Szpital Wojewódzki im. Jana Pawła II w Bełchatowie, Oddział Chirurgii Urazowo- Ortopedycznej, Bełchatów, Poland.
Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, 92-213 Lodz, ul. Pomorska 251, Lodz, Poland.
Arch Orthop Trauma Surg. 2024 May;144(5):1945-1953. doi: 10.1007/s00402-024-05241-5. Epub 2024 Mar 30.
The optimal positioning of the hip prosthesis components is influenced by the mobility and balance of the spine. The present study classifies patients with pathology of the spino-pelvic-hip complex, showing possible methods of preventing hip dislocations after arthroplasty.
Hip-Spine Classification helps arthroplasty surgeons to implant components in more patient-specific position.
The group of 100 patients treated with total hip arthroplasty. Antero-posterior (AP) X-rays of the pelvis in a standing position, lateral spine (standing and sitting) and AP of the pelvis (supine after the procedure) were analyzed. We analyzed a change in sacral tilt value when changing from standing to sitting (∆SS), Pelvic Incidence (PI), Lumbar Lordosis (LL) Mismatch, sagittal lumbar pelvic balance (standing position). Patients were classified according to the Hip-Spine Classification. Postoperatively, the inclination and anteversion of the implanted acetabular component were measured.
In our study 1 A was diagnosed in 61% of all cases, 1B in 18%, 2 A in 16%, 2B in 5%. 50 out of 61 (82%) in group 1 A were placed within the Levinnek "safe zone". In 1B, 2 A, 2B, the position of the acetabular component was influenced by both the spinopelvic mobility and sagittal spinal balance. The mean inclination was 43.35° and the anteversion was 17.4°.
Categorizing patients according to Hip-Spine Classification one can identify possible consequences the patients at risk. Pathology of the spino-pelvic-hipcomplex can lead to destabilization or dislocation of hip after surgery even though implanted according to Lewinnek's indications. Our findings suggest that Lewinnek safe zone should be abandoned in favor of the concept of functional safe zones.
髋关节假体组件的最佳定位受脊柱活动度和平衡的影响。本研究对脊柱骨盆髋关节复合体病变患者进行分类，展示了预防关节置换术后髋关节脱位的可能方法。
髋关节-脊柱分类有助于关节置换术外科医生更具患者特异性地植入假体组件。
该组共 100 例接受全髋关节置换术的患者。对站立位骨盆前后位（AP）X 线片、站立位和坐位侧位脊柱 X 线片以及术后仰卧位骨盆前后位 X 线片进行分析。我们分析了从站立位变为坐位时骶骨倾斜值的变化（∆SS）、骨盆入射角（PI）、腰椎前凸（LL）不匹配、站立位矢状位腰椎骨盆平衡。根据髋关节-脊柱分类对患者进行分类。术后测量植入髋臼假体的倾斜度和前倾角。
在我们的研究中，所有病例中 1A 型诊断占 61%，1B 型占 18%，2A 型占 16%，2B 型占 5%。在 1A 组中，50 例（82%）位于莱文内克“安全区”内。在 1B、2A 和 2B 中，髋臼假体的位置既受脊柱骨盆活动度又受矢状位脊柱平衡的影响。平均倾斜度为 43.35°，前倾角为 17.4°。
根据髋关节-脊柱分类对患者进行分类，可以确定有风险的患者可能出现的后果。脊柱骨盆髋关节复合体病变即使根据莱文内克的适应证植入，也可能导致术后髋关节不稳定或脱位。我们的研究结果表明，应放弃莱文内克安全区的概念，转而采用功能安全区的概念。
