中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (6): 857-861.doi: 10.12307/2023.794

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

发育性髋关节发育不良患者髋臼发育程度与脊柱-骨盆参数的相关性

林天烨1，2，张文胜1，2，何晓铭1，2，何敏聪1，2，李子祺1，2，陈镇秋3，张庆文1，2，何  伟1，2，魏秋实1，2   

  1. 1广东省中医骨伤研究院，广东省广州市   510405；2广州中医药大学第三附属医院，广东省广州市   510405；3广州中医药大学第一附属医院，广东省广州市   510000
  • 收稿日期:2022-11-24 接受日期:2023-01-04 出版日期:2024-02-28 发布日期:2023-07-11
  • 通讯作者: 魏秋实，博士，副主任医师，广东省中医骨伤研究院，广东省广州市 510405；广州中医药大学第三附属医院，广东省广州市 510405
  • 作者简介:林天烨，男，1992年生，广东省云浮市人，汉族，博士，主治医师，主要从事中医药治疗骨关节疾方面的研究。
  • 基金资助:
    国家自然科学基金面上项目(82274544)，项目负责人：魏秋实；广东省中医药管理局项目(20223012)，项目负责人：张庆文；广东省中医骨伤研究院开发课题(GYY202102-03)，项目负责人：张庆文；广州中医药大学第三附属医院科研创新基金课题(Sy2022002)，项目负责人：林天烨

Correlation between acetabular development and spinopelvic parameters in patients with developmental dysplasia of the hip

Lin Tianye1, 2, Zhang Wensheng1, 2, He Xiaoming1, 2, He Mincong1, 2, Li Ziqi1, 2, Chen Zhenqiu3, Zhang Qingwen1, 2, He Wei1, 2, Wei Qiushi1, 2   

  1. 1Guangdong Institute of Traditional Chinese Medicine Bone Trauma, Guangzhou 510405, Guangdong Province, China; 2Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 3First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
  • Received:2022-11-24 Accepted:2023-01-04 Online:2024-02-28 Published:2023-07-11
  • Contact: Wei Qiushi, MD, Associate chief physician, Guangdong Institute of Traditional Chinese Medicine Bone Trauma, Guangzhou 510405, Guangdong Province, China; Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • About author:Lin Tianye, MD, Attending physician, Guangdong Institute of Traditional Chinese Medicine Bone Trauma, Guangzhou 510405, Guangdong Province, China; Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:
    General Program of National Natural Science Foundation of China, No. 82274544 (to WQS); Project of Guangdong Provincial Administration of Traditional Chinese Medicine, No. 20223012 (to ZQW); Development Project of Guangdong Academy of Traditional Chinese Medicine Osteopathy, No. GYY202102-03 (to ZQW); Research and Innovation Fund of Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. Sy2022002 (to LTY)

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摘要：


文题释义：

发育性髋关节发育不良：是由于髋关节发育缺陷或滞后导致髋臼或股骨头的大小、形态、方向发生异常，进而影响髋臼、股骨头等骨性或关节囊、韧带及肌肉等髋周软组织的病变。随着发育性髋关节发育不良的病程进展，髋外翻、股骨头覆盖不足、股骨前倾角增加、髋臼浅和股骨颈缩短等严重畸形会出现。
脊柱-骨盆参数：脊柱与骨盆在解剖结构上相连接、共同维持躯干平衡，两者的参数相互关联、协调、匹配；当脊柱或骨盆发生疾患时，骨盆或脊柱会发生相应的代偿，从而维持躯干平衡，脊柱-骨盆参数可评估代偿程度的参数，主要包括骨盆倾斜角、骨盆投射角、骶骨倾斜角、胸椎后凸角、胸腰椎后凸角、腰椎前凸角和矢状位躯干偏移等。


背景：在发育性髋关节发育不良的相关研究中，大部分集中于髋关节畸形，目前缺乏髋臼发育不良对脊柱影响的报道。

目的：探讨发育性髋关节发育不良患者冠状位及矢状位脊柱-骨盆参数代偿情况，并探讨髋臼发育程度与脊柱-骨盆参数的相关性。
方法：选择2018年1月至 2022年6月于广州中医药大学第三附属医院就诊的发育性髋关节发育不良患者101例(试验组)，选择同期健康体检者114例(对照组)，两组均拍摄冠状位及矢状位脊柱全长X射线片，获取以下脊柱-骨盆参数：腰椎前凸角、骨盆前倾角、胸腰椎后凸角、Cobb角及C7铅垂线与骶骨中垂线的距离、骶骨倾斜角、骨盆入射角、胸椎后凸角，对比两组受试对象脊柱-骨盆参数差异；另外，对比单侧、双侧以及不同Crowe分型发育性髋关节发育不良患者的脊柱-骨盆参数差异，采用Pearson相关分析探讨髋臼发育程度(Sharp角)与脊柱-骨盆参数的相关性。

结果与结论：①在矢状位上，试验组腰椎前凸角小于对照组(P < 0.05)，骨盆倾斜角、胸腰段后凸角大于对照组(P < 0.05)；在冠状位上，试验组Cobb角、C7铅垂线与骶骨中垂线的距离大于对照组(P < 0.05)；两组间其余脊柱-骨盆参数测量值比较差异均无显著性意义(P > 0.05)；②双侧发育性髋关节发育不良患者的腰椎前凸角小于单侧发育性髋关节发育不良患者(P < 0.05)，骨盆倾斜角、胸腰段后凸角、Cobb角及C7铅垂线与骶骨中垂线的距离均大于单侧发育性髋关节发育不良患者(P < 0.05)；③腰椎前凸角随着Crowe分型严重程度的增加而减少(P < 0.05)，骨盆倾斜角随着Crowe分型严重程度的增加而增加(P < 0.05)；④ Pearson相关分析显示，Sharp角与腰椎前凸角呈负相关(P < 0.05)，骨盆前倾角、Cobb角及C7铅垂线与骶骨中垂线呈正相关(P < 0.05)；⑤结果显示，发育性髋关节发育不良患者的骨盆倾斜角、胸腰段后凸角、Cobb角及C7铅垂线与骶骨中垂线的距离增大，腰椎前凸角减少；髋臼发育不良程度与腰椎前凸角、骨盆倾斜角、Cobb角及C7铅垂线与骶骨中垂线呈显著的相关性。

https://orcid.org/0000-0002-0286-5425 (林天烨) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 髋臼发育程度, 发育性髋关节发育不良, 脊柱-骨盆参数, 代偿, 相关性, 侧弯

Abstract: BACKGROUND: The majority of studies on developmental dysplasia of the hip focus on hip malformations, but there are few reports on the effects of acetabular dysplasia on the spine.  
OBJECTIVE: To investigate the compensation of spinopelvic parameters in coronal and sagittal views in patients with developmental dysplasia of the hip, and to explore the correlation between acetabular development and spinopelvic parameters.
METHODS: A total of 101 patients with developmental dysplasia of the hip admitted to the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2018 to June 2022 were selected as the trial group, and 114 healthy subjects were selected as the control group during the same period. The spinopelvic parameters of the subjects were measured through the full-length X-ray films of the coronal and sagittal spines: lumbar lordosis, anterior pelvic tilt, thoracolumbar kyphosis, Cobb angle, and the distance between the C7 plumb line and the center sacral vertical line, sacral slope, pelvic incidence, and thoracic kyphosis. The differences in spinopelvic parameters were compared between the two groups. In addition, the differences in spinopelvic parameters in patients with unilateral, bilateral and different Crowe classifications of developmental dysplasia of the hip were compared. Pearson correlation analysis was used to explore the correlation between Sharp angle and spinopelvic parameters.  
RESULTS AND CONCLUSION: (1) In the sagittal view, the lumbar lordosis in the trial group was significantly lower than that in the control group (P < 0.05). The pelvic tilt and kyphosis angle of the thoracolumbar segment in the trial group were significantly greater than those in the control group (P < 0.05). In the coronary position, the Cobb angle and the distance between the C7 plumb line and center sacral vertical line in the trial group were significantly greater than those in the control group (P < 0.05). There was no significant difference in the remaining spinopelvic parameters between the two groups (P > 0.05). (2) The lumbar lordosis of patients with bilateral developmental dysplasia of the hip was significantly lower than that of patients with unilateral developmental dysplasia of the hip (P < 0.05). The pelvic tilt, thoracolumbar kyphosis, Cobb angle and the distance between the C7 plumb line and center sacral vertical line in bilateral developmental dysplasia of the hip patients were significantly greater than those in unilateral developmental dysplasia of the hip patients (P < 0.05). (3) The lumbar lordosis decreased with the increase of Crowe classification severity (P < 0.05). The pelvic tilt increased with the severity of the Crowe classification (P < 0.05). (4) Pearson correlation analysis showed that Sharp angle was negatively correlated with lumbar lordosis (P < 0.05), while Sharp angle was positively correlated with anterior pelvic tilt, Cobb angle, C7 plumb line and center sacral vertical line (P < 0.05). (5) It is concluded that the pelvic tilt, thoracolumbar kyphosis, Cobb angle and the distance between the C7 plumb line and center sacral vertical line increase, while lumbar lordosis decreases in developmental dysplasia of the hip patients. The degree of acetabular dysplasia was significantly correlated with lumbar lordosis, pelvic tilt, Cobb angle, C7 plumb line and center sacral vertical line.

Key words: acetabulum development degree, developmental dysplasia of hip, spinopelvic parameter, compensation, relevance, side bend

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