Spinopelvic Motion and Impingement in Total Hip Arthroplasty
Spinopelvic Motion and Impingement in Total Hip Arthroplasty
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DOI：
10.1016/j.arth.2019.01.033
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发表时间：
2019-07-01
影响因子：
3.5
通讯作者：
Dorr, Lawrence D.
中科院分区：
文献类型：
--
作者：
McKnight, Braden M.;Trasolini, Nicholas A.;Dorr, Lawrence D.
全髋关节置换术的稳定性依赖于髋臼杯的正确定位。最近的研究表明，这个杯子的位置比以前想象的更有活力。当骨盆向前或向后倾斜时，髋臼杯的三维方向会发生变化。骨盆倾斜度的这些变化与腰骶连接处的生物力学直接相关。在正常的生理状态下，腰椎在坐姿时会变直，而在站立时会变得更加前凸。由于骶髂关节附着牢固，这直接导致骨盆后倾或前倾。坐位时，骨盆后倾增加，髋臼打开，以适应髋关节的屈曲和内旋。这有助于防止前部撞击和后部髋关节脱位。站立时，骨盆前倾增加了髋臼的上级覆盖。这有助于防止后部撞击和前部髋关节脱位。当腰骶运动变为病理性时，脊髓骨盆运动改变，髋臼杯方向受到影响。在腰骶运动减少的情况下，患者依靠更大的髋关节运动来达到站立或坐姿。这可能导致病理性撞击。此外，传统的髋臼杯位置安全区可能不适用于病理性脊髓骨盆运动。本文讨论了正常生理的脊髓骨盆运动，病理变化的模式，其中的临床意义。(c)2019爱思唯尔公司All rights reserved.
The stability of a total hip arthroplasty relies on proper positioning of the acetabular cup. Recent research has shown that this cup position is more dynamic than previously thought. The 3-dimensional orientation of the acetabular cup changes when the pelvis tilts anteriorly or posteriorly. These changes in pelvic tilt are directly related to the biomechanics of the lumbosacral junction. In normal physiology, the lumbar spine straightens with sitting and becomes more lordotic with standing. This directly translates to posterior or anterior pelvic tilt due to the rigid sacroiliac attachments. During sitting, increased posterior pelvic tilt opens the acetabulum to accommodate flexion and internal rotation of the hip. This helps prevent anterior impingement and posterior hip dislocation. During standing, anterior pelvic tilt increases superior coverage of the acetabulum. This helps prevent posterior impingement and anterior hip dislocations. When lumbosacral motion becomes pathologic, spinopelvic motion changes and acetabular cup orientation is affected. In cases of decreased lumbosacral motion, patients rely on greater hip motion to reach standing or sitting positions. This can cause pathologic impingement. In addition, traditional safe zones for cup position may not apply in the presence of pathologic spinopelvic motion. This article discusses the normal physiology of spinopelvic motion, the patterns of pathologic change, and the clinical implications therein. (c) 2019 Elsevier Inc. All rights reserved.