Furuhashi Hiroki, Hoshino Hironobu, Shimizu Yuta, Yamato Yu, Hasegawa Tomohiko, Yoshida Go, Banno Tomohiro, Arima Hideyuki, Oe Shin, Ushirozako Hiroki, Ichinose Hatsumi, Matsuyama Yukihiro
Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
Eur J Orthop Surg Traumatol. 2023 Jan;33(1):143-150. doi: 10.1007/s00590-021-03166-y. Epub 2021 Nov 26.
To determine the changes in pelvic inclination in the supine and standing positions after spinal corrective surgery, and to identify the most predictive factor for changes in pelvic inclination with the supine position as the reference plane for total hip arthroplasty.
We retrospectively analysed the data of 124 patients who underwent spinal corrective fusion surgery for adult spinal deformity between 2012 and 2016 at our institution. Spinal parameters were assessed preoperatively and postoperatively using whole spine radiographs in the standing position. The sacral slope (SS) was measured using spine and pelvis computed tomography. Differences between the preoperative and postoperative SS values in each position were calculated as Δsupine SS and Δstanding SS, respectively. We statistically analysed the correlations between Δsupine SS and preoperative spinal parameters to determine the most useful predictor of Δ supine SS.
The mean Δsupine SS of 10.5°(-13°-50°) was significantly smaller than the mean Δstanding SS of 13.2° (-19°-44°) (p = 0.02). Moreover, 21 patients (17%) had Δsupine SS > 20°. The Δsupine SS was correlated with preoperative LL (r = -0.34 p < 0.01), PT (r = 0.42 p < 0.01), and SVA (r = 0.37 p < 0.01). Preoperative supine SS (r = -0.54, p < 0.01) had the highest correlation with Δsupine SS, whereas preoperative standing SS showed no correlation (r = -0.14 p = 0.12).
Preoperative supine SS is the most useful predictive factor for changes in supine pelvic inclination, and low preoperative values should be noted. This information should be considered for the management of patients with hip-spine syndrome.
确定脊柱矫正手术后仰卧位和站立位时骨盆倾斜度的变化，并以仰卧位为全髋关节置换的参考平面，确定骨盆倾斜度变化的最具预测性的因素。
我们回顾性分析了2012年至2016年在我院接受成人脊柱畸形脊柱矫正融合手术的124例患者的数据。术前和术后使用站立位全脊柱X线片评估脊柱参数。使用脊柱和骨盆计算机断层扫描测量骶骨斜率（SS）。每个位置术前和术后SS值的差异分别计算为Δ仰卧位SS和Δ站立位SS。我们对Δ仰卧位SS与术前脊柱参数之间的相关性进行了统计分析，以确定Δ仰卧位SS最有用的预测指标。
平均Δ仰卧位SS为10.5°（-13°至50°），明显小于平均Δ站立位SS的13.2°（-19°至44°）（p = 0.02）。此外，21例患者（17%）的Δ仰卧位SS>20°。Δ仰卧位SS与术前腰椎前凸（LL）（r = -0.34，p < 0.01）、骨盆倾斜角（PT）（r = 0.42，p < 0.01）和矢状面垂直轴（SVA）（r = 0.37，p < 0.01）相关。术前仰卧位SS（r = -0.54，p < 0.01）与Δ仰卧位SS的相关性最高，而术前站立位SS无相关性（r = -0.14，p = 0.12）。
术前仰卧位SS是仰卧位骨盆倾斜度变化最有用的预测因素，术前值较低时应予以注意。对于髋脊柱综合征患者的管理应考虑这一信息。
