Division of Spine Surgery, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York.
Department of Orthopaedic Surgery, Ascension Providence Hospital, Detroit, Michigan.
J Arthroplasty. 2020 Aug;35(8):2124-2130. doi: 10.1016/j.arth.2020.03.035. Epub 2020 Mar 27.
The purpose of this study is to determine whether simulated radiographs in the "flexed-seated" or "step-up" positions better demonstrate a patient's range of spinopelvic motion between standing and sitting positions than relaxed sitting and standing radiographs.
An institutional review board approved cohort of 43 patients with hip osteoarthritis whom underwent full body sitting-standing radiographs from August 2016 to December 2017 at a single institution was reviewed. Subjects underwent single-leg step-up standing and flexed-seated radiographs, and relaxed standing and sitting radiographs. Sacral slope, spinopelvic tilt (SPT), and lumbar lordosis were measured in all radiographs. Alignment parameters were compared between both sets of imaging, and the change in SPT between the imaging modalities was plotted and stratified by pre-existing lumbar pathology.
There were significant differences between the relaxed standing and step-up radiographs and the relaxed and flexed-seated radiographs for sacral slope, SPT, and lumbar lordosis (P < .002 for all), with the exception of SPT in the relaxed and step-up standing postures (P = .110). When transitioning from the standing to sitting position, the mean changes in SPT differed significantly between both sets of radiographs. Most importantly, when plotting changes in SPT between flexed and relaxed sitting postures, patients with fusions and flatback deformity trended toward greater anterior pelvic tilting, a position of greater risk of posterior dislocation.
Flexed sitting and single-leg standing imaging may emphasize the compensatory mechanisms of patients with concomitant hip and spine pathology more than relaxed imaging using our measurements. Our method may provide insight into high dislocation risk patients compared to the previously published hip measurement method.
III.
本研究的目的是确定在“弯曲坐姿”或“台阶站立”位模拟的 X 光片是否比放松坐姿和站立位 X 光片更能显示患者在站立位和坐姿之间的脊柱骨盆运动范围。
回顾了 2016 年 8 月至 2017 年 12 月在一家机构接受全身体位站立-坐姿 X 光片的 43 例髋关节炎患者的机构审查委员会批准的队列。患者接受单腿台阶站立和弯曲坐姿 X 光片以及放松站立和坐姿 X 光片。所有 X 光片均测量骶骨倾斜度、脊柱骨盆倾斜角（SPT）和腰椎前凸角。比较了两种成像方式的体位参数，绘制了 SPT 在不同成像方式之间的变化，并根据预先存在的腰椎病变进行分层。
放松站立和台阶站立位 X 光片与放松和弯曲坐姿 X 光片的骶骨倾斜度、SPT 和腰椎前凸角存在显著差异（所有 P<0.002），除了放松和台阶站立位 SPT（P=0.110）。从站立位过渡到坐位时，两种 X 光片之间 SPT 的平均变化有显著差异。最重要的是，当比较弯曲和放松坐姿之间 SPT 的变化时，融合和扁平背畸形的患者趋向于更大的骨盆前倾，这种姿势存在更大的后脱位风险。
与使用我们的测量方法的放松成像相比，弯曲坐姿和单腿站立成像可能更能强调同时存在髋关节和脊柱病变患者的代偿机制。与之前发表的髋关节测量方法相比，我们的方法可能为高脱位风险患者提供更多的信息。
III 级。
