| The first part : A study on the sagittal alignment of spinal-pelvic-lower leg and its clinical relevance in patients with KOAObjective:To document the sagittal morphological abnormalities and their clinical relevance in patients with knee osteoarthritis(KOA) by comparing with normal population.Methods:The standing lateral spinal-pelvic radiographs were collected from 58 normal people and 75 patients with KOA and measurements of the following parameters were carried out by two independent observers:(1) the spinal sagittal parameters: spinal-sacral angle(SSA), spinal tilt(ST), lumbar lordosis(LL);(2) the pelvic and lower leg sagittal parameters: pelvic incidence(PI), sacral slope(SS), pelvic tilt(PT), sacral femoral angle(SFA), pelvic femoral angle(PFA), femur inclination(FI). The comparisons among two independent groups were carried out by students’ t tests and the correlation among the sagittal parameters in the KOA group were carried out by Pearson tests.Results:Patients with KOA showed significantly higher FI(11.1±4.9), but smaller SFA(42.7±11.4) and PFA(2.0±8.7) than the normal control group(P<0.05). In addition, the ST(88.9±4.3) of patients with KOA were significantly smaller than the normal control group(P<0.05). Significant correlation were retrieved between SFA and PFA(r=0.494), between SFA and FI(r=-0.668), and between PFA and FI(r=-0.586) in patients with KOA.Conclusion:The significant forward inclination of spine and pelvis observed in KOA patients might due to the knee flexion. The abnormal sagittal spinal-pelvic alignmentin KOA patients should be considered when planning for total knee arthroplasty.The second part:A study on the relation between the sagittal alignment of spinal-pelvic-lower leg and LBP in patients with KOAObjective:To investigate the sagittal spine-pelvis-leg alignment pattern and the compensatory mechanism in patients with KOA and to study the possible mechanism of secondary LBP occurrence.Methods:The standing lateral spinal-pelvic radiographs were collected from 58 normal people and 75 patients with KOA and measurements of the following parameters were carried out by two independent observers:(1) the spinal sagittal parameters: spinal-sacral angle(SSA), spinal tilt(ST), lumbar lordosis(LL);(2) the pelvic and lower leg sagittal parameters: pelvic incidence(PI), sacral slope(SS), pelvic tilt(PT), sacral femoral angle(SFA), pelvic femoral angle(PFA), femur inclination(FI);Visual analogue score(VAS). The comparisons among two independent groups were carried out by students’ t tests and the correlation among the sagittal parameters in the KOA group were carried out by Pearson tests. The global balance patterns of spinopelvic alignment were classified as normal balance, slight unbalance and severe unbalance, according to the relative positions of the C7 plumb line to the sacrum and femoral heads.Results:Patients with KOA showed significantly larger FI(11.1±4.9) but smaller SFA(42.7±11.4), PFA(2.0±8.7) and C7T(88.9±4.3), and significantly higher incidence of severe unbalanced global spinopelvic alignment(26.7%) compared to the normal control group. The patients with FI ≤ 10o showed reduced LL andsignificantly smaller FI and C7 T, but similar pelvis and hip parameters when compared to the control group; whereas the patients with FI>10oshowed significantly larger FI and SS, but smaller C7 T, SFA and PFA when compared to the controls. Additionally, patients with FI ≤ 10o suffered higher incidence of secondary LBP than those with FI>10o.Conclusion : The sagittal alignment of the spine-pelvis-leg was significantly influenced by KOA. The lumbar spine would serve as the primary source to compensate for disturbance of the sagittal alignment in patients with mild knee flexion(FI≤10o), also showing a reduced LL and a forward inclined global spine but less change in the hip joint and pelvis. However, in patients with severe knee flexion(FI>10o), the spine, pelvis and hip joint were all involved in compensation, presenting as a forward inclined spine and pelvis and a flexed hip joint. Both the reduction in lumbar lordosis and forward inclination of the global spine would contribute to the development or deterioration of LBP in these patients.The third part:The sagittal alignment of spine-pelvis-lower leg and its clinical significance of patients with Crowe type IV DDHObjective:To document the sagittal morphological abnormalities and their clinical significance of patients with Crowe type IV developmental dysplasia of the hip(DDH) by comparing with normal population and patients with primary hip osteoarthritis(HOA).Methods:The up-right standing lateral spinal-pelvic radiographs were collected from normal people, 30 patients with HOA and 16 cases with bilateral Crowe IV type DDH and measurements of the following parameters were carried out by two independentobservers:(1) pelvic sagittal parameters: pelvic incidence(PI), sacral slope(SS), pelvic tilt(PT), sacral pelvic incidence(SPI), sacral femoral angle(SFA), pelvic femoral angle(PFA);(2) the spinal sagittal parameters: spinal tilt(ST), lumbar lordosis(LL);(3) the sagittal parameters: femur inclination(FI). Inter-observer reliabilities of these patients were carried out and then comparisons among three groups were carried out by one way ANOVA.Results:There was no statistical significance difference between the groups in age and gender distribution. The reliability of PI in DDH group(a=0.008) was lower than that of the normal control(a=0.350) and HOA group(a=0.276). Patients with DDH showed significantly higher SS(45.6±12.09), PT(16.7±8.81), PI(55.3 ± 16.63), PFA(12.7±15.15), SPI(76.4±10.87) and FI(14.3±7.12) than HOA group(P<0.05). In addition, the LL(37.3±15.87) and ST(87.8±5.43) of patients with DDH were comparable as those of HOA patients but significantly different from the normal control group(P<0.05).Conclusion:DDH patients have more forward tilted pelvis when compared to patients with HOA, which might lead to more forward inclination of spine and flexion of hip and knee joint. The spinal-pelvic sagittal alignment of DDH patients should be considered when planning for total hip arthroplasty. |
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