全髋关节置换术后髋骨关节炎患者腰骶椎的解剖学变化及其与小关节源性腰痛的相关性：一项队列研究

Anatomical changes in lumbosacral vertebrae and their correlation with facet joint-derived low back pain in patients with hip osteoarthritis after total hip arthroplasty: a cohort study.

作者信息

Cao Binhao, Li Xiang, Lu Zhengyu, Liang Jianwei, He Long

机构信息

Department of Orthopedics, Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, China.

出版信息

Ann Transl Med. 2022 Apr;10(7):404. doi: 10.21037/atm-22-999.

DOI:10.21037/atm-22-999

PMID:35530945

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9073784/

Abstract

BACKGROUND

Little is known about the anatomical changes in lumbosacral vertebrae and their correlation with facet joint-derived low back pain in patients with hip osteoarthritis (HOA) after total hip arthroplasty.

METHODS

Seventy-four HOA patients with low back pain who underwent initial total hip arthroplasty were included. Their Harris Hip Score (HHS), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) and anatomical parameters were analyzed. Paired tests were used to compare the various index scores before and after surgery, and independent sample tests were used for the between-group comparisons.

RESULTS

The HHS and ODI significantly changed at 3 and 6 months postoperatively [HHS: preoperative (43.56±4.34) 3 months (80.34±5.23) 6 months (84.37±4.78); ODI: preoperative (36.26±5.34) 3 months (26.44±3.23) 6 months (19.34±3.27); P<0.001]. At the first 3 months after surgery, the VAS low back pain score decreased from 5.24±1.21 to 2.89±1.03 (P<0.001), and the VAS hip pain score decreased from 7.45±1.32 to 2.34±1.12 (P<0.001). There was also a statistically significant difference between the preoperative and 1-month postoperative anatomical indices: lumbar lordosis (LL) increased significantly after surgery [preoperative (43.46°±13.89°) 1 month (48.27°±14.42°), P=0.001], while slip angle (SA) decreased significantly [preoperative (89.20°±5.03°) 1 month (84.45°±4.89°), P=0.010]. Sacral slope (SS) and radial abduction angle (RAA) showed significant postoperative changes compared with preoperative assessments; after surgery, SS increased significantly [preoperative (31.33°±8.23°) 1 month (37.65°±8.19°), P=0.006), while RAA decreased significantly [preoperative (42.32°±8.12°) 1 month (35.45°±7.67°), P=0.021]. Moreover, the increase of LL was both significantly correlated with the decrease of the VAS low back pain (P=0.009) and the VAS hip pain score (P=0.038).

CONCLUSIONS

Total hip arthroplasty was associated with the anatomical changes in lumbosacral vertebrae.

摘要

背景

对于全髋关节置换术后髋骨关节炎（HOA）患者腰骶椎的解剖学变化及其与小关节源性腰痛的相关性知之甚少。

方法

纳入74例因腰痛接受初次全髋关节置换术的HOA患者。分析他们的Harris髋关节评分（HHS）、Oswestry功能障碍指数（ODI）、视觉模拟量表（VAS）和解剖学参数。采用配对检验比较手术前后的各项指标评分，采用独立样本检验进行组间比较。

结果

术后3个月和6个月时，HHS和ODI有显著变化[HHS：术前（43.56±4.34）、3个月（80.34±5.23）、6个月（84.37±4.78）；ODI：术前（36.26±5.34）、3个月（26.44±3.23）、6个月（19.34±3.27）；P<0.001]。术后前3个月，VAS腰痛评分从5.24±1.21降至2.89±1.03（P<0.001），VAS髋部疼痛评分从7.45±1.32降至2.34±1.12（P<0.001）。术前与术后1个月的解剖学指标也存在统计学显著差异：术后腰椎前凸（LL）显著增加[术前（43.46°±13.89°）、1个月（48.27°±14.42°），P=0.001]，而滑脱角（SA）显著减小[术前（89.20°±5.03°）、1个月（84.45°±4.89°），P=0.010]。与术前评估相比，骶骨倾斜度（SS）和径向外展角（RAA）术后有显著变化；术后SS显著增加[术前（31.33°±8.23°）、1个月（37.65°±8.19°），P=0.006]，而RAA显著减小[术前（42.32°±8.12°）、1个月（35.45°±7.67°），P=0.021]。此外，LL的增加与VAS腰痛的降低（P=0.009）和VAS髋部疼痛评分的降低（P=0.038）均显著相关。