Kobayashi Naomi, Higashihira Shota, Kitayama Haruna, Kamono Emi, Yukizawa Yohei, Oishi Takayuki, Takagawa Shu, Honda Hideki, Choe Hyonmin, Inaba Yutaka
Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan.
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
Orthop J Sports Med. 2021 Apr 20;9(4):2325967121999464. doi: 10.1177/2325967121999464. eCollection 2021 Apr.
The influence of pelvic tilt mobility, which can be reproduced in computer-simulation models, is an important subject to be addressed in the understanding of femoroacetabular impingement (FAI) pathophysiology.
To use computer-simulation models of FAI cases to evaluate the optimum improvement in hip range of motion (ROM) achieved by decreasing the anterior pelvic tilt and compare the results with the improvement in ROM achieved after cam resection surgery.
Controlled laboratory study.
The pre- and postoperative computed tomography (CT) images from 28 patients with FAI treated with arthroscopic cam resection were evaluated. Using a dynamic computer-simulation program, 3-dimensional models with a 5° and a 10° decrease in anterior pelvic tilt from the supine functional pelvic plane (baseline) were created from the preoperative CT scans. Similar models were constructed for hips before (at baseline) and after cam resection. Improvements from baseline in maximum internal rotation at 45°, 70°, and 90° of flexion were assessed for the 5° change in pelvic tilt, 10° change in pelvic tilt, and cam resection models, and the results were compared for all conditions.
The combination of a 10° change in pelvic tilt and cam resection showed the largest ROM improvement from baseline ( < .001). Improvement in internal rotation in the cam resection model was significantly higher compared with the 5° pelvic tilt change model ( < .001), while there was no significant difference between the cam resection model and the 10° pelvic tilt change model.
Decreasing anterior pelvic tilt by 10° in the preoperative computer simulation model resulted in an equivalent effect to cam resection, while a 5° change in pelvic tilt was inferior to cam resection in terms of ROM improvement.
Enough of a decrease in anterior pelvic tilt may contribute to ROM improvement that is as effective as that of cam resection surgery.
骨盆倾斜活动度的影响可在计算机模拟模型中再现，是理解股骨髋臼撞击症（FAI）病理生理学时需要探讨的重要课题。
利用FAI病例的计算机模拟模型，评估通过减少骨盆前倾实现的髋关节活动度（ROM）的最佳改善情况，并将结果与凸轮切除术术后ROM的改善情况进行比较。
对照实验室研究。
评估28例行关节镜下凸轮切除术治疗的FAI患者术前和术后的计算机断层扫描（CT）图像。使用动态计算机模拟程序，根据术前CT扫描创建前骨盆倾斜度比仰卧位功能骨盆平面（基线）降低5°和10°的三维模型。为凸轮切除术前（基线时）和术后的髋关节构建类似模型。评估骨盆倾斜度改变5°、骨盆倾斜度改变10°和凸轮切除模型在45°、70°和90°屈曲时最大内旋角度相对于基线的改善情况，并比较所有情况下的结果。
骨盆倾斜度改变10°与凸轮切除相结合显示出相对于基线的最大ROM改善（P <.001）。凸轮切除模型的内旋改善明显高于骨盆倾斜度改变5°的模型（P <.001），而凸轮切除模型与骨盆倾斜度改变10°的模型之间无显著差异。
术前计算机模拟模型中骨盆前倾减少10°产生的效果与凸轮切除术相当，而骨盆倾斜度改变5°在ROM改善方面不如凸轮切除术。
足够程度的骨盆前倾减少可能有助于实现与凸轮切除手术同样有效的ROM改善。
