退变性脊柱侧凸和脊柱骨盆参数对髋关节半髋关节置换术后脱位的影响。
The effect of degenerative scoliosis and spinopelvic parameters on dislocation of hip hemiarthroplasty.
机构信息
Department of Orthopedics and Traumatology, Acıbadem Maslak Hospital, Istanbul-Türkiye.
Department of Orthopedics and Traumatology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul-Türkiye.
出版信息
Ulus Travma Acil Cerrahi Derg. 2024 Nov;30(11):813-820. doi: 10.14744/tjtes.2024.83696.
BACKGROUND
Degeneration of the spine may affect pelvic parameters and hip mobility. This study aimed to evaluate the effects of degenerative scoliosis and spinopelvic parameters on hip hemiarthroplasty dislocations.
METHODS
A retrospective analysis was conducted on patients who underwent hemiarthroplasty for intracapsular hip fracture over a twenty-year period. Demographic data, dislocation incidence, degenerative scoliosis (DS) status, type of hemiarthroplasty, surgical intervention to the hip, femoral head size, cement use, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and in-hospital mortality were evaluated. The Cobb angle (CA), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), and thoracic kyphosis (TK) angles were measured and analyzed.
RESULTS
A total of 284 patients were evaluated, with a mean age of 79.07 (±8.21) years. The frequency of hemiarthroplasty dislocation was 13% (n=37). Degenerative scoliosis was detected in 25.4% of the cases and was significantly more common in patients with degenerative scoliosis (p=0.001). Advanced age, higher BMI, higher ASA score, unipolar and cementless hemiarthroplasty, smaller femoral head size, and the posterior approach significantly increased dislocation frequency (p=0.004, p=0.001, p=0.03, p=0.001, p=0.001, and p=0.026, respectively). The mean PI, SS, PT, LL, and TK angles were significantly reduced in patients with dislocation and degenerative scoliosis (dislocation: p=0.001, p=0.001, p=0.001, p=0.003, p=0.048; degenerative scoliosis: p=0.001, p=0.001, p=0.001, p=0.001, p=0.001; respectively).
CONCLUSION
The presence of degenerative scoliosis and low pelvic incidence, sacral slope, pelvic tilt, thoracic kyphosis, and lumbar lordosis angles may increase the frequency of hemiarthroplasty dislocations. The posterior approach and small femoral head size may also elevate the risk of posterior dislocation.
背景
脊柱退变可能会影响骨盆参数和髋关节活动度。本研究旨在评估退变性脊柱侧凸和脊柱骨盆参数对髋关节半髋关节置换术后脱位的影响。
方法
对 20 年来因囊内髋部骨折行半髋关节置换术的患者进行回顾性分析。评估人口统计学数据、脱位发生率、退变性脊柱侧凸（DS）状态、半髋关节置换类型、髋关节手术干预、股骨头大小、骨水泥使用、美国麻醉师协会（ASA）评分、体重指数（BMI）和院内死亡率。测量并分析 Cobb 角（CA）、骨盆入射角（PI）、骶骨倾斜角（SS）、骨盆倾斜角（PT）、腰椎前凸角（LL）和胸椎后凸角（TK）。
结果
共评估了 284 例患者，平均年龄为 79.07（±8.21）岁。半髋关节置换术后脱位发生率为 13%（n=37）。25.4%的病例存在退变性脊柱侧凸，退变性脊柱侧凸患者更为常见（p=0.001）。高龄、较高 BMI、较高 ASA 评分、单极和非骨水泥半髋关节置换术、较小的股骨头大小和后路入路显著增加了脱位的发生率（p=0.004、p=0.001、p=0.03、p=0.001、p=0.001 和 p=0.026）。脱位和退变性脊柱侧凸患者的平均 PI、SS、PT、LL 和 TK 角显著降低（脱位：p=0.001、p=0.001、p=0.001、p=0.003、p=0.048；退变性脊柱侧凸：p=0.001、p=0.001、p=0.001、p=0.001、p=0.001）。
结论
退变性脊柱侧凸和较低的骨盆入射角、骶骨倾斜角、骨盆倾斜角、胸椎后凸角和腰椎前凸角可能会增加髋关节半髋关节置换术后脱位的发生率。后路入路和较小的股骨头大小也可能增加后脱位的风险。
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