脊柱疾病对全髋关节置换术后骨盆矢状面参数及髋部生物力学的影响

The effect of spine disease on pelvic sagittal alignment and hip biomechanics in total hip arthroplasty patients

目的分析脊柱疾病对全髋关节置换术(THA)后骨盆矢状面参数及髋部生物力学的影响。方法回顾性分析2013年1月至2015年9月在深圳市龙华区人民医院行THA患者,根据是否存在脊柱疾病将患者分为脊柱疾病组(患者存在强直性脊柱炎、后路腰椎间融合内固定术,40例)和对照组(患者无脊柱病史,120例)。记录并比较两组患者腰椎前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)和骶骨倾斜角(SS)。将人体建模仿真系统Anybody的内置模型进行调整,基于正、异常骨盆矢状面参数建立骨肌多体动力学模型(对照模型、疾病模型)。模拟站立位和坐位起身瞬间两种动作,通过逆向动力学的方法评估各动作下髋关节作用力、力矩和髋关节周围肌力。结果脊柱疾病组LL较对照组明显减小[(34.23 ± 12.81)°比(47.26 ± 14.67)°,P<0.05],差异有统计学意义。骨盆矢状面参数方面,两组PI比较差异无统计学意义(P>0.05)。两组PT、SS比较差异均有统计学意义[(17.51 ± 2.31)°比(8.31 ± 1.34)°,(27.61 ± 1.72)°比(38.01 ± 1.92)°,P<0.05]。站立位及坐位起身瞬间姿势下,疾病模型髋关节作用力和髋关节力矩明显高于对照模型,差异有统计学意义(P<0.05),其中两组模型的分力矩差异主要存在于矢状轴及垂直轴,差异有统计学意义(P<0.05)。两组模型站立位与坐位起身瞬间外旋肌群激活程度比较差异无统计学意义(P>0.05)。结论脊柱疾病导致骨盆矢状面参数发生变化,造成THA关节力学性能改变,可能影响髋关节力学稳定性。

Objective To investigate the effect of spine disease on pelvic sagittal alignment and hip biomechanics in total hip arthroplasty (THA) patients. Methods The clinical data of 120 THA patients who had normal lumbar spine (control group) and 40 THA patients who had lumbar disease (lumbar disease group) between January 2013 and September 2015 in Shenzhen Longhua District People′s Hospital were analyzed. Radiographical parameters, like lumbar lordosis (LL), pelvic incidence(PI), pelvic tilt (PT) and sacralslope (SS) were collected and compared. Normal and pathological musculoskeletal simulation model was established based on standing and sitting X-ray pelvic alignment. Hip contact force, moment and muscle forces in standing posture and sitting to standing posture were calculated. Results The value of LL in lumbar disease group was shorter than that in control group:(34.23 ± 12.81)°vs.(47.26 ± 14.67)°, P<0.05. Butthe value of PI in two groups had no significant difference (P > 0.05). The value of PT and SS in two groups had significant differences:(17.51 ± 2.31)° vs.(8.31 ± 1.34)°,(27.61 ± 1.72)° vs.(38.01 ± 1.92)°, P<0.05. At standing position and sitting moment position, the joint force and moment value between disease model and control model had significant differences (P<0.05), and the differences were mainly in sagittal and vertical axis (P<0.05). At standing position and the moment of sitting up, the extorsion muscle activation was at lower level and had no significant difference (P>0.05). Conclusions Pelvic sagittal alignment pathology could change hip biomechanical situation, making threats to hip stability.