Characteristics of sagittal spine-pelvis-leg alignment in patients with severe hip osteoarthritis
Characteristics of sagittal spine-pelvis-leg alignment in patients with severe hip osteoarthritis
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DOI：
10.1007/s00586-014-3700-5
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发表时间：
2015-06-01
影响因子：
2.8
通讯作者：
Qiu, Yong
中科院分区：
文献类型：
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作者：
Weng, Wen-Jie;Wang, Wei-Jun;Qiu, Yong
脊柱和骨盆的矢状面排列与脊柱疾病患者的代偿机制之间的相互作用已被充分证明。然而，在髋关节骨关节炎（HOA）患者中，很少有研究探讨髋关节病理如何影响髋关节、骨盆和脊柱的矢状面排列，也没有报道探讨这些变化是否参与这些患者腰痛的发病机制。本病例对照研究的目的是调查严重HOA患者的脊柱-骨盆-下肢矢状面排列，并了解这些患者的脊柱-骨盆-下肢矢状面排列是否与腰痛的发生和健康相关的生活质量有关。在患者处于直立位的情况下，获得脊柱、骨盆和股骨近端的数字化侧位X线片。测量以下影像学参数，以检查骨盆、髋关节和脊柱的矢状面排列：骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、骨盆股骨角（PFA）、股骨倾斜角（FI）、腰椎前凸（LL）、脊柱-骶骨角（SSA）、C7倾斜角（C7 T）和T1脊柱-骨盆倾斜角（T1-SPI）。根据C7垂线与骶骨、股骨头的相对位置，将脊柱-骨盆对线的整体平衡模式分为正常平衡、轻度失衡和重度失衡。采用简明36量表对患者进行问卷调查。HOA患者与对照组之间以及HOA患者有或无腰痛之间进行了比较。相关分析显示，HOA患者与对照组在年龄和性别分布上无显著性差异。与对照组相比，HOA患者的SS显著升高，PT显著降低，骨盆PI相似，C7 T显著减小，T1-SPI显著增大，但脊柱LL和SSA相似，髋关节PFA显著减小，但FI增大。此外，HOA患者严重脊柱-骨盆对线不平衡的发生率明显高于对照组（分别为22.4%和3.1%）。HOA患者PFA与SS、SSA、FI显著相关，与PI、LL、C7 T无显著相关性，而与T1-SPI、C7 T、FI显著相关。但有或无腰痛的HOA患者的影像学参数、整体矢状面平衡模式和Short Form-36无显著差异。重度HOA患者骨盆矢状面形态正常，可能与该疾病的发生和发展无关。虽然整个脊柱都参与了对屈曲髋关节的补偿，但这种能力差导致这些患者的脊柱-骨盆对线严重失衡。脊柱前倾和股骨后倾可能导致这些患者的体力活动不良。然而，严重HOA患者的脊柱-骨盆-下肢矢状面排列异常可能与腰痛的发病机制无关。
The interaction between the sagittal alignment of the spine and pelvis and the compensatory mechanism in patients suffering from spinal disorders has been well documented. However, in patients with hip osteoarthritis (HOA), few studies have explored how the hip joint pathology could affect the sagittal alignment of the hip, pelvis and spine, and no reports have investigated whether these changes are involved in the pathogenesis of low back pain in these patients. The aims of this case-control study were to investigate the sagittal spine-pelvis-leg alignment in patients suffering from severe HOA and to understand whether the alignment was related to the occurrence of low back pain and the health-related quality of life in these patients.Fifty-eight patients with severe HOA and 64 asymptomatic controls were studied. Digital lateral X-rays of the spine, pelvis and proximal femur were obtained with the patients placed in upright positions. The following radiographic parameters were measured to examine the sagittal alignment of the pelvis, hip and spine: pelvic incidence (PI), pelvic tilting (PT), sacral slope (SS), pelvic femoral angle (PFA), femoral inclination (FI), lumbar lordosis (LL), spino-sacral angle (SSA), C7 tilt (C7T) and T1 spinal-pelvic inclination (T1-SPI). The global balance patterns of spinal-pelvic alignment were classified as normal balance, slight unbalance and severe unbalance according to the relative position of the C7 plumb line to the sacrum and femoral heads. Short Form-36 questionnaire was carried out in the patients. Comparisons were carried out between the patients with HOA and the controls and between the HOA patients with or without low back pain. Correlation analysis was used to measure relationships between the HOA patients' parameters.There were no significant differences in the age and gender distribution between the HOA patients and control. Compared with the controls, the patients with HOA showed significantly higher SS and lower PT, similar PI in the pelvis, significantly smaller C7T, larger T1-SPI but comparable LL and SSA in the spine, and significantly smaller PFA but larger FI in the hip joint. In addition, the patients with HOA had a significantly greater incidence of severe unbalanced spinal-pelvic alignment than did the controls (22.4 vs 3.1 %, respectively). In patients with HOA, the PFA was significantly correlated with SS, SSA and FI but not with PI, LL or C7T; while the physical component score of short form-36 was significantly correlated with T1-SPI, C7T and FI. A comparison between the HOA patients with or without low back pain, however, showed no significant differences in the radiographic parameters, global sagittal balance patterns and Short Form-36.The sagittal morphology of the pelvis in patients with severe HOA was normal and might not be involved in the development and progression of this disorder. Although the whole spine was involved in compensating for the flexed hip joint, the poor ability resulted in severely unbalanced spinal-pelvic alignment in these patients. The forward inclined spine and retroverted femur would contribute to the poor physical activities in these patients. However, the abnormal sagittal spine-pelvis-leg alignment in patients with severe HOA might not be involved in the pathogenesis of low back pain.