状的 DDH 患者存在站立位骨盆后倾，髋臼周围截骨术后 2 年仍存在。这种 PSI 的体位变化似乎不会影响髋臼周围截骨术的效果。然而，在术前规划时，外科医生应认识到，在一些 DDH 患者中，仰卧位和站立位时髋臼前倾角或前侧髋臼覆盖度不同。版权所有 © 2019 矫形研究学会。由 Wiley Periodicals, Inc. 出版。J 矫形研究 38:578-587, 2020。
