Search

BACKGROUND: Pelvic tilt, which is often seen in hip diseases, is also a common functional problem after total hip arthroplasty. OBJECTIVE: To investigate the mechanism of occurrence and recovery of pelvic tilt after unilateral total hip arthroplasty in patients with femoral head necrosis. METHODS: The clinical data of 100 patients with femoral head necrosis who underwent unilateral total hip arthroplasty in the Department of Femoral Head Necrosis, Bone Injury Center of First Affiliated Hospital of Guangzhou University of Chinese Medicine were collected retrospectively from June 2021 to February 2023. The patients were divided into three groups, namely, groups A (< 2°, n=48), B (2°-3°, n=34), and C (> 3°, n=18), according to the severity of pelvic tilt on postoperative 3 day. Statistical data were collected and compared between the pre- and postoperative periods of patients of these three groups in terms of the angle of the coronal plane of the pelvis tilt, the length of the gluteus medius muscles of the bilateral sides, the heights of the rotational centers of the femoral heads, the difference in the lengths of the gluteus medius muscles of the bilateral sides and the heights of the rotational centers of the femoral heads, and the ratio of changes in the angle of the pelvic tilt. Pearson correlation coefficient was used to examine the correlation between pelvic tilt angle and other indexes. RESULTS AND CONCLUSION: (1) Pelvic tilt aggravation occurred in the short term after surgery. (2) The ratio of change in pelvic tilt angle from postoperative 3 days to postoperative 1 month time period differed between the groups, with group C > group B > group A. There was a difference between group C and the other groups in the time period from postoperative 1 to postoperative 3 months, with the ratio of change being the smallest in group C. There was no difference in the ratio of change between the groups in the time period from postoperative 3 days to postoperative 3 months. (3) The difference in bilateral gluteus medius muscles decreased gradually after surgery, and there was no difference in the comparison of bilateral gluteus medius muscles in the time period from postoperative 3 months. (4) The difference between bilateral centers of rotation increased after surgery, and the difference between bilateral heights at 3 months after surgery was smaller than that before surgery. (5) The pelvic tilt angle at 3 days after surgery, the duration of the disease and the pelvic tilt angle at 3 months after surgery were significantly correlated (all P=0.000), and the difference between bilateral gluteus medius muscles before surgery and the pelvic tilt angle at 3 days after surgery was significantly correlated (P=0.006) (6) The functional pelvic tilt occurred in the patients with femoral head necrosis after total hip arthroplasty. Correction of the pelvic tilt after surgery was based on the adaptive restoration of the functional pelvic tilt angle after surgery. Functional pelvic tilt arises as a compensatory adaptation of the organism based on the short-term postoperative reconstruction of bony structures and the survival of cumulative soft tissue damage. [ABSTRACT FROM AUTHOR]

BACKGROUND: Osteoporotic vertebral compression fracture is a common fracture secondary to osteoporosis. At present, there is no effective prediction index and method for osteoporotic vertebral compression fracture. OBJECTIVE: To investigate the predictive effect of the comprehensive index of lumbar vertebral body bone strength on osteoporotic vertebral compression fracture. METHODS: 233 patients with osteoporosis were divided into a fracture group and a non-fracture group according to whether a vertebral fracture occurred. The demography, body mass index, vertebral bone mineral density and other details were collected. Lateral X-ray films of the lumbar spine were photographed. The vertebral body width, vertebral body length, sacral slope, pelvic tilt, pelvic incidence, lumbar compressive strength index and the lumbar impact strength index were measured, calculated, and analyzed by univariate and multivariate, and the receiver operating characteristic curve was analyzed. The survival analysis was conducted according to the cut-off value. RESULTS AND CONCLUSION: (1) All patients were followed up for 2-4 years, with an average of 3.1 years. During the follow-up period, 99 cases (38 cases of L1 vertebral body, 61 cases of L2 vertebral body) had fractures (fracture group), and 134 cases (52 cases of L1 vertebral body, 82 cases of L2 vertebral body) had no fractures (non-fracture group). Univariate analysis showed that there was no significant difference in age, sex, height, body mass, body mass index and fracture segment between the two groups (P > 0.05). (2) Lumbar compressive strength index and lumbar impact strength index in the fracture group were lower than those in the non-fracture group (P<0.05). Pelvic incidence and pelvic tilt in the fracture group were higher than those in the non-fracture group (P<0.05). (3) Multivariate analysis showed that lumbar compressive strength index, lumbar impact strength index and pelvic tilt were risk factors for osteoporotic vertebral compression fractures (P<0.05). (4) Receiver operating characteristic curve analysis showed that the cutoff values of vertebral bone mineral density, lumbar compressive strength index, lumbar impact strength index, pelvic tilt and pelvic incidence were 0.913 5 g/cm2, 1.932, 0.903, 21.5° and 55°, respectively; areas under the curve were 0.630, 0.800, 0.911, 0.633 and 0.568, respectively. (5) According to the survival analysis (with osteoporotic vertebral compression fracture as the end point), the average survival time of the patients with lumbar impact strength index ≥0.903 was significantly longer than that of the patients with lumbar impact strength index < 0.903 (P<0.05). (6) These findings conclude that the comprehensive index of lumbar vertebral body bone strength is more accurate than the bone mineral density of the vertebral body and spine-pelvis sagittal parameters in predicting osteoporotic vertebral compression fractures, which is helpful for early prevention and treatment of osteoporotic vertebral compression fractures. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lumbar spinal stenosis is the most common degenerative disease of the spine in the elderly, and its symptoms and postoperative efficacy are related to both local sequence and overall balance. However, the reasonable range of spinal-pelvic sagittal parameters in this population is unknown. OBJECTIVE: To determine and validate the acceptable interval of sagittal lumbo-pelvic parameters for lumbar spinal stenosis patients. METHODS: A total of 376 patients with lumbar spinal stenosis who were admitted to Peking University People's Hospital from June 2016 to December 2019 were selected. According to the scoring principle of propensity matching and the ratio of (2-3):1, they were divided into a derivation cohort group (n=276) and a validation cohort group (n=100). Imaging examinations were performed preoperatively and at the final postoperative follow-up to obtain sagittal spinopelvic parameters, containing thoracolumbar kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt and sagittal vertical axis. | Pelvic incidence - lumbar lordosis |, pelvic tilt and sagittal vertical axis were seen as the main parameters. Quality-of-life was evaluated by the Oswestry disability index, which contained four quarters orderly: mild, sub-mild, sub-severe and severe dysfunction. The reasonable threshold of parameters corresponding to Oswestry disability index was determined by both linear regression and logistic regression. Cases in the validation cohort were used to verify the results concluded from derivation cohort. RESULTS AND CONCLUSION: (1) Oswestry disability index got improvement in the final follow-up. At baseline, Oswestry disability index was positively correlated to | pelvic incidence - lumbar lordosis | (P=0.011) while at final Oswestry disability index was positively correlated to | pelvic incidence - lumbar lordosis | and pelvic tilt (P=0.029, P=0.008) but not correlated to sagittal vertical axis in the derivation cohort. (2) Mild, sub-mild, sub-severe and severe dysfunctions of Oswestry disability index were 15-35, 36-39, 40-43, and 44-50 preoperatively, but 0-4, 5-8, 9-12, and 13-40 in the final follow-up, respectively in the derivation cohort. Multiple regression analysis showed that the independent factor affecting preoperative Oswestry disability index was | pelvic incidence - lumbar lordosis |, with Oswestry disability index =0.19×| pelvic incidence - lumbar lordosis |+36.9 and the mean threshold of preoperative | pelvic incidence - lumbar lordosis | was 10.7°. At final, pelvic tilt was the influencing factor of Oswestry disability index and | pelvic incidence - lumbar lordosis | was the influencing factor of pelvic tilt with Oswestry disability index =0.21× pelvic tilt +3.16 and pelvic tilt =0.60×| pelvic incidence - lumbar lordosis |+12.22. (3) The mean threshold of postoperative | pelvic incidence - lumbar lordosis | was 16.0° and pelvic tilt was 23.1° by both linear regression and logistic regression. (4) In validation cohort, Oswestry disability index in patients less than the threshold of | pelvic incidence - lumbar lordosis | was superior to cases with over-larged | pelvic incidence - lumbar lordosis | (P=0.046). (5) It is concluded that | pelvic incidence - lumbar lordosis |=16.0° was probably the reasonable sagittal range for lumbar spinal stenosis with posterior surgery and we should be tolerate to spino-pelvic matching for this population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous studies have reported the comparison of the sagittal parameters of the spine and pelvis between patients with lumbar spondylolisthesis and the normal population, but comparative studies on the differences in imaging parameters between patients with different subtypes of lumbar spondylolisthesis and their impact on the quality of life scores are relatively scarce. OBJECTIVE: To analyze the differences in imaging parameters between subtypes of lumbar spondylolisthesis and its relationship with quality of life. METHODS: This study retrospectively analyzed 63 patients with lumbar spondylolisthesis. These patients were divided into degenerative lumbar spondylolisthesis group (n=35) and isthmic spondylolisthesis group (n=28). Spine and pelvic imaging parameters, including sagittal vertebral axis, lumbarlordosis, pelvic incidence, pelvic tilt, sacral slope, pelvic incidence-lumbar lordosis matching, lumbar 1 plumb line, upper lumbar curve, and lower lumbar curve, and functional score (health related quality of life score) were analyzed between the two groups. The protocols were in accordance with the relevant ethical requirements of Declaration of Helsinki and Tianjin People’s Hospital. The patients signed informed consent. RESULTS AND CONCLUSION: (1) In the study of preoperative imaging parameters, sagittal vertebral axis was significantly higher in the degenerative lumbar spondylolisthesis group than that in the isthmic spondylolisthesis group. Pelvic tilt, lumbar lordosis, upper lumbar curve, and lower lumbar curve were significantly lower in the degenerative lumbar spondylolisthesis group than those in the isthmic spondylolisthesis group (all P < 0.05 or P < 0.01). The other imaging indications showed no significant differences between the two groups. (2) Pelvic tilt was significantly lower in patients with visual analogue scale (low back pain) score ≤3 than that in patients scoring > 3 (P=0.026, P=0.047). (3) There was no significant difference in imaging indexes between the two groups of patients with preoperative Oswestry disability index > 40 and those with Oswestry disability index ≤40. (4) The results have shown that there are significant differences in sagittal biomechanics between degenerative lumbar spondylolisthesis and isthmic fissure lumbar spondylolisthesis. Pelvic tilt was significantly lower in patients with visual analogue scale (low back pain) score ≤3 than that in patients scoring > 3. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Capital Institute of Physical Education is the property of Shoudu Tiyu Xueyuan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective The aim of this study was to investigate the occurrence patterns and classification method of pelvic tilts （PT） induced by hip-joint diseases via analyzing the causes and clinical features. Methods 180 patients with PT induced by hip-joint diseases who were treated at the department of orthopedics in the first affiliated hospital of Kunming Medical University from January 2012 to December 2014 were analyzed retrospectively. The clinical manifestations， progression， deformity features， hip-joint functions， and WHO pain degree were confirmed， their relationships with different PT types were analyzed，the occurrence patterns and the classification method were investigated. Results （1） There were 37 patients subjected to the type I PT， who were abduction contracture with flexion occurred to the affected hips and their pelvis tilted towards the affected limb. Their pain degrees were relatively low. Besides，the other 143 patients with type II PT，were abduction contracture with flexion occurred and pelvis tilted towards the contralateral limb. Their pain degrees were relatively heavy. （2） There were significantly differences in PT constituent ratios among different causes and different pain grades （fisher exact value were 40.267 and 96.739， respectively. P ＜0.05） . So，causes as well as pain grade were both correlated to the type of PTs. Conclusion （1） If the pain grade is lower，the affected hip joint will mostly bend and show abduction contracture malformation with a pelvic tilt towards the affected side. If the pain grade is higher， the affected joint will mostly bend and show adduction contracture malformation with a pelvic tilt towards contralateral side. （2） The coronal PT direction induced by hip-joint diseases is consistent with the moving direction of body's center gravity. （3） According to the types of contracture malformation and the shortening conditions of the affected limbs，PTs are divided into the following groups: Type I: Abduction contracture of the affected hip-joint，including Type IA: with equal bilateral spine-ankle lines （SAL），and Type IB: with unequal bilateral ASL；Type II: Adduction contracture of the affected hip-joint， including Type IIA: with equal bilateral SAL，and Type IIB: with unequal bilateral SAL. （4） Coronal PTs induced by unilateral hip-joint diseases are mostly Type II PT. [ABSTRACT FROM AUTHOR]

Objective: To study the effects of simulating leg length inequality on the spine and pelvic posture in standing and walking states and to explore their compensatory laws. Methods: From January to April, a total of 44 healthy volunteers were rasterstereographically examined for spine and pelvis in Institute of Digitized Medicine, Wenzhou Medical University and Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University.Volunteers wore uniform shoes, and single 5 mm thick insoles were customized.The simulating leg length inequalities (5-30 mm) were artificially created by increasing insole height.The parameters of 3D body surface parameters and 4D dynamic parameters of the pelvic and spine were measured and statistically analyzed in standing and walking states. Results: In the static standing state, with the increase of the difference of both lower extremities, coronal plane pelvic tilt and sagittal plane pelvic torsion also increased[the maximum value about (10.6±4.3) mm and (3.3±3.5)°], as well as the frontal deviation of the spine [the maximum value about (11.1±17.9) mm]. But the pelvic rotation, vertebral surface rotation angle (rms) and spine sagittal plane deviation were no obvious changes.In the walking state, with the difference between lower extremities increased, the maximum angles of vertebral surface rotation to the left and right and pelvic rotation to the left and right were no obvious changes, but (coronal) spinal maximum offset distance to left and right increased [the maximum value about (9.8±5.1), (10.4±6.9) mm]. Conclusion: The effect of the leg length discrepancy on the pelvic coronal plane and the sagittal plane changes are obvious, but little effect has on the pelvic cross section.The pelvis is compensated by the increase of the inclination of the coronal plane and the sagittal angle at first order.Similarly, the effect on the coronal plane of the spine is more markedly, but the changes of sagittal and cross-section of the spine is less affected, the spine is mainly compensated by the coronal plane bending at second order.