Influência da artroplastia total de quadril sobre o equilíbrio sagital lombopélvico: Avaliação dos parâmetros radiográficos^[*]

Resumo

Objetivo Analisar prospectivamente as variáveis radiográficas do equilíbrio sagital da coluna lombossacral no pré e pós-operatório dos pacientes submetidos a artroplastia total de quadril (ATQ).

Métodos Estudo prospectivo, observacional e comparativo que avaliou parâmetros radiográficos pré e pós-operatórios imediatos de 71 pacientes submetidos a 72 ATQs em três anos (2014–2017) por coxartrose primária, dos quais 28 fizeram controle pós-operatório tardio (6 meses), através do programa Surgimap Spine (Surgimap, Nova York, NY, EUA). A análise estatística foi feita com o teste t de Student, o modelo de análise de covariância (ANCOVA, na sigla em inglês) e o teste de Kolmogorov-Smirnov. Os dados foram analisados com o programa IBM SPSS Statistics for Windows, Versão 20.0 (IBM Corp., Armonk, NY, EUA). Valores de p < 0,05 indicaram significância estatística.

Resultados Os 72 casos avaliados apresentaram uma idade média de 57,9 anos, com predominância do sexo feminino (60,6%) e de pacientes > 50 anos (71,8%). Houve uma diminuição global nos valores da lordose lombar no pós-operatório imediato, sem grandes alterações globais na evolução tardia. Aferiu-se que pacientes com uma incidência pélvica ≥ 60° tendem a ter os demais parâmetros do equilíbrio sagital elevados.

Conclusão Não houve diferença significativa entre as variáveis radiográficas do equilíbrio sagital lombopélvico nos períodos avaliados. A lordose lombar e a incidência pélvica foram os principais fatores modificantes. A melhoria da lombalgia pós-ATQ sem alterações desses parâmetros sugere diferentes mecanismos da patologia ainda a serem esclarecidos.

Palavras-chave

artroplastia de quadril - coluna vertebral - dor lombar

^* Trabalho feito no serviço de Ortopedia e Traumatologia do Hospital Universitário Cajuru (PUC-PR), Curitiba, PR, Brasil. Publicado Originalmente por Elsevier Editora Ltda.

• Referências

• 1 Jackson RP, McManus AC. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine 1994; 19 (14) 1611-1618
• 2 Duval-Beaupère G, Robain G. Visualization on full spine radiographs of the anatomical connections of the centres of the segmental body mass supported by each vertebra and measured in vivo. Int Orthop 1987; 11 (03) 261-269
• 3 Morvan G, Wybier M, Mathieu P, Vuillemin V, Guerini H. [Plain radiographs of the spine: static and relationships between spine and pelvis]. J Radiol 2008; 89 (5 Pt 2): 654-663 , quiz 664–666
• 4 Dimar II JR, Carreon LY, Labelle H. , et al. Intra- and inter-observer reliability of determining radiographic sagittal parameters of the spine and pelvis using a manual and a computer-assisted methods. Eur Spine J 2008; 17 (10) 1373-1379
• 5 Akbar M, Terran J, Ames CP, Lafage V, Schwab F. Use of Surgimap Spine in sagittal plane analysis, osteotomy planning, and correction calculation. Neurosurg Clin N Am 2013; 24 (02) 163-172
• 6 Le Huec JC, Roussouly P. Sagittal spino-pelvic balance is a crucial analysis for normal and degenerative spine. Eur Spine J 2011; 20 (Suppl. 05) 556-557
• 7 Eyvazov K, Eyvazov B, Basar S, Nasto LA, Kanatli U. Effects of total hip arthroplasty on spinal sagittal alignment and static balance: a prospective study on 28 patients. Eur Spine J 2016; 25 (11) 3615-3621
• 8 Lazennec JY, Brusson A, Rousseau MA. Hip-spine relations and sagittal balance clinical consequences. Eur Spine J 2011; 20 (Suppl. 05) 686-698
• 9 Buckland AJ, Vigdorchik J, Schwab FJ. , et al. Acetabular anteversion changes due to spinal deformity correction: bridging the gap between hip and spine surgeons. J Bone Joint Surg Am 2015; 97 (23) 1913-1920
• 10 Offierski CM, MacNab I. Hip-spine syndrome. Spine 1983; 8 (03) 316-321
• 11 Bisson EJ, McEwen D, Lajoie Y, Bilodeau M. Effects of ankle and hip muscle fatigue on postural sway and attentional demands during unipedal stance. Gait Posture 2011; 33 (01) 83-87
• 12 Duval-Beaupère G, Schmidt C, Cosson P. A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng 1992; 20 (04) 451-462
• 13 Gelb DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW. An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 1995; 20 (12) 1351-1358
• 14 Vedantam R, Lenke LG, Keeney JA, Bridwell KH. Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults. Spine 1998; 23 (02) 211-215
• 15 Kulcheski AL, Soler I, Graells X, Benato ML, Baretta G. Avaliação angular do equilíbrio sagital em pacientes obesos. Coluna/Columna 2013; 12 (03) 224-227
• 16 Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 1998; 7 (02) 99-103
• 17 Vaz G, Roussouly P, Berthonnaud E, Dimnet J. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 2002; 11 (01) 80-87
• 18 Barrey C, Jund J, Noseda O, Roussouly P. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 2007; 16 (09) 1459-1467
• 19 Labelle H, Roussouly P, Berthonnaud E. , et al. Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine 2004; 29 (18) 2049-2054
• 20 Ben-Galim P, Ben-Galim T, Rand N. , et al. Hip-spine syndrome: the effect of total hip replacement surgery on low back pain in severe osteoarthritis of the hip. Spine 2007; 32 (19) 2099-2102
• 21 Radcliff KE, Orozco F, Molby N. , et al. Change in spinal alignment after total hip arthroplasty. Orthop Surg 2013; 5 (04) 261-265
• 22 Weng WJ, Wang WJ, Wu MD, Xu ZH, Xu LL, Qiu Y. Characteristics of sagittal spine-pelvis-leg alignment in patients with severe hip osteoarthritis. Eur Spine J 2015; 24 (06) 1228-1236
• 23 Buckwalter JA, Saltzman C, Brown T. The impact of osteoarthritis: implications for research. Clin Orthop Relat Res 2004; (427, Suppl) S6-S15
• 24 Morrey BF, Adams RA, Kessler M. A conservative femoral replacement for total hip arthroplasty. A prospective study. J Bone Joint Surg Br 2000; 82 (07) 952-958
• 25 Murphy WS, Klingenstein G, Murphy SB, Zheng G. Pelvic tilt is minimally changed by total hip arthroplasty. Clin Orthop Relat Res 2013; 471 (02) 417-421
• 26 Blondel B, Parratte S, Tropiano P, Pauly V, Aubaniac JM, Argenson JN. Pelvic tilt measurement before and after total hip arthroplasty. Orthop Traumatol Surg Res 2009; 95 (08) 568-572
• 27 Miki H, Kyo T, Kuroda Y, Nakahara I, Sugano N. Risk of edge-loading and prosthesis impingement due to posterior pelvic tilting after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2014; 29 (06) 607-613
• 28 Shon WY, Sharma V, Keon OJ, Moon JG, Suh DH. Can pelvic tilting be ignored in total hip arthroplasty?. Int J Surg Case Rep 2014; 5 (09) 633-636