Sankar Wudbhav N, Flynn John M
Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
J Pediatr Orthop. 2008 Jun;28(4):440-3. doi: 10.1097/BPO.0b013e318168d97e.
Ezoe et al showed that the prevalence of acetabular retroversion in adults with Legg-Calvé-Perthes disease (LCPD) was 42% versus 6% in normal controls. Our purpose was to study the development of acetabular retroversion in children with LCPD and perhaps draw conclusions regarding cause and effect.
We reviewed all 271 patients with LCPD seen at our institution to identify those patients with axial imaging before closure of the triradiate cartilage. Fifty-three hips (44 patients) formed our study population; the 35 normal hips in those patients with unilateral disease served as an internal control. Acetabular version was measured on the axial cut with the largest femoral head cross-section. Diseased versus control hips were compared using a paired t test. Two disease-severity subgroups, Herring A or B (42 hips) and B/C or C (11 hips), were compared using an independent-samples t test. In those patients followed past skeletal maturity (16 of 53 hips), we evaluated final AP pelvic radiographs for acetabular retroversion (presence of a crossover sign).
Before skeletal maturity, all but 1 patient in our series demonstrated positive acetabular version (anteversion). We found no significant difference between the diseased and control hips: mean acetabular version in LCPD hips was 13.6 +/- 4.3 versus 15.4 +/- 5.4 degrees in unaffected hips. More severe cases (B/C or C) exhibited significantly more relative retroversion (10.8 degrees) than less severe cases (14.6 degrees, P = 0.047). Of the 16 hips followed past skeletal maturity, 5 demonstrated crossover signs on anteroposterior pelvic radiographs, indicating a 31% prevalence of acetabular retroversion.
Early after diagnosis, the prevalence of acetabular retroversion in our skeletally immature children with LCPD was extremely rare (1.8%), and there was no significant difference in version between the normal hips and hips with LCPD. However, over time, a child with a more deformed femoral head is more likely to develop acetabular retroversion, suggesting a cause-and-effect relationship.
Level III (case-control).
江添等研究表明，患有Legg-Calvé-Perthes病（LCPD）的成年人髋臼后倾患病率为42%，而正常对照组为6%。我们的目的是研究LCPD患儿髋臼后倾的发展情况，并可能得出因果关系的结论。
我们回顾了在我们机构就诊的所有271例LCPD患者，以确定那些在髋臼软骨三联体闭合前有轴向成像的患者。53个髋关节（44例患者）构成了我们的研究人群；单侧患病患者中的35个正常髋关节作为内部对照。在具有最大股骨头横截面的轴位切片上测量髋臼旋转角度。使用配对t检验比较患病髋关节与对照髋关节。使用独立样本t检验比较两个疾病严重程度亚组，即Herring A或B（42个髋关节）和B/C或C（11个髋关节）。在那些随访至骨骼成熟后的患者（53个髋关节中的16个）中，我们评估了最终的前后位骨盆X线片以确定髋臼后倾（交叉征的存在）。
在骨骼成熟之前，我们系列中除1例患者外，所有患者的髋臼旋转角度均为正值（前倾）。我们发现患病髋关节与对照髋关节之间无显著差异：LCPD髋关节的平均髋臼旋转角度为13.6±4.3度，而未受影响髋关节为15.4±5.4度。病情较重的病例（B/C或C）比病情较轻的病例（14.6度）表现出明显更多的相对后倾（10.8度，P = 0.047）。在随访至骨骼成熟后的16个髋关节中，5个在前后位骨盆X线片上显示交叉征，表明髋臼后倾患病率为31%。
在诊断后的早期，我们骨骼未成熟的LCPD患儿髋臼后倾的患病率极低（1.8%），正常髋关节与LCPD髋关节之间的旋转角度无显著差异。然而，随着时间的推移，股骨头畸形更严重的儿童更有可能发展为髋臼后倾，提示存在因果关系。
III级（病例对照）。
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