Ram Sudhan S, Surendran Sibin, Gopinath Naveen P, C U Jijulal, Muhammed Fazil V V, Gopinathan P, Nikhil K V
Fellow in Arthroplasty, Sports surgery & Rehabilitation, Yenepoya Medical College Hospital, Yenepoya University, Deralakatte, Karnataka, 575018, India.
Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, 673008, India.
J Orthop. 2024 Aug 14;60:105-114. doi: 10.1016/j.jor.2024.08.008. eCollection 2025 Feb.
A systematic literature review and meta- analysis.
To extract and combine the available literature focused on normal and abnormal biomechanical principles of spine-pelvis-hip complex and to sum up the data in the application of THA both in the setting with and without spinal disorders.
An extensive search and analysis of the articles was done by 3 authors independently in 7 platforms based on PRISMA and MOOSE guidelines. Selection criteria 1. Articles that assessed spinopelvic parameters (SS, SPT, PI, and acetabular cup orientation) in patients undergoing THA, Articles that assessed balance in spinopelvic complex after THA, Randomized control studies, Systematic literature reviews, Meta-analyses, Clinical trials / original research studies, Review articles and Articles after 2015 were included. Cochrane's GRADE method was used to define the level of evidence. 2.Participants: Patients who underwent THA only (in asymptomatic spine), those who had ankylosing spondylitis and underwent THA and those who underwent THA with prior spinal arthrodesis. 3.Study parameters: Ante Inclination (AI), sacral slope (SS), pelvic Incidence (PI) and spinopelvic tilt (SPT) in both positions of standing and sitting. ΔAI, ΔSS and ΔSPT. Data were collected and analyzed, the means of the study parameters with SD were calculated and a meta-analysis is performed to evaluate the pooled means with optimal value range.
From 218 abstracts extracted and after eligibility assessment and exclusion, 4 articles involving 439 patients were enrolled. The mean SS in standing and sitting calculated were 35.53±10.52 and 33.13±12.38. The mean of AI and SPT in standing /sitting positions are 29.7±12.29/34.69±12.96 (n = 242) and 19.56±8.9/21.22±12.53 (n=439) respectively. The ΔAI, ΔSS, and ΔSPT were 4.99,2.4 and 1.66 respectively.
There is a proportionate change between the spinopelvic tilt and the acetabular orientation in postural variations. Evaluation of spine, pelvis and hip becomes more critical in identifying these changes and thereby prompting the acetabular cup position in the functional safe zone.
系统文献综述与荟萃分析。
提取并整合聚焦于脊柱 - 骨盆 - 髋关节复合体正常和异常生物力学原理的现有文献，并总结全髋关节置换术（THA）在有无脊柱疾病情况下应用的数据。
3位作者依据PRISMA和MOOSE指南，在7个平台独立对文章进行广泛检索与分析。纳入标准：1.评估接受THA患者的脊柱骨盆参数（矢状面垂直轴[SS]、骶骨倾斜角[SPT]、骨盆入射角[PI]和髋臼杯方向）的文章；评估THA后脊柱骨盆复合体平衡的文章；随机对照研究、系统文献综述、荟萃分析、临床试验/原始研究、综述文章以及2015年后的文章。采用Cochrane的GRADE方法定义证据水平。2.参与者：仅接受THA（无症状脊柱）的患者、患有强直性脊柱炎并接受THA的患者以及先前接受脊柱融合术并接受THA的患者。3.研究参数：站立位和坐位时的前倾角（AI）、骶骨倾斜角（SS）、骨盆入射角（PI）和脊柱骨盆倾斜角（SPT）。ΔAI、ΔSS和ΔSPT。收集并分析数据，计算研究参数的均值及标准差，并进行荟萃分析以评估合并均值及最佳值范围。
在提取的218篇摘要经合格性评估和排除后，纳入4篇涉及439例患者的文章。计算得出站立位和坐位时的平均SS分别为35.53±10.52和33.13±12.38。站立位/坐位时AI和SPT的均值分别为29.7±12.29/34.69±12.96（n = 242）和19.56±8.9/21.22±12.53（n = 439）。ΔAI、ΔSS和ΔSPT分别为4.99、2.4和1.66。
姿势变化时脊柱骨盆倾斜与髋臼方向之间存在相应变化。在识别这些变化并由此将髋臼杯位置置于功能安全区内时，对脊柱、骨盆和髋关节的评估变得更为关键。
