Abstract：
To clarify the impact of restriction of hip extension on radiographic whole-body sagittal alignment with using postoperative changes of radiographical parameters for hip osteoarthritis.
We prospectively enrolled 68 patients with hip osteoarthritis scheduled for arthroplasty. Variables included manual examination of hip range of motion (H-ROM) and radiographic whole-body sagittal alignment parameters including sagittal vertical axis (SVA), center of acoustic meatus and femoral head offset (CAM-HA), thoracic kyphosis (TK), lumbar lordosis, sacral slope (SS), and knee flexion angle (KF). We divided patients with preoperative hip extension angle < 0 into the extension restriction (ER) + group and ≥ 0 into the ER- group. Differences in H-ROM, radiographic parameters between groups and postoperative changes were comparatively analyzed.
Fifty-seven patients (The ER + group included 28 patients and the ER- group included 29 patients.) were available for the analysis. Pre-/postoperative H-ROM were 99.7 ± 24.9/118.1 ± 16.0 degrees (p < .01). Greater increases in SVA (5.4 ± 3.4 vs 3.4 ± 2.8 cm, p = .02) and in CAM-HA (3.9 ± 3.9 vs 2.8 ± 3.4 cm, p = 013) were found in the ER + group versus ER- group. Postoperatively, the ER + group showed an increase in TK (pre-/postoperative: 35.2 ± 9.7/37.4 ± 8.8 degrees, p = .04) and decreases in SS (36.5 ± 9.6/33.7 ± 9.9 degrees, p < .01) and KF (9.5 ± 7.0/6.9 ± 6.0 degrees, p = .02). Postoperative changes in radiographic parameters in the ER- group were not significant.
Patients with restriction of hip extension showed global spine imbalance, and significant changes in TK, SS, and KF were observed after arthroplasty. The presence of hip joint disorder and H-ROM restriction must be considered when evaluating spinopelvic alignment and whole-body sagittal alignment.
We prospectively enrolled 68 patients with hip osteoarthritis scheduled for arthroplasty. Variables included manual examination of hip range of motion (H-ROM) and radiographic whole-body sagittal alignment parameters including sagittal vertical axis (SVA), center of acoustic meatus and femoral head offset (CAM-HA), thoracic kyphosis (TK), lumbar lordosis, sacral slope (SS), and knee flexion angle (KF). We divided patients with preoperative hip extension angle < 0 into the extension restriction (ER) + group and ≥ 0 into the ER- group. Differences in H-ROM, radiographic parameters between groups and postoperative changes were comparatively analyzed.
Fifty-seven patients (The ER + group included 28 patients and the ER- group included 29 patients.) were available for the analysis. Pre-/postoperative H-ROM were 99.7 ± 24.9/118.1 ± 16.0 degrees (p < .01). Greater increases in SVA (5.4 ± 3.4 vs 3.4 ± 2.8 cm, p = .02) and in CAM-HA (3.9 ± 3.9 vs 2.8 ± 3.4 cm, p = 013) were found in the ER + group versus ER- group. Postoperatively, the ER + group showed an increase in TK (pre-/postoperative: 35.2 ± 9.7/37.4 ± 8.8 degrees, p = .04) and decreases in SS (36.5 ± 9.6/33.7 ± 9.9 degrees, p < .01) and KF (9.5 ± 7.0/6.9 ± 6.0 degrees, p = .02). Postoperative changes in radiographic parameters in the ER- group were not significant.
Patients with restriction of hip extension showed global spine imbalance, and significant changes in TK, SS, and KF were observed after arthroplasty. The presence of hip joint disorder and H-ROM restriction must be considered when evaluating spinopelvic alignment and whole-body sagittal alignment.
摘要：
目的利用髋部骨关节炎术后影像学参数的变化，阐明限制髋部伸展对影像学全身矢状位的影响。
我们前瞻性招募了68例髋关节骨性关节炎患者进行关节置换术。变量包括髋关节活动范围（H-ROM）的手动检查和包括矢状垂直轴（SVA）在内的射线照相全身矢状对准参数，耳道中心和股骨头偏移(CAM-HA)，胸椎后凸(TK),腰椎前凸,骶骨斜坡(SS),和膝关节屈曲角度（KF）。我们将术前髋部伸展角度<0的患者分为伸展受限（ER）组，≥0的患者分为ER-组。H-ROM的差异，对比分析组间影像学参数及术后变化。
57例患者（ER+组28例，ER-组29例。)可用于分析。术前/术后H-ROM为99.7±24.9/118.1±16.0度(p<.01)。SVA增加更大(5.4±3.4vs3.4±2.8厘米，p=.02）和CAM-HA（3.9±3.9vs2.8±3.4cm，p=013）在ER+组与ER-组中发现。术后,ER+组TK升高（术前/术后：35.2±9.7/37.4±8.8度，p=.04）和SS降低（36.5±9.6/33.7±9.9度，p<.01）和KF（9.5±7.0/6.9±6.0度，p=.02）。ER组术后影像学参数变化不显著。
髋关节伸展受限的患者表现出整体脊柱失衡，以及传统知识的重大变化，SS,关节置换术后观察到KF。在评估脊柱骨盆对准和全身矢状位对准时，必须考虑髋关节疾病和H-ROM限制的存在。
我们前瞻性招募了68例髋关节骨性关节炎患者进行关节置换术。变量包括髋关节活动范围（H-ROM）的手动检查和包括矢状垂直轴（SVA）在内的射线照相全身矢状对准参数，耳道中心和股骨头偏移(CAM-HA)，胸椎后凸(TK),腰椎前凸,骶骨斜坡(SS),和膝关节屈曲角度（KF）。我们将术前髋部伸展角度<0的患者分为伸展受限（ER）组，≥0的患者分为ER-组。H-ROM的差异，对比分析组间影像学参数及术后变化。
57例患者（ER+组28例，ER-组29例。)可用于分析。术前/术后H-ROM为99.7±24.9/118.1±16.0度(p<.01)。SVA增加更大(5.4±3.4vs3.4±2.8厘米，p=.02）和CAM-HA（3.9±3.9vs2.8±3.4cm，p=013）在ER+组与ER-组中发现。术后,ER+组TK升高（术前/术后：35.2±9.7/37.4±8.8度，p=.04）和SS降低（36.5±9.6/33.7±9.9度，p<.01）和KF（9.5±7.0/6.9±6.0度，p=.02）。ER组术后影像学参数变化不显著。
髋关节伸展受限的患者表现出整体脊柱失衡，以及传统知识的重大变化，SS,关节置换术后观察到KF。在评估脊柱骨盆对准和全身矢状位对准时，必须考虑髋关节疾病和H-ROM限制的存在。
