全髋关节置换术患者矢状位脊柱畸形的发生率

全髋关节置换术患者矢状位脊柱畸形的发生率

背景：矢状位脊柱排列与全髋关节置换术(THA)之间的重要关系越来越受到人们的重视。既往的研究表明，矢状位脊柱畸形(SSD)与THA不稳定有着显著的关系。本研究旨在确定术前THA患者中SSD的患病率。

方法：对术前对多中心数据库的患者进行分析，对所有站立位X线片进行测量，测量参数包括骨盆前平面倾斜度(APPt)、脊柱斜度(SPT)和腰椎前凸角(LL)，骨盆入射角(PI)由计算机断层扫描(CT)测量。PI-LL>10°定义为失衡，平衡为-10°~10°的PI-LL，PI-LL<-10°为过度前凸。

结果：共分析1088例(平均64岁，女性占48%)。59%(n=644)患者力线平衡，16%(n=174)PI-LL>10°，4%(n=46)PI-LL>20°(严重平背畸形)。过度前凸的发生率为25%，共270例。严重平背畸形患者较其余患者年龄更大 (69.5y vs 64.0y vs 60.8y，P<0.001)。平背畸形组较其余患者的SPT(24.7°vs 15.4°vs 7.0°)、APPt(-7.1°vs-2.0°vs 2.5°)和PI(64.1°vs 56.8°vs 49.0°)均有显着性差异(P<0.001)。

结论：在接受THA手术的患者中，只有59%的患者有正常排列的腰椎角度。SSD平背的发生率为16%(4%为4%)，其中25%为单纯性前凸。腰椎平背（僵直）与年龄增加、骨盆后倾、PI增大有关。脊柱畸形在这类人群中的患病率相对较高，这就加强了在术前规划和风险分析中考虑髋脊柱力线畸形的重要性。

Prevalence of Sagittal Spinal Deformity Among Patients Undergoing Total Hip Arthroplasty

BACKGROUND: The important relationship between sagittal spinal alignment and total hip arthroplasty (THA) is becoming well recognized. Prior research has shown a significant relationship between sagittal spinal deformity (SSD) and THA instability. This study aims at determining the prevalence of SSD among preoperative THA patients.

METHODS: A multicenter database of preoperative THA patients was analyzed. Radiographic parameters measured from standing radiographs included anterior pelvic plane tilt, spinopelvic tilt, and lumbar lordosis (LL); pelvic incidence (PI) was measured from computed tomography scans. Lumbar flatback was defined as PI-LL mismatch >10°, balanced as PI-LL of -10° to 10°, and hyperlordosis as PI-LL <-10°.

RESULTS: A total of 1088 patients were analyzed (mean, 64 years; 48% female). And 59% (n = 644) of patients had balanced alignment, 16% (n = 174) had a PI-LL > 10°, and 4% (n = 46) had a PI-LL > 20° (severe flatback deformity). The prevalence of hyperlordosis was 25% (n = 270). Flatback patients tended to be older than balanced and hyperlordotic patients (69.5 vs 64.0 vs 60.8 years, P < .001). Spinopelvic tilt was more posterior in flatback compared to balanced and hyperlordotic patients (24.7° vs 15.4° vs 7.0°) as was anterior pelvic plane tilt (-7.1° vs -2.0° vs 2.5°) and PI (64.1° vs 56.8° vs 49.0°), all P < .001.

CONCLUSION: Only 59% of patients undergoing THA have normally aligned lumbar spines. Flatback SSD was observed in 16% (4% with severe flatback deformity) and there was a 25% prevalence of hyperlordosis. Lumbar flatback was associated with increasing age, posterior pelvic tilt, and larger PI. The relatively high prevalence of spinal deformity in this population reinforces the importance of considering spinopelvic alignment in THA planning and risk stratification.

文献出处：Buckland AJ, Ayres EW, Shimmin AJ, Bare JV, McMahon SJ3 Vigdorchik JM. Prevalence of Sagittal Spinal Deformity Among Patients Undergoing Total Hip Arthroplasty. J Arthroplasty. 2019 Aug 10. pii: S0883-5403(19)30751-X. doi: 10.1016/j.arth.2019.08.020.