Abstract
Reliability and reproducibility of two radiological pelvic parameters are tested: thickness (length of the segment defined by the middle of the upper endplate of the sacrum to the middle of the bi-coxo-femoral axis) and pelvic incidence (angle defined by the perpendicular line to the centre of the upper endplate of the sacrum and the thickness line). These two parameters provide a pelvis description and assess the relation between pelvis and spinal curves. The anatomical reliability of these radiological parameters was not achieved. The values of these two parameters from X-ray versus direct measurement on 12 anatomical specimens are compared. The direct measurement was performed by means of an electromagnetic Fastrak system (Polhemus society) providing 3D position of anatomical landmarks and allowing to measure the incidence and the thickness. These parameters were also measured from sagittal X-ray. Their values were compared. Incidence: the paired t-test and the variance ratio test were not statistically significant and a highly significant positive correlation existed between anatomical and radiological values (r=0.98; P<0.001). Thickness: the paired t-test was significant (P<0.01). There was a negative correlation between anatomical values of incidence and thickness (r= −0.54; P<0.05) but not for radiological values. A strong correlation exists which validates the radiological measurement of an angle, i.e. incidence, although there is a lack of reliability of the X-ray measurement of a distance, i.e. thickness, which is due to technical conditions of the X-ray examination. The results of this study suggest that in daily practice the X-ray measurement of the incidence only may be considered as an accurate indicator of pelvis morphology for the study of relations between pelvis anatomy and spinal curves (e.g., lordosis, scoliosis, spondylolisthesis).
Rèsumé
Deux paramètres radiologiques pelviens, l’épaisseur (distance entre le milieu du plateau supèrieur du sacrum et le milieu de l’axe bi-coxo-fémoral) et l’incidence (angle entre la perpendiculaire appliquée au centre du plateau supérieur du sacrum et l’épaisseur) décrivent la morphologie osseuse du pelvis et sa relation avec le rachis. Pour chaque paramètre, fiabilité et reproductibilité sont évaluées en comparant leur mesure anatomique et radiologique. La mesure directe de 12 pièces anatomiques est réalisée avec un système électromagnétique Fastrak (société Polhemus). La mesure radiologique des paramètres est effectuée sur une radiographie de profil. Le coefficient d’agrandissement est 1,113. Incidence: les comparaisons de moyennes et de variances (anatomie versus radiologie) n’étaient pas significatives; une corrélation positive très significative existait entre mesure anatomique et radiologique (r =0.98; P<0.001). Epaisseur: la comparaison de moyennes était significative (P<0.01), bien qu’il existait une corrélation positive significative entre valeurs anatomiques et radiologiques (r=0.52; P<0.05). Les mesures anatomiques de l’incidence et de l’épaisseur sont corrélées négativement (r= −0.54; P< 0.05) mais non pour les mesures radiologiques. La mesure de l’angle incidence, est fiable et reproductible: sa valeur radiologique reproduit la réalité anatomique. Alors que la mesure radiologique de la distance épaisseur reproduit moins fidèlement sa mesure réelle anatomique à cause des conditions techniques radiologiques. En pratique clinique, cela pourrait valider la mesure radiologique de la seule incidence comme indice personnel précis de la morphologie pelvienne.
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Acknowledgements
We would like to thank some colleagues for their scientific contributions, the Laboratoire de Biomécanique (ENSAM, Paris, France) and their valuable advice (B. Bussel, J. Dubousset). We thank the Institut Garches (Hôpital R. Poincaré, Garches, France), D. Miller (Sofamor-Danek) and the ARAO (Hôpital Saint-Vincent-de-Paul, Paris, France) for their grants and contributing action to the project. The author appreciates and acknowledges the considerable support and instructive advice given by the Montpellier E.R.R.F. Association.
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Boulay, C., Tardieu, C., Hecquet, J. et al. Anatomical reliability of two fundamental radiological and clinical pelvic parameters: incidence and thickness. Eur J Orthop Surg Traumatol 15, 197–204 (2005). https://doi.org/10.1007/s00590-005-0239-5
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DOI: https://doi.org/10.1007/s00590-005-0239-5