Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157, Xiwu Road, Xi'an, Shaanxi Province, 710004, People's Republic of China.
Department of Orthopaedics, Chengdu Second People's Hospital, Chengdu, Sichuan Province, 610000, People's Republic of China.
Eur J Med Res. 2022 Aug 27;27(1):160. doi: 10.1186/s40001-022-00786-w.
How the hip dysplasia affects the spinopelvic alignment in developmental dysplasia of the hip (DDH) patients is unclear, but it is an essential part for the management of this disease. This study aimed to investigate the coronal and sagittal spinopelvic alignment and the correlations between the spinopelvic parameters and the extent of hip dysplasia or the low back pain in unilateral DDH patients.
From September 2016 to March 2021, 22 unilateral patients were enrolled in the DDH group with an average age of 43.6 years and 20 recruited healthy volunteers were assigned to the control group with an average age of 41.4 years. The Cobb angle, seventh cervical vertebra plumbline-central sacral vertical line (C7PL-CSVL), third lumbar vertebra inclination angle (L3IA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK) and lumbar lordosis (LL) were measured on the standing anteroposterior and lateral full-length standing spine radiographs. Additionally, the Oswestry Disability Index (ODI) and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were used to assess the degree of low back pain.
Cobb angle (8.68 ± 6.21° vs. 2.31 ± 0.12°), L3IA (4.80 ± 5.47° vs. 0.83 ± 0.51°), C7PL-CSVL (1.65 ± 1.57 cm vs. 0.48 ± 0.33 cm), PT (15.02 ± 9.55° vs. 9.99 ± 2.97°) and TLK (7.69 ± 6.66° vs. 3.54 ± 1.63°) were significantly larger in DDH patients, whereas LL (37.41 ± 17.17° vs. 48.79 ± 7.75°) was significantly smaller (P < 0.05). No correlation was found between significantly different spinopelvic parameters and the extent of dysplasia. Statistical analysis revealed correlations between ODI and Cobb angle (r = 0.59, P < 0.01), PT (r = 0.49, P = 0.02), TK (r = -0.46, P = 0.03) and TLK (r = 0.44, P = 0.04). Correlations between JOABPQE score and the Cobb angle (r = -0.44, P = 0.04), L3IA (r = -0.53, P = 0.01), PT (r = -0.44, P = 0.04), and TK (r = 0.46, P = 0.03) were also observed.
Cobb angle, L3IA, C7PL-CSVL in coronal plane and PT, TLK in sagittal plane increased, while LL decreased in unilateral DDH patients. These significantly different spinopelvic parameters have no correlation with the extent of dysplasia. Changes in coronal and sagittal plane including Cobb angle, L3IA, PT, TK and TLK were associated with the low back pain in the patients with unilateral DDH.
髋关节发育不良（DDH）患者的脊柱骨盆矢状面和冠状面排列情况尚不清楚，但这是该疾病治疗的重要组成部分。本研究旨在探讨单侧 DDH 患者的脊柱骨盆矢状面和冠状面排列情况，以及脊柱骨盆参数与髋关节发育不良程度或下腰痛之间的相关性。
2016 年 9 月至 2021 年 3 月，纳入 22 例单侧 DDH 患者（平均年龄 43.6 岁）为 DDH 组，纳入 20 名健康志愿者（平均年龄 41.4 岁）为对照组。测量站立前后位和全长站立位脊柱侧位片的 Cobb 角、第七颈椎铅垂线-中矢状线（C7PL-CSVL）、第三腰椎倾斜角（L3IA）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、胸椎后凸角（TK）、胸腰椎后凸角（TLK）和腰椎前凸角（LL）。同时，采用 Oswestry 功能障碍指数（ODI）和日本矫形协会腰痛评估问卷（JOABPEQ）评估下腰痛程度。
DDH 患者的 Cobb 角（8.68±6.21° vs. 2.31±0.12°）、L3IA（4.80±5.47° vs. 0.83±0.51°）、C7PL-CSVL（1.65±1.57 cm vs. 0.48±0.33 cm）、PT（15.02±9.55° vs. 9.99±2.97°）和 TLK（7.69±6.66° vs. 3.54±1.63°）明显增大，而 LL（37.41±17.17° vs. 48.79±7.75°）明显减小（P<0.05）。脊柱骨盆参数的显著差异与髋关节发育不良程度无相关性。统计学分析显示，ODI 与 Cobb 角（r=0.59，P<0.01）、PT（r=0.49，P=0.02）、TK（r=-0.46，P=0.03）和 TLK（r=0.44，P=0.04）呈正相关。JOABPEQ 评分与 Cobb 角（r=-0.44，P=0.04）、L3IA（r=-0.53，P=0.01）、PT（r=-0.44，P=0.04）和 TK（r=0.46，P=0.03）呈负相关。
单侧 DDH 患者的 Cobb 角、L3IA、C7PL-CSVL 在冠状面增加，PT、TLK 在矢状面增加，而 LL 在冠状面减少。这些明显不同的脊柱骨盆参数与髋关节发育不良程度无相关性。包括 Cobb 角、L3IA、PT、TK 和 TLK 在内的冠状面和矢状面变化与单侧 DDH 患者的下腰痛有关。
