Kawamura Ichiro, Tominaga Hiroyuki, Tokumoto Hiroto, Sanada Masato, Ogura Takuma, Kuroshima Tomoki, Kamizono Junichi, Taniguchi Noboru
Department of Orthopaedic Surgery, Graduate School of Medicine and Dental Science, Kagoshima University, Kagoshima, Japan.
Department of Orthopaedic Surgery, Sendai Medical Association Hospital, Kagoshima, Japan.
Spine Surg Relat Res. 2024 Feb 14;8(3):330-337. doi: 10.22603/ssrr.2023-0273. eCollection 2024 May 27.
Studies describing the relationship between the hip and spine have reported that corrective spinal surgery for adult spinal deformity (ASD) affects the orientation of the acetabulum. However, the extent to which spinal correction in ASD affects acetabular anteversion in the standing position is unclear, especially after total hip arthroplasty, for which dislocation is a concern. The purpose of this study was to evaluate changes in anterior acetabular coverage in the upright position due to extensive correction surgery for ASD.
Thirty-six consecutive patients who had undergone spinal corrective surgery from the thoracolumbar region to the pelvis were enrolled and evaluated. The ventral-central-acetabular (VCA) angle and anterior acetabular head index (AAHI) were measured with a false-profile view to evaluate the relationship between acetabular anteversion in the standing position and spinopelvic parameters before and after surgery. The spinopelvic parameters measured included thoracic kyphosis, pelvic incidence, pelvic tilt (PT), sacral slope, lumbar lordosis (LL), sagittal vertical axis, and global tilt.
The VCA angle and AAHI were significantly increased after spinal deformity correction (p<0.001). The changes in LL and PT were correlated with the VCA angle (LL: right, ρ=0.56; left, ρ=0.55, p<0.001; PT: right, ρ=-0.59; left, ρ=-0.64, p<0.001) and AAHI (LL: right, ρ=0.51; left, ρ=0.58, p<0.01; PT: right, ρ=-0.52; left, ρ=-0.59, p<0.01), respectively. Linear regression analysis revealed that a 10° increase in LL results in 1.4°-1.9° and 1.6%-2% increases in the VCA angle and AAHI, respectively.
Surgical correction for ASD significantly affects sagittal spinopelvic parameters, resulting in increased acetabular anteversion. The anterior coverage of the acetabulum in the postoperative standing position could be predicted with the intraoperatively measured LL, and evaluation using a false-profile was considered useful for treating ASD, particularly in patients after total hip arthroplasty.
描述髋关节与脊柱关系的研究报告称，成人脊柱畸形（ASD）的矫正性脊柱手术会影响髋臼的方向。然而，ASD的脊柱矫正对站立位时髋臼前倾角的影响程度尚不清楚，尤其是在全髋关节置换术后，脱位是一个需要关注的问题。本研究的目的是评估ASD广泛矫正手术导致的直立位髋臼前侧覆盖度的变化。
连续纳入36例接受了从胸腰段到骨盆的脊柱矫正手术的患者并进行评估。通过假斜位片测量腹侧中央髋臼（VCA）角和髋臼前侧股骨头指数（AAHI），以评估站立位时髋臼前倾角与手术前后脊柱骨盆参数之间的关系。测量的脊柱骨盆参数包括胸椎后凸、骨盆入射角、骨盆倾斜度（PT）、骶骨倾斜度、腰椎前凸（LL）、矢状垂直轴和整体倾斜度。
脊柱畸形矫正后，VCA角和AAHI显著增加（p<0.001）。LL和PT的变化分别与VCA角（LL：右侧，ρ=0.56；左侧，ρ=0.55，p<0.001；PT：右侧，ρ=-0.59；左侧，ρ=-0.64，p<0.001）和AAHI（LL：右侧，ρ=0.51；左侧，ρ=0.58，p<0.01；PT：右侧，ρ=-0.52；左侧，ρ=-0.59，p<0.01）相关。线性回归分析显示，LL增加10°分别导致VCA角和AAHI增加1.4°-1.9°和1.6%-2%。
ASD的手术矫正显著影响矢状位脊柱骨盆参数，导致髋臼前倾角增加。术后站立位时髋臼的前侧覆盖度可以通过术中测量的LL来预测，并且使用假斜位片进行评估被认为对治疗ASD有用，特别是在全髋关节置换术后的患者中。
