Functional Acetabular Orientation Varies Between Supine and Standing Radiographs: Implications for Treatment of Femoroacetabular Impingement
Functional Acetabular Orientation Varies Between Supine and Standing Radiographs: Implications for Treatment of Femoroacetabular Impingement
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DOI：
10.1007/s11999-014-4104-x
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发表时间：
2015-04-01
影响因子：
4.2
通讯作者：
Bedi, Asheesh
中科院分区：
文献类型：
--
作者：
Ross, James R.;Tannenbaum, Eric P.;Bedi, Asheesh
通常，骨盆前后位片（AP）是在患者仰卧位进行的。然而，这可能并不代表骨盆和髋臼的功能位置，因此当评估患者的股骨髋臼撞击（FAI）时，站立位X线片可能更好地结合了关节周围肌肉组织和矢状面平衡的动态影响。本研究的目的是确定仰卧位和站立位骨盆方向对（1）髋臼扭转和FAI常见X线征象的测量（如二维和三维（3-D）成像评估）的影响;术前骨盆CT扫描50例（50髋）分析了2013年7月至2014年10月期间接受关节镜手术治疗FAI的患者。研究人群的平均年龄为29 ± 10岁（范围：15-50岁），70%为男性。所有患者均拍摄了站立位前后位骨盆X线片，根据CT数据重建仰卧位X线片，并创建了一个3-D模型，以允许操纵骨盆倾斜并模拟ROM与骨接触。在模拟平片上测量髋臼扭转，并记录交叉征、坐骨棘突出征和后壁征的存在。在（1）模拟髋关节屈曲;（2）模拟90 A屈曲度内旋（IRF）;和（3）模拟90 A屈曲度内旋和15 A内收（FARF）过程中测量ROM与骨撞击的关系，并确定股骨近端和髋臼缘之间的骨接触位置。计算仰卧位和站立位骨盆方向的这些测量值。配对Student t检验用于连续变量的比较，而卡方检验用于分类变量。P值< 0.05被认为是显著的。当从仰卧位改变为站立位X线片时，平均颅侧位和中心位分别增加了2A度AA +/-A4 A度（95%置信区间[CI]，1A度-3A度）和2A度AA +/-A3 A度（95% CI，1A度-3A度）（均p < 0.001）。然而，根据现有的数据，阳性交叉、后壁和突出坐骨棘体征的比例没有变化。站立骨盆位倾斜导致髋关节屈曲度增加3A度（95% CI，2A度-4A度）以及IRF增加2A度（95% CI，1A度-3A度）和3A度的FAQs（95%可信区间，2A度-4A度）（所有p < 0.001）髋臼的功能方位在仰卧位和站立位X线片之间是不同的，在诊断和治疗时必须加以考虑。有症状的FAI患者。站立骨盆方位导致骨盆后倾，随后在运动弧中发生FAI。虽然我们不能推荐仅在当前研究中进行站立位X线片检查，但我们建议进行更大规模的研究，以确定是否真的存在任何显著差异。
Often, anteroposterior (AP) pelvic radiographs are performed with the patient positioned supine. However, this may not represent the functional position of the pelvis and the acetabulum, and so when assessing patients for conditions like femoroacetabular impingement (FAI), it is possible that standing radiographs better incorporate the dynamic influences of periarticular musculature and sagittal balance. However, this thesis remains largely untested.The purpose of this study was to determine the effect of supine and standing pelvic orientation on (1) measurements of acetabular version and common radiographic signs of FAI as assessed on two- and three-dimensional (3-D) imaging; and (2) on terminal hip range of motion (ROM).Preoperative pelvic CT scans of 50 patients (50 hips) who underwent arthroscopic surgery for the treatment of FAI between July 2013 and October 2014 were analyzed. The mean age of the study population was 29 +/- A 10 years (range, 15-50 years) and 70% were male. All patients had a standing AP pelvis radiograph, a reconstructed supine radiograph from the CT data, and a 3-D model created to allow manipulation of pelvic tilt and simulate ROM to osseous contact. Acetabular version was measured and the presence of the crossover sign, prominent ischial spine sign, and posterior wall sign were recorded on simulated plain radiographs. Measurements of ROM to bony impingement were made during (1) simulated hip flexion; (2) simulated internal rotation in 90A degrees of flexion (IRF); and (3) simulated internal rotation in 90A degrees of flexion and 15A degrees adduction (FADIR), and the location of bony contact between the proximal femur and acetabular rim was defined. These measurements were calculated for supine and standing pelvic orientations. A paired Student's t-test was used for comparison of continuous variables, whereas chi square testing was used for categorical variables. A p value of < 0.05 was considered significant.When changing from supine to the standing radiographs, both mean cranial and central version increased by 2A degrees A A +/- A 4A degrees (95% confidence interval [CI], 1A degrees-3A degrees) and 2A degrees A A +/- A 3A degrees (95% CI, 1A degrees-3A degrees), respectively (both p < 0.001). However, with the numbers available, there were no changes in the proportion of positive crossover, posterior wall, and prominent ischial spine signs. Standing pelvic position tilt resulted in an increased hip flexion of 3A degrees (95% CI, 2A degrees-4A degrees) as well as an increase in IRF of 2A degrees (95% CI, 1A degrees-3A degrees) and FADIR of 3A degrees (95% CI, 2A degrees-4A degrees) (all p < 0.001).The functional orientation of the acetabulum varies between supine and standing radiographs and must be considered when diagnosing and treating patients with symptomatic FAI. Standing pelvic orientation results in posterior pelvic tilt and later occurrence of FAI in the arc of motion. Although we cannot recommend standing radiographs on the current study alone, we do recommend larger studies to determine whether any significant differences truly exist.Level III, diagnostic study.