Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
J Bone Joint Surg Am. 2010 Apr;92(4):895-903. doi: 10.2106/JBJS.I.00046.
Patients with developmental dysplasia of the hip are prone to the development of degenerative changes in the affected hip. The aim of this study was to evaluate the prevalence, morphological features, and clinical relevance of acetabular retroversion in these patients.
We investigated the version and morphological features of the acetabulum using pelvic radiographs and computed tomography images of ninety-six hips in fifty-nine patients with developmental dysplasia of the hip. A diagnosis of acetabular retroversion was based on the presence of a positive cross-over sign on the pelvic radiograph. Using computed tomography images, we determined the acetabular anteversion angle at various levels in the axial plane. The acetabular sector angle served as an indicator of acetabular coverage of the femoral head. We evaluated the association between acetabular version and the patient's age at the onset of pain. Fifty normal hips were examined as controls.
We observed acetabular retroversion in 18% (seventeen) of the ninety-six hips in the patients with developmental dysplasia of the hip. The mean acetabular anteversion angle in the hips with acetabular retroversion was significantly smaller, at all levels, than that in the hips with acetabular anteversion; this tendency was more evident at proximal levels. There was significantly less posterior and posterosuperior coverage in the hips with acetabular retroversion than in those with acetabular anteversion, but superior acetabular coverage did not differ between the groups. Multivariate analysis showed that the onset of pain occurred at a significantly earlier age in patients with acetabular retroversion (27.9 years) than in those with acetabular anteversion (40.5 years), regardless of the severity of the dysplasia (p = 0.003).
In patients with developmental dysplasia of the hip, acetabular retroversion results from relatively deficient coverage by the posterior portion of the acetabulum. Developmental dysplasia with acetabular retroversion is associated with an earlier onset of pain than is developmental dysplasia with anteversion, suggesting a correlation between deficiency of the posterior acetabular wall and the earlier onset of pain.
发育性髋关节发育不良的患者易发生患髋退行性改变。本研究旨在评估这些患者髋臼后倾的发生率、形态特征及其与临床的相关性。
我们通过骨盆 X 线片和 59 例发育性髋关节发育不良患者的 96 髋 CT 图像评估髋臼的倾斜度和形态特征。骨盆 X 线片上的阳性交叉征是髋臼后倾的诊断依据。我们在轴位 CT 图像上确定髋臼前倾角在不同水平的位置。髋臼扇形角是反映股骨头覆盖髋臼的指标。我们评估了髋臼倾斜度与患者疼痛出现时的年龄之间的关系。以 50 个正常髋关节作为对照。
我们观察到发育性髋关节发育不良患者的 96 髋中有 18%（17 髋）存在髋臼后倾。髋臼后倾组的髋臼前倾角在所有水平均显著小于髋臼前倾组；近端水平的这种趋势更为明显。髋臼后倾组的髋臼后上方覆盖明显小于髋臼前倾组，但髋臼上方覆盖两组间无差异。多变量分析显示，髋臼后倾组疼痛出现的年龄明显早于髋臼前倾组（髋臼后倾组 27.9 岁，髋臼前倾组 40.5 岁），与发育不良的严重程度无关（p = 0.003）。
在发育性髋关节发育不良的患者中，髋臼后倾是由于髋臼后份覆盖不足所致。髋臼后倾型发育性髋关节发育不良较髋臼前倾型更早出现疼痛，提示髋臼后侧壁的不足与疼痛的早发相关。
