The Research Of The Spinal-pelvic Alignment In Patients With Totol Hip Arthroplasty

Background:Spine-pelvis-lower limb alignment is a hot topic in recent years in spine surgery.It is known that hip joint disease can affect the spino-pelvic sagittal alignment and lead to spinal symptoms.In return,spinal disease can also result in pelvic compensatory tilting,which affects the function of the hip joint.Spinal-pelvic alignment is abnormal in patient with high dislocated developmental dysplasia of the hip(DDH),but the specific character of spinal-pelvic alignment,and if it change after total hip arthroplastyare still unclear.It is reported that the stiffness or deformity of the spine can affect the stability of the total hip joint,however,there is still a lack of screening methods for evaluation of the preoperative spinal state of THA patients,nor the strategies for coping with THA patients with various spinal problems.Therefore,the purpose of this study are,1.To evaluate preoperative spinal-pelvic sagittal alignment and parameters of patients with high dislocated dysplastic hip,and the effect of artificial hip arthroplasty on it.2.To evaluate the coronal spine alignment and postoperative changes of patients with unilateral high dislocated DDH.3.To explore and establish a simple and feasible screening process for evaluation of pre-operative spinal state of THA patients.Methods:1.From June,2016 to June,2017,patients with high dislocated dysplastic hip underwent THA in our hospital were enrolled.Patients with femoral head necrosis at the same period were enrolled as control group.Spine VAS was used to evaluate clinical result.SS,LL,SVA were measured on X-ray.Data was compared between two groups,as well as between pre-operation and post-operation.2.Patients with unilateral high dislocated dysplastic hip underwent THA in our hospital from June,2016 to June,2017 were enrolled.Pelvic tilt on coronal plane,lumbar Cobb angle,C7PL-CSVL were measured and compared between pre-operation and post-operation.3.Establish a simple and feasible screening process for evaluation of pre-operative spinal state of THA patients,including AP,LAT dynamics X-ray of lumbar spine.Patients underwent THA in our hospital were enrolled for a pilot study.Result:1.Patients with high dislocated dysplastic hip showed higher rate of lower back pain than control group.Before operation,the average LL,SS of DDH group was higher than that in the control group.The difference was statistically significant.the average LL,SS,SVA of patients with DDH were changed after THA surgery.The difference was statistically significant.The mean SS,LL Angle of the control group was decreased after THA,but the difference was not statistically significant.2.The mean lateral tilt angle of the pelvis before surgery was 10.0° ±4.3°,and lumbar Cobb angle was 12.5°±5.1°C7PL-CSVL was less than 2cm in 83%of the patients.The mean pelvic lateral tilt and lumbar Cobb Angle were lower after operation.Each patients had a C7PL-CSVL value less than 2cm post-operation.Conclusion:1.Patients with high dislocated dysplastic hip had a backward trunk with lumbar hyperlordosis and anterior tilted pelvis,and these abnormity can be improved after THA.2.Pelvis lateral tilt and increased lumbar cobb angle were seen in patients with unilateral high dislocated dysplastic hip,and these can be improved by total hip arthroplasty.3.Preoperative lumbar screening in THA patients is useful for preoperative surgical planning and reduction of complications.