Role of the sacrum and low-lumbar spine in determining the spatial position and pathology development of the proximal femur

Objective. To analyze the relationship of the lumbar spine, sacrum and the proximal femur. Material and methods. 30 patients and 10 volunteers underwent MSCT of the femur, and X-rays of the lumbar spine and the sacrum in 2 projections. Both groups were examined by a neurologist and spine surgeon. Angular relationships between the elements of the proximal femur were determined using our proposed evaluation method. The angle of lordosis of the lumbar spine and the position of the sacrum were estimated on radiographs. Results. In the control group of volunteers the elements of the proximal femur had the following spatial orientation: anteflexion of the femoral head was 0.0 ± 0.4°; anteversion of the femoral neck – 75.6 ± 1.2°; antetorsion of the proximal femur – 101.7 ± 0.7°, lumbar lordosis – 131.0 ± 0.2°, pelvic misalignment – 1°, and the angle of sacral inclination – 30-40°. All patients of the main group had pelvic misalignment of 4.8 ± 0.2° and grade 1 spondylarthrosis. Two patients of this group had lumbar hyperlordosis of 155.5 ± 0.9° and grade 1 retrolisthesis with syndromes of fixed lumbar lordosis, jerky gait, lumbar-hip extensor rigidity and unilateral or bilateral ischialgia. They demonstrated normoflexion of 0.0 ± 0.4°, retroversion of 68.0 ± 1.2° and antetorsion of 111.0 ± 1.1°. In 7 patients of the main group lumbar hyperlordosis was 120.6 ± 1.2° with flexion contracture of the hip. Among them 10 hips had anteflexion of 10.2 ± 0.6° and 3 hips – normoflexion of 0.0 ± 0.4°. A retroversion of 69.6 ± 0.7° was revealed in 8 patients, and an anteversion of 81.5 ± 1.3° — in 5 cases. In 9 patients an antetorsion was 121.5 ± 1.8°, in 2 cases – 94.7 ± 0.6° and in 1 case a normal torsion of 101.0 ± 1.7° was observed. In 1 patient lumbar lordosis was 133°, lumbar ischialgia and lumbar spine pathology were not observed, normoflexion was 0.0 ± 0.4°, normoversion – 75.2 ± 0,3°, and antetorsion – 120.5 ± 1.7°. Conclusion. This study shows that the change in the spatial position of the sacrum, lumbar spine, and the elements of the proximal femur is interconnected. Horizontal or vertical change in the sacrum slope is a risk factor for the development of degenerative changes in the lumbar spine and hip joints.

Prokhorenko V.M. – doctor of medical sciences, professor, head of the chair for traumatology and orthopedics, deputy director on clinical work, e-mail: VProhorenko@niito.ru

Turkov P.S. – postgraduate student, e-mail:sugery@yandex.ru

Kuzin V.Yu. – candidate of medical sciences, physician

Perfilyev A.M. – physician