Email this article 
FEATURES OF SURGICAL TACTICS FOR PATIENTS WITH COXO-VERTEBRAL SYNDROME
- Authors: Kudyashev A.L.1, Khominets V.V.1, Shapovalov V.M.1, Metlenko P.A.1, Miroevsky M.V.1, Rezvantsev M.V.1, Teremshonok A.V.1
-
Affiliations:
- Kirov Military Medical Academy of the Ministry of Defense of Russian Federation
- Issue: Vol 23, No 1 (2017)
- Pages: 132-143
- Section: Discussions
- URL: https://journal.rniito.org/jour/article/view/698
- DOI: https://doi.org/10.21823/2311-2905-2017-23-1-132-143
- ID: 698
Cite item
Full Text
Abstract
Purpose of the study – to design the algorithm of selection for rational surgical tactics for treatment of patients with coxo-vertebral syndrome.
Material and methods. 175 patients with coxo-vertebral syndrome were included into the study who underwent total hip replacement in the period from 2009 till 2016. The authors analyzed outcomes of treatment of 134 patients at midterm follow up of 9 months (range from 8 to 10 months) after the surgery. Mean age of patients was 54,4±12,7 y.o. Patients were subdivided into a test group (94 patients) and control group (81 patients). Standard THR approaches were used in the control group by restoring anatomical center of rotation and lower leg length. The suggested algorithm of the optimal procedure selection was applied in the test group. Clinical and functional data was evaluated by Harris Hip Score and Oswestry score. Radiographic evaluation was performed based on x-rays of vertebral-pelvic complex in standing position, by functional x-rays, CT and MRI. Evaluation of differences significance between the groups was performed by MannWhitney U-test and McNemar test.
Results. Application of proposed surgical approaches allowed to increase the number of patients with good clinical and functional outcomes (test group – 82,4%, control group – 26,7%) and achieve better function of hip joint and patients’ life quality in short-term postoperative period. Excellent outcomes by Harris hip score were observed in 53,2% of patients, in control group – in 9,7%. Share of the patients complaining of lumber pain, limping and need for a walking stick after THR in the test group was less than in control group. Share of patients demonstrating pain at palpation of spinous processes, with positive test of elevated extended leg and radicular syndrome was also significantly less in test group as compared to control group.
Conclusion. Practical application of proposed algorithm for selection of a rational tactics of surgical treatment for patients with combined degenerative and distrophic pathology of the hip joint and spine allows in short-term after THR to statistically significantly improve treatment outcomes in comparison with patients that underwent conventional preoperative planning and THR.
About the authors
A. L. Kudyashev
Kirov Military Medical Academy of the Ministry of Defense of Russian Federation
Author for correspondence.
Email: a.kudyashev@gmail.com
Alexey L. Kudyashev – Cand. Sci. (Med.), Deputy Head of the Department and Clinic of Traumatology and Orthopedics
6, ul. Akad. Lebedeva, St. Petersburg, 194044
Russian FederationV. V. Khominets
Kirov Military Medical Academy of the Ministry of Defense of Russian Federation
Email: fake@neicon.ru
Vladimir V. Khominets – Dr. Sci. (Med.), Head of the Department and Clinic of Traumatology and Orthopedics Russian Federation
V. M. Shapovalov
Kirov Military Medical Academy of the Ministry of Defense of Russian Federation
Email: fake@neicon.ru
Шаповалов Владимир Михайлович – доктор медицинских наук профессор кафедры и клиники военной травматологии и ортопедии Russian Federation
P. A. Metlenko
Kirov Military Medical Academy of the Ministry of Defense of Russian Federation
Email: fake@neicon.ru
Pavel A. Metlenko – Cand. Sci. (Med.), Director of Orthopedic Department of the Department and Clinic of Traumatology and Orthopedics Russian Federation
M. V. Miroevsky
Kirov Military Medical Academy of the Ministry of Defense of Russian Federation
Email: fake@neicon.ru
Philipp V. Miroevsky – Cand. Sci. (Med.), Doctor at the Department of Traumatology and Orthopedics Russian Federation
M. V. Rezvantsev
Kirov Military Medical Academy of the Ministry of Defense of Russian Federation
Email: fake@neicon.ru
Mikhail V. Rezvantsev – Cand. Sci. (Med.), Deputy Head of the educational-methodical department Russian Federation
A. V. Teremshonok
Kirov Military Medical Academy of the Ministry of Defense of Russian Federation
Email: fake@neicon.ru
Andrei V. Teremshonok – Cand. Sci. (Med.), Head Teacher of the Department and Clinic of Traumatology and Orthopedics Russian Federation
References
- Вакуленко В.М., Худобин В.Ю., Бублик Л.А. Дегенеративно-дистрофические поражения тазобедренных суставов и позвоночника. Травма. 2000;1(1):24-26.
- Герцен Г.И., Дыбкалюк С.В., Остапчук Н.П. Лечение дегенеративно-дистрофической патологии позвоночного сегмента при пояснично-тазобедренном синдроме. Літопис травматології та ортопедії. 2003;(1/2):75-78.
- Денисов А.О., Шильников В.А., Барнс С.А. Коксовертебральный синдром и его значение при эндопртезировании тазобедренного сустава (обзор литературы). Травматология и ортопедия России. 2012;(1):121-127.
- Продан А.И., Радченко В.А., Хвисюк А.Н., Куценко В.А. Закономерности формирования вертикальной осанки и параметры сагиттального позвоночно-тазового баланса у пациентов с хронической люмбалгией и люмбоишиалгией. Хирургия позвоночника. 2006;(4):61-69.
- Реброва О.Ю. Статистический анализ медицинских данных. Применение пакета прикладных программ Statistica. М. : МедиаСфера; 2003. 312 с.
- Руководство по эндопротезированию тазобедренного сустава / под ред. Р.М. Тихилова, В.М. Шаповалова. СПб., 2008. 324 с..
- Сазонова Н.В., Щурова Е.Н. Влияние комплексной консервативной терапии на динамику интенсивности боли при hip-spine syndrome. Хирургия позвоночника. 2008;(3):48-51.
- Хоминец В.В., Кудяшев А.Л., Шаповалов В.М., Мироевский Ф.В. Современные подходы к диагностике сочетанной дегенеративно-дистрофической патологии тазобедренного сустава и позвоночника. Травматология и ортопедия России. 2014; (4):16-26.
- Юнкеров В.И., Григорьев С.Г., Резванцев М.В. Математико-статистическая обработка данных медицинских исследований. 3-е изд., доп. СПб. : ВМедА; 2011. 318 с.
- 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 (Phila Pa 1976). 2007;32(19): 2099-2102. doi: 10.1097/BRS.0b013e318145a3c5.
- Burns S.A., Burshteyn M., Mintken P.E. Sign of the buttock following total hip arthroplasty. J Orthop Sports Phys Ther. 2010;40(6):377. doi: 10.2519/jospt.2010.0410.
- During J., Goudfrooij H., Keessen W. et al. Toward standards for posture. Postural characteristics of the lower back system in normal and pathologic condi-tions. Spine (Phila Pa 1976). 1985;10(1):83-87.
- Fogel G.R., Esses S.I. Hip spine syndrome: management of coexisting radiculopathy and arthritis of the lower extremity. Spine J. 2003;3(3):238-241.
- K obayashi T., Atsuta Y., Matsuno T., Takeda N. A longitudinal study of congruent sagittal spinal alignment in an adult cohort. Spine (Phila Pa 1976). 2004;29(6): 671-676.
- Le Huec J.C., Saddiki R., Franke J. et al. Equilibrium of the human body and the gravity line: the basics. Eur Spine J. 2011;20(Suppl. 5):558-563. doi: 10.1007/s00586-011-1939-7.
- Legaye J., Duval-Beaupere G., Hecquet J., Marty C. Pelvic incidence: a fundamental pelvic parameter for threedimensional regulation of spinal sagittal curves. Eur Spine J. 1998;7(2):99-103.
- Offierski C.M., Macnab I. Hip-spine syndrome. Spine. 1983;8(3):316-321.
- Schwab F., V. Lafage, A. Patel, Farcy J.P. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976). 2009;34(17):1828-1833. doi: 10.1097/BRS.0b013e3181a13c08.
- Yoshimoto H., Sato S., Masuda T. et al. Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain. Spine (Phila Pa 1976). 2005;30(14):1650-1657.
Supplementary files
