Watanabe Shintaro, Choe Hyonmin, Kobayashi Naomi, Ike Hiroyuki, Kobayashi Daigo, Inaba Yutaka
Department of Orthopedic Surgery, 13155Yokohama City University, Yokohama City, Kanagawa, Japan.
Department of Orthopedic Surgery, 13155Yokohama City University Medical Center, Yokohama City, Kanagawa, Japan.
J Orthop Surg (Hong Kong). 2021 May-Aug;29(2):23094990211019099. doi: 10.1177/23094990211019099.
Dislocation is a major complication after total hip arthroplasty (THA), and pelvic stiffness is reportedly a significant risk factor for dislocation. This study aimed to investigate spinopelvic alignment, and identify preoperative factors associated with postoperative pelvic mobility.
We enrolled 78 THA patients with unilateral osteoarthritis. The sagittal spinopelvic alignment in the standing and sitting position was measured using an EOS imaging system before and 3 months after THA. We evaluated postoperative pelvic mobility, and defined cases with less than 10° of sacral slope change as pelvic stiff type. The preoperative characteristics of those with postoperative stiff type, and preoperative factors associated with risk of postoperative stiff type were evaluated.
Sagittal spinopelvic alignment except for lumbar alignment were significantly changed after THA.A total of 13 patients (17%) were identified as postoperative pelvic stiff type. Preoperative lower pelvic and lumbar mobility were determined as significant factors for prediction of postoperative pelvic stiff type. Among these patients, nine patients (69%) did not have pelvic stiffness before THA. Preoperative factor associated with the risk of postoperative pelvic stiff type in those without preoperative stiffness was lower lumbar lordosis in standing position by multivariate regression analysis.
Spinopelvic alignments except lumber alignment was significantly changed after THA. The lower pelvic mobility and lumbar alignment were identified as the preoperative predictive factors for postoperative pelvic mobility. Evaluation of preoperative lumbar alignment may be especially useful for the prediction in patients with hip contractures, for these patients may possibly experience the extensive perioperative change in pelvic mobility.
脱位是全髋关节置换术（THA）后的主要并发症，据报道骨盆僵硬是脱位的重要危险因素。本研究旨在调查脊柱骨盆对线情况，并确定与术后骨盆活动度相关的术前因素。
我们纳入了78例单侧骨关节炎的THA患者。使用EOS成像系统在THA术前和术后3个月测量站立位和坐位时的矢状面脊柱骨盆对线情况。我们评估了术后骨盆活动度，并将骶骨倾斜度变化小于10°的病例定义为骨盆僵硬型。评估了术后僵硬型患者的术前特征以及与术后僵硬型风险相关的术前因素。
THA术后除腰椎对线外，矢状面脊柱骨盆对线均有显著变化。共有13例患者（17%）被确定为术后骨盆僵硬型。术前骨盆下部和腰椎活动度被确定为预测术后骨盆僵硬型的重要因素。在这些患者中，9例患者（69%）在THA术前没有骨盆僵硬。多因素回归分析显示，术前无僵硬的患者中，与术后骨盆僵硬型风险相关的术前因素是站立位时腰椎前凸较小。
THA术后除腰椎对线外，脊柱骨盆对线均有显著变化。骨盆下部活动度和腰椎对线被确定为术后骨盆活动度的术前预测因素。术前评估腰椎对线对于预测髋关节挛缩患者可能特别有用，因为这些患者在围手术期可能会经历骨盆活动度的广泛变化。
