Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, No. 47, Shangteng Road, Cangshan District, Fuzhou, China.
Fujian University of Traditional Chinese Medicine, Fuzhou, China.
Orthopade. 2021 Aug;50(8):664-673. doi: 10.1007/s00132-021-04069-w. Epub 2021 Feb 12.
Degenerative lumbar spondylolisthesis (DSPL), as opposed to other degenerative spinal conditions, is disregarded in the assessment of hip stability after total hip arthroplasty (THA). This study aimed to determine whether patients with DSPL have different acetabular anteversion compared to patients with normal spine before and following THA.
Preoperative and postoperative 6‑month lateral pelvic radiographs in standing and sitting positions from 91 patients who underwent primary THA were retrospectively compared for spinopelvic parameters between patients with DSPL (n = 31) and with normal spine (n = 34).
Compared to control patients in the standing position, patients with DSPL had significantly increased preoperative pelvic tilt (24° in DSPL vs. 8° in controls; p < 0.01), pelvic-femoral angle (194° in DSPL vs. 174° in controls; p < 0.05), decreased lumbar lordosis (35° in DSPL vs. 43° in controls; p < 0.05), increased postoperative pelvic tilt (22° in DSPL vs. 7° in controls; p < 0.01), pelvic-femoral angle (187° in DSPL vs. 179° in controls; p < 0.05), and acetabular anteversion (31° in DSPL vs. 23° in controls; p < 0.05). Preoperative (p = 0.181) and postoperative (p = 0.201) sitting pelvic tilt did not differ. There were positive correlations between preoperative standing pelvic tilt and postoperative standing acetabular anteversion, pelvic-femoral angle, and combined sagittal index (CSI) in DSPL (R = 0.8416; R = 0.9180; R = 0.9459, respectively, p < 0.01) and in controls (R = 0.6872; R = 0.6176; R = 0.7129, respectively, p < 0.01).
While the imbalance of seated sagittal plane is usually insignificant and compensable, the mechanism by which DSPL patients achieve a standing posture is different from control patients, with more hip extension and posterior tilt of the pelvis. Special attention should be paid to the risk of impingement caused by the increase of acetabular anteversion in the postoperative standing position.
与其他退行性脊柱疾病相反，退变性腰椎滑脱（DSPL）在全髋关节置换术（THA）后髋关节稳定性评估中被忽视。本研究旨在确定 DSPL 患者与脊柱正常患者相比，在 THA 前后髋臼前倾角是否存在差异。
回顾性比较 91 例接受初次 THA 的患者术前和术后 6 个月的站立位和坐位侧骨盆位片的脊柱骨盆参数，其中 31 例为 DSPL 患者，34 例为脊柱正常患者。
与对照组患者相比，DSPL 患者在站立位时骨盆倾斜度明显增加（24° vs. 8°；p<0.01），骨盆股骨角（194° vs. 174°；p<0.05），腰椎前凸减少（35° vs. 43°；p<0.05），术后骨盆倾斜度增加（22° vs. 7°；p<0.01），骨盆股骨角（187° vs. 179°；p<0.05），髋臼前倾角增加（31° vs. 23°；p<0.05）。术前（p=0.181）和术后（p=0.201）坐位骨盆倾斜度无差异。DSPL 患者术前站立位骨盆倾斜度与术后站立位髋臼前倾角、骨盆股骨角和综合矢状指数（CSI）呈正相关（R=0.8416；R=0.9180；R=0.9459，均 p<0.01），对照组患者也呈正相关（R=0.6872；R=0.6176；R=0.7129，均 p<0.01）。
虽然坐姿矢状面失衡通常不明显且可代偿，但 DSPL 患者站立时的机制与对照组患者不同，表现为髋关节伸展增加和骨盆后倾。术后站立位时髋臼前倾角增加导致撞击的风险应引起特别关注。
