背景:这项研究旨在评估成人脊柱畸形脊柱排列矫正手术后脊柱骨盆排列参数与髋关节骨关节炎进展之间的关系,重点关注术前术后脊柱骨盆排列的变化。
方法:这项回顾性研究纳入了100名接受脊柱融合术的成人脊柱畸形患者(196个髋关节),在排除之前的全髋关节置换术的四个关节后。髋臼车顶倾角(ARO),测量髋关节中心边缘角(CE)和Kellgren和Lawrence(KL)等级。术前和术后1个月测量脊柱骨盆对准参数,并计算在此期间的变化(Δ)。对患者进行≥5年的随访,并通过logistic回归分析确定术后5年与KL分级进展相关的因素。
结果:在对所有病例的分析中,KL等级在23个关节中进展。Logistic回归分析显示年龄(OR:1.098,95%CI:1.007-1.198,p=0.019),ARO(OR:1.176,95%CI:1.01-1.37,p=0.026),和ΔPI(OR:0.791,95%CI:0.688-0.997,p<0.001)作为与KL分级进展显着相关的参数。另一方面,在分析中,仅有185例术后1个月KL等级为0,KL等级在13个关节中进展。Logistic回归分析显示PI-LL(OR:1.058,95%CI:1.001-1.117,p=0.04),ΔPI(OR:0.785,95%CI:0.649-0.951,p<0.001),和ΔCobb(OR:1.127,95%CI:1.012-1.253,p=0.009)作为与进展显著相关的参数。
结论:这项研究的总体分析和有限分析都确定了术前到术后PI的变化是影响脊柱融合术后髋关节骨关节炎进展的参数。PI降低可能代表预先存在的骶髂关节松弛。具有此危险因素的患者应仔细随访,以了解可能的髋关节骨关节炎进展。
BACKGROUND: This study aimed to evaluate the association between spinopelvic alignment parameters and hip osteoarthritis progression after spinal alignment correction surgery for adult spinal deformity, focusing on the preoperative to postoperative change in spinopelvic alignment.
METHODS: This retrospective study enrolled 100 adult spinal deformity patients (196 hip joints) who underwent spinal fusion surgery, after excluding four joints with previous total hip arthroplasty. Acetabular roof obliquity (ARO), center edge angle (CE) and Kellgren and Lawrence (KL) grade were measured in the hip joint. Spinopelvic alignment parameters were measured preoperatively and 1-month postoperatively and the changes (Δ) during this period were calculated. Patients were followed-up for ≥ 5 years and factors associated with KL grade progression at 5-years postoperatively were determined by logistic regression analysis.
RESULTS: In the analysis with all cases, KL grade progressed in 23 joints. Logistic regression analysis revealed age (OR: 1.098, 95% CI: 1.007-1.198, p = 0.019), ARO (OR: 1.176, 95% CI: 1.01-1.37, p = 0.026), and Δ PI (OR: 0.791, 95% CI: 0.688-0.997, p < 0.001) as parameters significantly associated with KL grade progression. On the other hand, in the analysis limited to 185 cases with 1-month postoperative KL grade of 0, KL grade progressed in 13 joints. Logistic regression analysis revealed PI-LL (OR: 1.058, 95% CI: 1.001-1.117, p = 0.04), ΔPI (OR: 0.785, 95% CI: 0.649-0.951, p < 0.001), and ΔCobb (OR: 1.127, 95% CI: 1.012-1.253, p = 0.009) as parameters significantly associated with progression.
CONCLUSIONS: Both the overall and limited analyzes of this study identified preoperative to postoperative change in PI as parameters affecting the hip osteoarthritis progression after spinal fusion surgery. Decrease in PI might represent preexisting sacroiliac joint laxity. Patients with this risk factor should be carefully followed for possible hip osteoarthritis progression.