髋关节骨关节炎背景下髋关节活动度（ROM）降低的脊柱骨盆代偿机制。
Spinopelvic Compensatory Mechanisms for Reduced Hip Motion (ROM) in the Setting of Hip Osteoarthritis.
作者信息
Buckland Aaron J, Steinmetz Leah, Zhou Peter, Vasquez-Montes Dennis, Kingery Matthew, Stekas Nicholas D, Ayres Ethan W, Varlotta Christopher G, Lafage Virginie, Lafage Renaud, Errico Thomas, Passias Peter G, Protopsaltis Themistocles S, Vigdorchik Jonathan
机构信息
Department of Orthopaedics, NYU Langone Orthopedic Hospital, 301 East 17th St, New York, NY 10003, USA.
Department of Orthopaedics, NYU Langone Orthopedic Hospital, 301 East 17th St, New York, NY 10003, USA.
出版信息
Spine Deform. 2019 Nov;7(6):923-928. doi: 10.1016/j.jspd.2019.03.007.
STUDY DESIGN
Retrospective review from a single institution.
OBJECTIVE
To investigate the effect of hip osteoarthritis (OA) on spinopelvic compensatory mechanisms as a result of reduced hip range of motion (ROM) between sitting and standing.
SUMMARY OF BACKGROUND DATA
Hip OA results in reduced hip ROM and contracture, causing pain during postural changes. Hip flexion contracture is known to reduce the ability to compensate for spinal deformity while standing; however, the effects of postural spinal alignment change between sitting and standing is not well understood.
METHODS
Sit-stand radiographs of patients without prior spinal fusion or hip prosthesis were evaluated. Hip OA was graded by Kellgren-Lawrence grades and divided into low-grade (LOA; grade 0-2) and severe (SOA; grade 3 or 4) groups. Radiographic parameters evaluated were pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), PI-LL, thoracic kyphosis (TK), SVA, T1-pelvic angle (TPA), T10-L2, proximal femoral shaft angle (PFSA), and hip flexion (PT change-PFSA change). Changes in sit-stand parameters were compared between LOA and SOA groups.
RESULTS
548 patients were included (LOA = 311; SOA = 237). After propensity score matching for age, body mass index, and PI, 183 LOA and 183 SOA patients were analyzed. Standing analysis demonstrated that SOA had higher SVA (31.1 vs. 21.7), lower TK (-36.2 vs. -41.1), and larger PFSA (9.1 vs. 7.4) (all p < .05). Sitting analysis demonstrated that SOA had higher PT (29.7 vs. 23.3), higher PI-LL (21.6 vs. 12.4), less LL (31.7 vs. 41.6), less TK (-33.2 vs. -38.6), and greater TPA (27.9 vs. 22.5) (all p < .05). SOA had less hip ROM from standing to sitting versus LOA (71.5 vs. 81.6) (p < .05). Therefore, SOA had more change in PT (15.2 vs. 7.3), PI-LL (20.6 vs. 13.7), LL (-21.4 vs. -13.1), and T10-L2 (-4.9 vs. -1.1) (all p < .001), allowing the femurs to change position despite reduced hip ROM. SOA had greater TPA reduction (15.1 vs. 9.6) and less PFSA change (86.7 vs. 88.8) compared with LOA (both p < .001).
CONCLUSIONS
Spinopelvic compensatory mechanisms are adapted for reduced hip joint motion associated with hip OA in standing and sitting.
LEVEL OF EVIDENCE
Level III.
研究设计
来自单一机构的回顾性研究。
目的
探讨髋骨关节炎（OA）因坐立位之间髋关节活动度（ROM）降低对脊柱骨盆代偿机制的影响。
背景数据总结
髋OA导致髋关节ROM降低和挛缩，在姿势改变时引起疼痛。已知髋屈曲挛缩会降低站立时补偿脊柱畸形的能力；然而，坐立位之间姿势性脊柱排列变化的影响尚不清楚。
方法
对无既往脊柱融合或髋关节假体的患者的坐立位X线片进行评估。髋OA根据Kellgren-Lawrence分级进行分级，分为低度（LOA；0-2级）和重度（SOA；3或4级）组。评估的影像学参数包括骨盆入射角（PI）、骨盆倾斜度（PT）、腰椎前凸（LL）、PI-LL、胸椎后凸（TK）、矢状面垂直轴（SVA）、T1-骨盆角（TPA）、T10-L2、股骨近端骨干角（PFSA）和髋关节屈曲（PT变化-PFSA变化）。比较LOA组和SOA组坐立位参数的变化。
结果
纳入548例患者（LOA = 311；SOA = 237）。在对年龄、体重指数和PI进行倾向评分匹配后，分析了183例LOA患者和183例SOA患者。站立位分析显示，SOA的SVA更高（31.1对21.7），TK更低（-36.2对-41.1），PFSA更大（9.1对7.4）（均p <.05）。坐位分析显示，SOA的PT更高（29.7对23.3），PI-LL更高（21.6对12.4），LL更低（31.7对41.6），TK更低（-33.2对-38.6），TPA更大（27.9对22.5）（均p <.05）。与LOA相比，SOA从站立到坐位的髋关节ROM更小（71.5对81.6）（p <.05）。因此，SOA的PT变化更大（15.2对7.3），PI-LL变化更大（20.6对13.7），LL变化更大（-21.4对-13.1），T10-L2变化更大（-4.9对-1.1）（均p <.001），尽管髋关节ROM降低，但仍能使股骨改变位置。与LOA相比，SOA的TPA降低更大（15.1对9.6），PFSA变化更小（86.7对88.8）（均p <.001）。
结论
脊柱骨盆代偿机制适应于与髋OA相关的站立位和坐位时髋关节活动度降低。
证据水平
III级。
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