Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY.
Colorado Joint Replacement, Denver, CO.
J Arthroplasty. 2020 Jun;35(6S):S252-S254. doi: 10.1016/j.arth.2020.01.031. Epub 2020 Jan 22.
Total hip arthroplasty (THA) patients with limited lumbar flexion (LF) have increased rates of dislocation. An instrumented spinal fusion is a well-recognized cause whose risk increases with increasing number of levels fused. However, many patients without an instrumented fusion (IF) also exhibit abnormal spinopelvic mobility. The purpose of this study was to understand the proportion of THA patients without an IF that have a stiff spine (SS) and behave as if they are surgically fused.
A retrospective analysis was performed on 6340 primary THA patients, all of whom had preoperative spinopelvic measurements. Any IF of the lumbar spine was observed on the lateral standing radiograph and recorded. SS was classified by LF ≤ 20°, and the percentage of patients with an IF and limited LF was determined.
Three hundred fifty-six (6%) patients had a SS, and only 67 (19%) had an IF. Of the entire 6340 patients, 207 (3%) had an IF. Of these 207, only 67 (32%) had a SS.
The vast majority (81%) of THA patients with a SS do not have an IF. We recommend preoperative spinopelvic assessment of all patients undergoing THA, as only a minority of those with limited LF have an IF and may otherwise be overlooked. Lumbar degenerative disc disease is common in THA patients, limits the available LF in the same way an IF might and potentially increases the risk of dislocation in this subset of patients.
III.
全髋关节置换术（THA）患者腰椎前屈受限（LF）会增加脱位率。脊柱融合术是一种公认的原因，其风险随着融合节段的增加而增加。然而，许多没有进行器械融合（IF）的患者也表现出异常的脊柱骨盆活动度。本研究的目的是了解没有 IF 的 THA 患者中僵硬脊柱（SS）的比例，以及他们的行为表现是否类似于接受过手术融合的患者。
对 6340 例初次 THA 患者进行回顾性分析，所有患者均行术前脊柱骨盆测量。观察侧位站立位 X 线片上的任何腰椎 IF，并记录下来。SS 根据 LF≤20°进行分类，并确定有 IF 和 LF 受限的患者比例。
356 例（6%）患者存在 SS，仅有 67 例（19%）存在 IF。在 6340 例患者中，有 207 例（3%）存在 IF。在这 207 例患者中，仅有 67 例（32%）存在 SS。
绝大多数（81%）存在 SS 的 THA 患者没有 IF。我们建议对所有接受 THA 的患者进行术前脊柱骨盆评估，因为只有少数 LF 受限的患者存在 IF，否则可能会被忽视。腰椎退行性椎间盘疾病在 THA 患者中很常见，其对 LF 的限制与 IF 相同，并且可能会增加这部分患者的脱位风险。
III。
