Fischer Maximilian, Nonnenmacher Lars, Nitsch Andreas, Mühler Matthias R, Hofer Andre, Wassilew Georgi I
Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine University Medicine Greifswald Greifswald Germany.
Department of Radiology and Neuroradiology University Medicine Greifswald Greifswald Germany.
J Exp Orthop. 2025 Feb 10;12(1):e70167. doi: 10.1002/jeo2.70167. eCollection 2025 Jan.
The functional hip-spine interaction is increasingly noted in hip preservation by periacetabular osteotomy (PAO), while potentially affecting the impingement-free acetabular reorientation. However, the clinically relevant sex-related differences in lumbopelvic alignment have been poorly studied. Thus, the purpose of this study was to evaluate a matched PAO patient cohort for sex-related differences in lumbopelvic alignment.
Out of 138 patients undergoing PAO between January 2024 and September 2024 at one high-volume centre, there were 68 data sets (34 male, 34 female) included. The data sets of this diagnostic cohort study were prospectively collected, and the patients were matched in a 1:1 ratio for sex, age and acetabular morphology (hip dysplasia, borderline hip dysplasia, acetabular retroversion). Lumbopelvic alignment was assessed with serial sagittal lumbopelvic radiographs in standing, relaxed-seated and deep-seated positions. Each radiograph was reviewed for pelvic tilt (PT), lumbar lordosis and sacral slope.
Females showed a significantly lower PT in standing (7.8 vs. 14.3°, < 0.001), relaxed-seated (28.1 vs. 34.9°, = 0.012) and deep-seated (3.7 vs. 11.0°, = 0.013) positions. Furthermore, females had a significantly increased lumbar mobility (Δ relaxed-seated - deep-seated position - 35.4° vs. 27.0°, = 0.003), while there was no sex-related difference in sacral mobility ( > 0.05).
There are sex-related differences in functional lumbopelvic alignment across various positions of daily living in patients undergoing PAO. With a greater anterior PT, females are at risk of an anterior hip impingement. Thus, the intraoperative anterior and posterior wall reorientation by PAO should be adapted to the sex-related lumbopelvic alignment to ensure an impingement-free surgical outcome.
Level IV, case series.
在髋臼周围截骨术（PAO）保髋治疗中，髋部与脊柱的功能相互作用日益受到关注，同时这可能会影响无撞击髋臼重新定向。然而，关于腰骨盆对线的临床相关性别差异研究较少。因此，本研究旨在评估一组配对的PAO患者队列中腰骨盆对线的性别差异。
在2024年1月至2024年9月期间，在一个高容量中心接受PAO手术的138例患者中，纳入了68个数据集（34例男性，34例女性）。本诊断队列研究的数据集是前瞻性收集的，患者按性别、年龄和髋臼形态（髋关节发育不良、临界髋关节发育不良、髋臼后倾）1:1配对。通过站立位、放松坐位和深坐位的连续矢状位腰骨盆X线片评估腰骨盆对线。每张X线片均评估骨盆倾斜度（PT）、腰椎前凸和骶骨坡度。
女性在站立位（7.8°对14.3°，P<0.001）、放松坐位（28.1°对34.9°，P=0.012）和深坐位（3.7°对11.0°，P=0.013）时的PT显著更低。此外，女性的腰椎活动度显著增加（放松坐位-深坐位的差值为-35.4°对27.0°，P=0.003），而骶骨活动度无性别差异（P>0.05）。
接受PAO手术的患者在日常生活的不同姿势下，腰骨盆功能对线存在性别差异。由于女性的前PT更大，她们存在前髋撞击的风险。因此，PAO术中髋臼前后壁的重新定向应根据性别相关的腰骨盆对线进行调整，以确保手术结果无撞击。
IV级，病例系列。
