Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
Department of Orthopaedics and Traumatology, University Hospital Antwerp, Drie Eikenstraat 655, Edegem, 2650, Antwerp, Belgium.
Arch Orthop Trauma Surg. 2024 Nov;144(11):4887-4898. doi: 10.1007/s00402-024-05575-0. Epub 2024 Sep 17.
Patients with increased pelvic tilt (PT) are at risk for instability following total hip arthroplasty (THA). Identification of increased PT using anteroposterior (AP) pelvic radiographs could avoid additional spinopelvic radiographs. This study aimed to (1) describe which AP pelvic parameters most accurately estimate sagittal PT, and (2) determine thresholds for these parameters that can identify patients with increased PT.
This was a retrospective, consecutive, cohort study in a tertiary referral hospital on 225 patients (age: 66 ± 12 years-old; 52% female) listed for THA. Patients underwent pre-operative standing AP pelvic radiographs to measure distance- and angular- based parameters from several anatomical landmarks. Sagittal PT was measured on a standing lateral spinopelvic radiograph and considered high when ≥ 20°.
No AP pelvic parameters correlated strongly with sagittal PT. Ratio between horizontal and vertical diameter of the pelvic foramen (C/D ratio) (rho - 0.341; p < 0.001); and vertical distance between trans-SIJ and trans-ASIS line (SITA) (rho 0.307; p < 0.001) correlated moderately with sagittal PT. Sacro-femoral-pubic (SFP) angle < 60° had highest sensitivity (85%), but lowest specificity (52%) to differentiate between patients with and without increased PT. If SITA > 62 mm, C/D ratio < 0.5 and SFP < 60°, specificity increased (88%), but sensitivity was low (49%).
In the absence of computerized models, AP pelvic parameters cannot accurately predict sagittal PT. However, an SFP < 60° should alert a hip surgeon that a patient may have an increased PT, and would benefit from additional lateral spinopelvic imaging prior to THA.
Level II, diagnostic study.
骨盆倾斜角（PT）增加的患者在全髋关节置换术后（THA）有不稳定的风险。使用前后位（AP）骨盆 X 线片识别 PT 增加可避免额外的脊柱骨盆 X 线片。本研究旨在：（1）描述哪些 AP 骨盆参数最能准确估计矢状面 PT；（2）确定可识别 PT 增加的这些参数的阈值。
这是在一家三级转诊医院进行的回顾性、连续队列研究，纳入了 225 名接受 THA 的患者（年龄：66±12 岁；52%为女性）。患者接受术前站立位 AP 骨盆 X 线片检查，以测量来自几个解剖标志的距离和角度参数。站立位侧位脊柱骨盆 X 线片测量矢状面 PT，当≥20°时认为 PT 较高。
没有 AP 骨盆参数与矢状面 PT 有很强的相关性。骨盆孔的水平与垂直直径比（C/D 比）（rho-0.341；p<0.001）；以及 trans-SIJ 与 trans-ASIS 线之间的垂直距离（SITA）（rho 0.307；p<0.001）与矢状面 PT 中度相关。Sacro-femoral-pubic（SFP）角<60°对区分 PT 增加和无增加的患者具有最高的敏感性（85%），但最低的特异性（52%）。如果 SITA>62mm，C/D 比<0.5 和 SFP<60°，特异性增加（88%），但敏感性低（49%）。
在没有计算机模型的情况下，AP 骨盆参数不能准确预测矢状面 PT。然而，SFP<60°应提醒髋关节外科医生，患者可能存在 PT 增加，并且在接受 THA 之前需要额外的脊柱骨盆侧位成像。
II 级，诊断研究。
