Jamali Amir A, Mladenov Kiril, Meyer Dominik C, Martinez Alberto, Beck Martin, Ganz Reinhold, Leunig Michael
Department of Orthopaedic Surgery, University of Berne, Inselspital, CH-3010 Berne, Switzerland.
J Orthop Res. 2007 Jun;25(6):758-65. doi: 10.1002/jor.20380.
Acetabular retroversion has been proposed to contribute to the development of osteoarthritis of the hip. For the diagnosis of this condition, conventional AP pelvic radiographs may represent a reliable, easily available diagnostic modality as they can be obtained with a reproducible technique allowing the anterior and posterior acetabular rims to be visible for assessment. This study was designed to: (i) determine cranial, central, and caudal anatomic acetabular version (AV) from cadaveric specimens; (ii) establish the validity and reliability of the radiographic measurements of central acetabular anteversion; and (iii) determine the validity and reliability of the radiographic "cross-over-sign" to detect acetabular retroversion. Using 43 desiccated pelvises (86 acetabuli) the anatomic AVs were measured at three different transverse planes (cranially, centrally, and caudally). From these pelvises, standardized AP pelvic radiographs were obtained. To directly measure central AV, a modified radiographic method is introduced for the use of AP pelvic radiographs. The validity and reliability of this radiographic method and of the radiographic cross-over-sign to detect cranial acetabular retroversion were determined. The mean central and caudal anatomic AVs were approximately 20 degrees , and the mean cranial AV was 8 degrees . Cranial retroversion (AV < 0 degrees ) was present in 19 of 86 hips (22%). A linear correlation was found between the central and cranial AV. Below 10 degrees of central AV, all acetabuli were cranially retroverted. Between 10 degrees and 20 degrees , 30% of the acetabuli were cranially retroverted, and above 20 degrees , only 1 of 45 acetabuli was cranially retroverted. The radiographic measurement of the central AV (20.3 +/- 6.5 degrees ) correlated strongly with the anatomic AV (20.1 +/- 6.4 degrees ). The sensitivity of the cross-over-sign to detect a cranial acetabular anteversion of less than 4 degrees was 96%, its specificity 95%, and the positive predictive and negative predictive values 90% and 98%, respectively. Both the modified radiographic anteversion measurements and the cross-over-sign demonstrated substantial inter- and intraobserver reliability. Retroversion is almost exclusively a problem of the cranial acetabulum. The cranial AV is on average 12 degrees lower than the central AV, with the latter directly measurable from AP pelvic radiographs. A central AV of less than 10 degrees was associated with cranial retroversion. The presence of a positive cross-over-sign is a highly reliable indicator of cranial AV of <4 degrees.
髋臼后倾被认为与髋关节骨关节炎的发生有关。对于这种情况的诊断，传统的骨盆前后位X线片可能是一种可靠且易于获得的诊断方式，因为它们可以通过可重复的技术获得，使髋臼前后缘清晰可见以便评估。本研究旨在：(i) 从尸体标本中确定髋臼的头侧、中央和尾侧解剖髋臼旋转（AV）；(ii) 确定髋臼中央前倾角X线测量的有效性和可靠性；(iii) 确定X线“交叉征”检测髋臼后倾的有效性和可靠性。使用43个干燥骨盆（86个髋臼）在三个不同的横断面上（头侧、中央和尾侧）测量解剖AV。从这些骨盆中获得标准化的骨盆前后位X线片。为直接测量中央AV，引入一种改良的X线方法用于骨盆前后位X线片。确定了这种X线方法和X线交叉征检测头侧髋臼后倾的有效性和可靠性。中央和尾侧解剖AV的平均值约为20度，头侧AV的平均值为8度。86个髋关节中有19个（22%）存在头侧后倾（AV < 0度）。发现中央和头侧AV之间存在线性相关性。中央AV低于10度时，所有髋臼均为头侧后倾。在10度至20度之间，30%的髋臼为头侧后倾，高于20度时，45个髋臼中只有1个为头侧后倾。中央AV的X线测量值（20.3±6.5度）与解剖AV（20.1±6.4度）密切相关。交叉征检测头侧髋臼前倾角小于4度的敏感性为96%，特异性为95%，阳性预测值和阴性预测值分别为90%和98%。改良的X线前倾角测量和交叉征在观察者间和观察者内均显示出高度可靠性。后倾几乎完全是头侧髋臼的问题。头侧AV平均比中央AV低12度，后者可直接从骨盆前后位X线片中测量。中央AV小于10度与头侧后倾相关。交叉征阳性是头侧AV < 4度的高度可靠指标。
