Dora C, Leunig M, Beck M, Simovitch R, Ganz R
Department of Orthopaedics, University of Zurich, Balgrist, Switzerland.
Hip Int. 2006 Jul-Sep;16(3):215-22. doi: 10.1177/112070000601600307.
Interest in acetabular version arose from the study of unstable developmental dysplastic hips (DDH). Initial studies and clinical observations described the dysplastic hip as being excessively anteverted. Doubts on this view arose from analysis of complications such as persistent posterior subluxation after acetabular reorienting procedures. Computed tomography fails to determine conclusively whether or not the dysplastic acetabulum is abnormally anteverted. Controversy evolves from different methods of measuring and from the fact that the acetabular opening gradually spirals from mild anteversion proximally to increasing anteversion distally. This renders the measurement of version dependent on pelvic inclination and the level of the transverse CT scan slice. On an orthograde pelvic radiograph, both pelvic inclination and rotation can be controlled. Therefore, acetabular version is best estimated based on the relationship of the anterior and posterior acetabular rims to each other on an orthograde pelvic radiograph. Acetabular retroversion has been found to be a characteristic feature of specific hip disorders such as post-traumatic dysplasia, proximal femoral focal deficiency and bladder exstrophy. In addition, acetabular retroversion has been described in DDH as well as in dysplastic hips in the context of neuromuscular and genetic disorders. Iatrogenic acetabular retroversion can also result from corrective pelvic osteotomies in childhood. Finally, retroverted acetabula may be found in otherwise nondysplastic hips. The relevance of acetabular retroversion is twofold: First, it demands a more individualized approach to acetabular dysplasia because the presence of retroversion will affect the manner in which the corrective osteotomy should be done. Second, the long-term effect of acetabular retroversion is harmful.
对髋臼前倾的关注源于对发育性髋关节发育不良（DDH）不稳定情况的研究。最初的研究和临床观察将发育不良的髋关节描述为过度前倾。对这一观点的质疑源于对髋臼重新定向手术后持续后脱位等并发症的分析。计算机断层扫描无法最终确定发育不良的髋臼是否异常前倾。争议源于不同的测量方法以及髋臼开口从近端轻度前倾向远端前倾逐渐增加呈螺旋状这一事实。这使得前倾的测量依赖于骨盆倾斜度和横断CT扫描层面的水平。在正位骨盆X线片上，骨盆倾斜度和旋转度均可控制。因此，基于正位骨盆X线片上髋臼前后缘之间的关系来最佳估计髋臼前倾。髋臼后倾已被发现是特定髋关节疾病的特征，如创伤后发育不良、股骨近端局灶性缺损和膀胱外翻。此外，在DDH以及神经肌肉和遗传性疾病背景下的发育不良髋关节中也描述了髋臼后倾。儿童期矫正性骨盆截骨术也可能导致医源性髋臼后倾。最后，在其他方面无发育不良的髋关节中也可能发现后倾髋臼。髋臼后倾的相关性有两方面：第一，它要求对髋臼发育不良采取更个体化的方法，因为后倾的存在会影响矫正截骨术的实施方式。第二，髋臼后倾的长期影响是有害的。
