To analyze principal parameters of sagittal spinopelvic relations in patients with hip-spine syndrome. Material and Methods. Clinical examination protocols and X-ray images of 42 patients with unilateral or bilateral grade 3 hip arthrosis and vertebrogenic pain syndrome were analyzed. Four principal sagittal parameters of spino-pelvic balance were measured, statistically processed, and compared with normal values. Results. The positive correlation was found between the sacral slope and the lumbar lordosis. Normal spino-pelvic relations were noted in 6 (14.3 %) cases, an excessive anteversion of the pelvis with compensatory hyperlordosis-in 34 (81.0 %), and retroversion of the pelvis with flattening of the lumbar lordosis-in 2 (4.7 %) cases. Conclusion. Changes in hip joints cause compensatory responses of the spine. Unilateral or bilateral hip joint arthrosis in most cases leads to excessive anteversion of the pelvis and hyperlordosis of the lumber spine with overloading of its segments. Another variant of compensatory posture is retroversion of the pelvis with a loss of lumbar lordosis. Both types of compensatory vertical posture are associated with vertebrogenic pain syndrome and degenerative-dystrophic changes in the spine.

Objective. To define the effective surgical management of posttraumatic kyphotic deformities in the thoracic spine basing on experimental biomechanical and clinical studies Material and Methods. Experimental biomechanical study was performed in 30 spine specimens. Anterior wedge osteotomy and fixation of a specimen in a kyphotic position modeled kyphotic deformity. Deformity correction with various instrumentation systems was firstly performed by maximal extension of segments adjacent to kyphosis-producing block, and carried on after crossing of intervertebral anatomical structures. Clinical study consisted in X-ray and instrumental examinations of 80 patients operated on for thoracic spine trauma. The magnitude of true posttraumatic deformity was defined as a difference between measured Cobb angle and mean physiological kyphosis value in the studied spine level. Results. Deformity rigidity, character of spine mobilization at the level of correction and size of posttraumatic deformity are the most significant factors determining the efficacy of thoracic posttraumatic kyphosis correction. The study resulted in defining rational approach to surgical correction of posttraumatic deformities in the thoracic spine. Conclusion. Minor kyphotic deformities in the thoracic spine are effectively corrected by instrumentation without mobilization of the spine. Large unfixed kyphosis sometimes requires anterior mobilization. Cases with rigid posttraumatic kyphotic deformity should be operated on with combined mobilization of the spine.

No abstract

Федеральное государственное бюджетное военное образовательное учреждение высшего образования «Военно-медицинская академия имени С.М. Кирова» Министерства обороны Российской Федерации, г. Санкт-Петербург, Россия

Experimental biomechanical study was performed in 60 spine specimens. Anterior wedge osteotomy and fixation of a specimen in a kyphotic position modeled kyphotic deformity. Deformity correction with various instrumentation systems was firstly performed by maximal extension of segments adjacent to kyphosis-producing block, and carried on after crossing of intervertebral anatomical structures. The study resulted in defining rational approach to surgical correction of posttraumatic deformities in the thoracic and lumbar spine. Minor kyphotic deformities are effectively corrected by instrumentation without mobilization of the spine. Large unfixed kyphosis sometimes requires anterior mobilization. Cases with rigid posttraumatic kyphotic deformity should be operated on with combined mobilization of the spine.