Medical School of Chinese PLA, Beijing, China.
Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.
Orthop Surg. 2022 May;14(5):919-926. doi: 10.1111/os.13275. Epub 2022 Apr 21.
To explore and analyze the change of pelvic sagittal tilt (PST) after total hip arthroplasty (THA) in patients with bilateral Crowe type IV developmental dysplasia of the hip (DDH).
The study retrospectively evaluated 43 patients with bilateral Crowe type IV DDH undergoing THA from January 2008 to June 2019 who were followed up for 12 months postoperatively. Four parameters, including the ratio between the height and width of the obturator foramina(H/W ratio), the vertical distance between the upper edge of the symphysis and the middle of the sacrococcygeal joint (SSc distance), the vertical distance between the upper edge of the symphysis and the line connecting bilateral hip centers (SC distance) and the vertical distance between the upper edge of the symphysis and the line connecting the bilateral lower ends of the sacroiliac joints (SSi distance), which could indirectly reflect the change of PST, were observed and measured by radiographs. The change of each parameter before operation, immediately after operation, and in 3, 6 and 12 months postoperatively was compared and analyzed.
Compared with the value before operation, the H/W ratio immediately after operation and in 3, 6 and 12 months postoperatively were 0.61 ± 0.12 (t = 0.893, P = 0.377), 0.61 ± 0.11 (t = 1.622, P = 0.112), 0.67 ± 0.10 (t = 5.995, P < 0.001) and 0.76 ± 0.12 (t = -9.313, P < 0.001), respectively, and the SSc, SC and SSi distance in 6 months postoperatively were 30.12 ± 7.06 mm (t = 3.506, P = 0.002), 42.8 ± 7.7 mm (t = 5.843, P < 0.001), 129.3 ± 12.6 mm (t = 5.888, P < 0.001), respectively, and in 12 months postoperatively were 27.24 ± 7.68 mm (t = 6.510, P < 0.001), 36.1 ± 9.1 mm (t = 9.230, P < 0.001), 118.9 ± 14.9 mm (t = 8.940, P < 0.001), respectively. The radiographs obtained in 6 and 12 months postoperatively demonstrated a significantly increased H/W ratio and decreased SSc, SC and SSi distance. At the last follow-up, the clinical evaluations significantly improved in all patients and there were no revisions.
The significant change of pelvic sagittal posterior tilt in patients with bilateral Crowe type IV DDH might be a significant phenomenon after THA, which could occur in 6 months postoperatively.
探讨和分析双侧 Crowe Ⅳ型发育性髋关节发育不良（DDH）患者全髋关节置换术后骨盆矢状倾斜（PST）的变化。
本研究回顾性评估了 2008 年 1 月至 2019 年 6 月期间接受双侧 Crowe Ⅳ型 DDH 全髋关节置换术的 43 例患者，术后随访 12 个月。通过 X 线观察和测量 4 个参数，包括闭孔高宽比（H/W 比）、耻骨联合上缘与骶尾关节中点的垂直距离（SSc 距离）、耻骨联合上缘与双侧髋关节中心连线的垂直距离（SC 距离）和耻骨联合上缘与双侧骶髂关节下端连线的垂直距离（SSi 距离），这些参数可以间接反映 PST 的变化。比较并分析术前、术后即刻、术后 3、6 和 12 个月时各参数的变化。
与术前相比，术后即刻和术后 3、6、12 个月的 H/W 比分别为 0.61±0.12（t=0.893，P=0.377）、0.61±0.11（t=1.622，P=0.112）、0.67±0.10（t=5.995，P<0.001）和 0.76±0.12（t=-9.313，P<0.001），术后 6 个月的 SSc、SC 和 SSi 距离分别为 30.12±7.06mm（t=3.506，P=0.002）、42.8±7.7mm（t=5.843，P<0.001）、129.3±12.6mm（t=5.888，P<0.001），术后 12 个月时分别为 27.24±7.68mm（t=6.510，P<0.001）、36.1±9.1mm（t=9.230，P<0.001）、118.9±14.9mm（t=8.940，P<0.001）。术后 6 个月和 12 个月的 X 线片显示 H/W 比显著增加，SSc、SC 和 SSi 距离显著降低。末次随访时，所有患者的临床评估均显著改善，且无翻修。
双侧 Crowe Ⅳ型 DDH 患者全髋关节置换术后骨盆矢状后倾明显变化可能是一个显著的现象，这种变化可能在术后 6 个月发生。
