Haluzinskii O. The relationship of the parameters of the spine-pelvic balance with the passage of the hip-spine syndrome

The thesis is devoted to the problems of pathogenesis, to the peculiarities of the clinical and radiographic picture, passage and to the results of the treatment of osteo-arthritis with the corresponding pathology of the spine (hip and lumbar syndrome). A biomechanical model of the stress-strain state of the "spine-pelvis-hip joints" system with the primary lesion of one hip joint has been created. The model highlights a decrease in the axle load on the hip joint by 10 to 30%, which corresponds to the functional insufficiency of the lower extremity with osteo-arthritis І-ІІ and ІІІ-ІV stages respectively. It has been proved that the redistribution of load and deformation in the opposite hip joint and the sacroilical joint depends on the parameters of the spine-pelvic balance (the angle and severity of lumbar lordosis) in patients with osteo-arthritis. The maximum tension is found in the opposite hip joint and intervertebral discs of the lumbar spine with hypolordosis and hyperlordosis – in the opposite sacroilical joint and vertebral joints LI-LV. The obtained data of biomechanical studies are confirmed by clinical manifestations of the hip-spine syndrome. Two-sided osteo-arthritis dominates in patients with hypolordosis, and one-sided osteo-arthritis – with hyperlordosis. Overload of the anterior column (intervertebral discs) of the lumbar spine is clinically accompanied by low back pain with ischias, while overload of the posterior column (vertebral joints) – by low back pain. There is also dependence between the flexor contracture of the hip joint and the angle of the sacrum: in the horizontal position, the flexor contracture is more pronounced, while the vertical one is less. The angle of the sacrum is a constant in an adult, which, together with the flexor contracture of the hip joint, are involved in the formation of lumbar lordosis. It has been found that the clinical and radiographic manifestations of the hip and lumbar syndrome also depend on the parameters of the spine-pelvic balance. Patients with hyperlordosis posture have the genuine form of the hip-spine syndrome dominating (the development of vertebrogenic pathology outstrips the development of osteo-arthritis). Osteoarthritis is predominantly hyperplastic with a slow form of progression. At the same time, the reverse form of the hip-spine syndrome (the development of osteoarthritis preceding the development of vertebrogenic pathology) dominates in patients with hypolordosis posture. Osteoarthritis is predominantly hypoplastic, with a rapid form of progression. The correlation between the parameters of the spine-pelvic balance and the intensity of the residual pain syndrome after hip replacement has been revealed. Low back and thigh pain has been assessed according to the scales WOMAK, Oswestry and Harris. Patients with normolorodic posture seem to have the best result of hip replacement, without any signs of residual pain syndrome found. Satisfactory result of hip replacement is observed in patients with hyperplastic posture, and a small proportion of patients develop low back pain. However, patients with hypolordosis posture have worse result of hip replacement, according to statistics, the pain syndrome is caused mainly by low back pain with ischias. The observed patterns should be taken into account in hip joint replacement. Patients with normoand hyperlordosis under go hip replacement with further general rehabilitation, and patients with hypolordosis need a thorough examination from a neurologist and a vertebrologist before surgery.