Balgrist University Hospital, University of Zurich, Department of Orthopedics, Forchstrasse 340, 8008 Zurich, Switzerland.
Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland.
J Orthop Sci. 2023 Nov;28(6):1353-1358. doi: 10.1016/j.jos.2022.10.002. Epub 2022 Nov 3.
The relationship between anterior pelvic tilt and overall sagittal alignment has been well-described previously. However, the relationship between pelvic tilt, frontal, and axial leg alignment remains unclear. The aim of the study was to analyze the relationship between pelvic tilt and frontal and axial leg alignment in healthy subjects.
Thirty healthy subjects (60 legs) without prior surgery underwent standing biplanar long leg radiograph. Pelvic parameters (pelvic tilt, pelvic incidence, sacral slope), hip-knee-ankle angle (HKA), femoral antetorsion and tibial torsion were measured using SterEOS (EOS Imaging) software. EOS was acquired with the feet directing straight anteriorly, which corresponds to a neutral foot progression angle (FPA). The influence of HKA, femoral antetorsion, tibial torsion and gender on pelvic tilt was analyzed in a univariate correlation and multiple regression model.
Sixteen female subjects and 14 male subjects with a mean age of 27.1 years ± 10 (range 20-67) were included. HKA, femoral antetorsion, and tibial torsion correlated with anterior pelvic tilt in univariate analysis (all p < 0.05). Anterior pelvic tilt increased 1.1° (95% CI: 0.7 to 1.5) per 1° of knee valgus (p < 0.001) and 0.5° (95% CI: 0.3 to 0.7) per 1° of external tibial torsion (p < 0.001). Overall, linear regression model fit explained 39% of variance in pelvic tilt by the HKA, femoral antetorsion and tibial torsion (R = 0.385; p < 0.001).
Valgus alignment and increasing tibial torsion demonstrated a weak correlation with an increase in anterior pelvic tilt in healthy subjects when placing their feet anteriorly. The relationship between frontal, axial leg alignment and pelvic tilt needs to be considered in patients with multiple joint disorders at the hip, knee and spine. Alteration of the frontal, or rotational profile after realignment surgery or by implant positioning might influence the pelvic tilt when the FPA is kept constant.
先前已经充分描述了前骨盆倾斜与整体矢状面排列之间的关系。然而，骨盆倾斜、额状面和轴向腿部排列之间的关系仍不清楚。本研究的目的是分析健康受试者中骨盆倾斜与额状面和轴向腿部排列之间的关系。
30 名无既往手术史的健康受试者（60 条腿）接受站立位双平面长腿 X 线片检查。使用 SterEOS（EOS Imaging）软件测量骨盆参数（骨盆倾斜、骨盆入射角、骶骨倾斜）、髋膝踝角（HKA）、股骨前旋和胫骨扭转。EOS 采集时，足部指向正前方，对应于中立足进路角（FPA）。在单变量相关性和多元回归模型中分析 HKA、股骨前旋、胫骨扭转和性别对骨盆倾斜的影响。
纳入 16 名女性和 14 名男性受试者，平均年龄 27.1 岁±10 岁（范围 20-67 岁）。HKA、股骨前旋和胫骨扭转在单变量分析中与前骨盆倾斜相关（均 p<0.05）。每增加 1°膝外翻，骨盆倾斜增加 1.1°（95%CI：0.7-1.5，p<0.001）；每增加 1°胫骨外旋，骨盆倾斜增加 0.5°（95%CI：0.3-0.7，p<0.001）。总体而言，HKA、股骨前旋和胫骨扭转的线性回归模型拟合解释了骨盆倾斜 39%的方差（R=0.385；p<0.001）。
当健康受试者将足部置于前方时，膝外翻和胫骨扭转增加与前骨盆倾斜增加呈弱相关。在髋关节、膝关节和脊柱多处关节疾病的患者中，需要考虑额状面、轴向腿部排列与骨盆倾斜之间的关系。在保持 FPA 不变的情况下，对线或植入物定位后额状面或旋转轮廓的改变可能会影响骨盆倾斜。
