Fujita Ryo, Takahashi Kohei, Hashimoto Ko, Baba Kazuyoshi, Yahata Kenichiro, Onoki Takahiro, Aki Takashi, Ishikawa Keisuke, Aizawa Toshimi
Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Asian Spine J. 2025 Aug 11. doi: 10.31616/asj.2024.0475.
retrospective study.
This study aimed to develop an indicator of the compensatory capacity of hip joints in response to spinopelvic mismatch using standard radiographs.
EOS imaging has enabled detailed analysis of hip and lower extremity compensation in sagittal malalignment. However, its high cost and limited availability hinder widespread clinical use. Currently, there are no established indicators to assess hip compensation for spinopelvic mismatch using standard radiographs.
A total of 209 patients with osteoporosis and 54 with adult spinal deformities were included. Patients were divided into two groups based on pelvic incidence-lumbar lordosis (PI-LL): <20° and ≥20° groups. The sagittal vertical axis (SVA), thoracic kyphosis, PI, pelvic tilt (PT), LL, sacral slope, and pelvic femoral angle (PFA) were measured. Health-related quality of life (HRQOL) was assessed in 86 patients using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). A new index, PFA-(PI-LL), was defined as spinopelvic-hip mismatch. Correlation coefficients were calculated for each radiographic parameter, and the coefficient of determination (R2) for the relationship of each parameter with SVA was evaluated in both groups. The correlations between SVA, PT, PI-LL, PFA-(PI-LL), and JOABPEQ domain scores were also analyzed.
PI-LL correlated with PFA in the PI-LL <20° group (r=0.56, p<0.001) but not in the PI-LL ≥20° group. Among all parameters, PFA-(PI-LL) demonstrated the strongest association with SVA, indicating its superior ability to explain variations in sagittal alignment in both groups and across all patients (all patients, R2=0.77). Significant correlations were observed between the radiographic parameters and JOABPEQ scores across all domains.
PFA-(PI-LL), which represented spinopelvic-hip mismatch, was a reliable indicator of hip compensatory function in terms of anterior trunk inclination and HRQOL.
回顾性研究。
本研究旨在利用标准X线片开发一种髋关节对脊柱骨盆失配的代偿能力指标。
EOS成像能够对矢状面排列不齐时的髋关节和下肢代偿进行详细分析。然而，其高昂的成本和有限的可用性阻碍了其在临床的广泛应用。目前，尚无使用标准X线片评估髋关节对脊柱骨盆失配的代偿指标。
共纳入209例骨质疏松患者和54例成人脊柱畸形患者。根据骨盆入射角-腰椎前凸（PI-LL）将患者分为两组：<20°组和≥20°组。测量矢状垂直轴（SVA）、胸椎后凸、PI、骨盆倾斜（PT）、LL、骶骨倾斜度和骨盆股骨角（PFA）。使用日本骨科协会背痛评估问卷（JOABPEQ）对86例患者的健康相关生活质量（HRQOL）进行评估。定义了一个新指标PFA-（PI-LL），称为脊柱骨盆-髋关节失配。计算每个影像学参数的相关系数，并在两组中评估每个参数与SVA关系的决定系数（R2）。还分析了SVA、PT、PI-LL、PFA-（PI-LL）与JOABPEQ各领域评分之间的相关性。
在PI-LL<20°组中，PI-LL与PFA相关（r=0.56，p<0.001），而在PI-LL≥20°组中不相关。在所有参数中，PFA-（PI-LL）与SVA的相关性最强，表明其在两组及所有患者中解释矢状面排列变化的能力更强（所有患者，R2=0.77）。在所有领域，影像学参数与JOABPEQ评分之间均存在显著相关性。
代表脊柱骨盆-髋关节失配的PFA-（PI-LL）在前躯干倾斜度和HRQOL方面是髋关节代偿功能的可靠指标。
