Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon.
Bordeaux University Hospital, Bordeaux, France.
Eur Spine J. 2020 Aug;29(8):2010-2017. doi: 10.1007/s00586-020-06397-5. Epub 2020 Apr 3.
To evaluate the 3D deformity of the acetabula and lower limbs in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with spino-pelvic alignment.
Two hundred and seventy-four subjects with AIS (frontal Cobb: 33.5° ± 18° [10°-110°]) and 84 controls were enrolled. All subjects underwent full-body biplanar X-rays with subsequent 3D reconstructions. Classic spino-pelvic and lower limb parameters were collected as well as acetabular parameters: acetabular orientation in the 3 planes (tilt, anteversion and abduction), center-edge angle (CEA) and anterior and posterior sector angles. Subjects with AIS were represented by both lower limb sides and classified by elevated (ES) or lowered (LS), depending on the frontal pelvic obliquity. Parameters were then compared between groups. Determinants of acetabular and lower limb alterations were investigated among spino-pelvic parameters.
Acetabular abduction was higher on the ES in AIS (59.2° ± 6°) when compared to both LS (55.6° ± 6°) and controls (57.5° ± 3.9°, p < 0.001). CEA and acetabular anteversion were higher on the LS in AIS (32° ± 6.1°, 20.5° ± 5.7°) when compared to both ES (28.7° ± 5.1°, 19.8° ± 5.1°) and controls (29.8° ± 4.8°, 19.1° ± 4°, respectively, p < 0.001). Anterior sector angle was lower on both ES and LS in AIS when compared to controls. CEA, acetabular abduction and acetabular anteversion were found to be mostly determined (adjusted R: 0.08-0.32) by pelvic tilt and less by frontal pelvic obliquity, frontal Cobb and T1T12.
Subjects with AIS had a more abducted acetabulum at the lowered side, more anteverted acetabulum and a lack of anterior coverage of both acetabula. These alterations were strongly related to pelvic tilt.
评估青少年特发性脊柱侧凸（AIS）患者髋臼和下肢的三维畸形及其与脊柱骨盆矢状面的关系。
共纳入 274 例 AIS 患者（前凸 Cobb 角：33.5°±18°[10°-110°]）和 84 例对照组。所有患者均行全身双平面 X 线片检查，并进行三维重建。收集了经典的脊柱骨盆和下肢参数，以及髋臼参数：髋臼在 3 个平面上的方位（倾斜度、前倾角和外展角）、中心边缘角（CEA）以及前、后扇区角。AIS 患者以双侧下肢为代表，根据骨盆前倾斜度分为抬高（ES）或降低（LS）侧。然后比较组间参数。在脊柱骨盆参数中研究髋臼和下肢改变的决定因素。
与 LS（55.6°±6°）和对照组（57.5°±3.9°）相比，AIS 中 ES 侧髋臼外展角更高（59.2°±6°，p<0.001）。与 ES（28.7°±5.1°，19.8°±5.1°）和对照组（29.8°±4.8°，19.1°±4°）相比，AIS 中 LS 侧 CEA 和髋臼前倾角更高（分别为 32°±6.1°和 20.5°±5.7°，p<0.001）。与对照组相比，AIS 中 ES 和 LS 侧的前扇区角均较低。CEA、髋臼外展角和髋臼前倾角主要由骨盆倾斜度决定（调整后的 R：0.08-0.32），其次是骨盆前倾斜度、前凸 Cobb 角和 T1T12。
AIS 患者在降低侧髋臼更外展，髋臼更前倾，且髋臼前覆盖不足。这些改变与骨盆倾斜密切相关。
