Hingsammer Andreas M, Bixby Sarah, Zurakowski David, Yen Yi-Meng, Kim Young-Jo
Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Switzerland.
Clin Orthop Relat Res. 2015 Apr;473(4):1224-33. doi: 10.1007/s11999-014-4014-y.
Normal changes in acetabular version over the course of skeletal development have not been well characterized. Knowledge of normal version development is important because acetabular retroversion has been implicated in several pathologic hip processes.
QUESTIONS/PURPOSES: The purpose of this study was to characterize the orientation of the acetabulum by measuring (1) acetabular version and (2) acetabular sector angles in pediatric patients during development. We also sought to determine whether these parameters vary by sex in the developing child.
We evaluated CT images of 200 hips in 100 asymptomatic pediatric patients (45 boys, 55 girls; mean age, 13.5 years; range, 9-18 years) stratified by the status of the triradiate physis and sex. We determined the acetabular anteversion angle at various levels in the axial plane as well as acetabular sector angles at five radial planes around the acetabulum.
For both genders, anteversion angle was greater for the closed physis group throughout all levels (p < 0.001) and both open and closed physis groups were more anteverted as the cut moved caudally away from the acetabular roof (p < 0.001). At the center of the femoral head, the mean anteversion angle (± SD) in girls was 15° ± 3° in the open group and 19° ± 5° in the closed group (p < 0.001). In boys, the mean anteversion angle increased from 14° ± 4° in the open group to 19° ± 4° in the closed group (p = 0.003). In the superior, posterosuperior, and posterior planes, the acetabular sector angles were greater in the closed compared with the open physis group for both boys and girls with the largest increase occurring in the male posterosuperior plane (approximately 20°) (all p < 0.05).
This study demonstrates that acetabular anteversion and acetabular sector angles in both male and female subjects increase with skeletal maturity as a result of growth of the posterior wall. This suggests that radiographic appearance of acetabular retroversion may not be attributable to overgrowth of the anterior wall but rather insufficient growth of the posterior wall, which has clinical treatment implications for pincer-type impingement.
髋臼旋转角度在骨骼发育过程中的正常变化尚未得到充分描述。了解正常旋转角度的发育情况很重要，因为髋臼后倾与多种病理性髋关节病变有关。
问题/目的：本研究的目的是通过测量（1）髋臼旋转角度和（2）发育中的儿科患者的髋臼扇形角来描述髋臼的方向。我们还试图确定这些参数在发育中的儿童中是否因性别而异。
我们评估了100例无症状儿科患者（45名男孩，55名女孩；平均年龄13.5岁；范围9 - 18岁）的200个髋关节的CT图像，根据Y形软骨状态和性别进行分层。我们确定了轴向平面不同水平的髋臼前倾角度以及髋臼周围五个径向平面的髋臼扇形角。
对于男女两性，在所有水平上，闭合Y形软骨组的前倾角度均更大（p < 0.001），并且随着切割线从髋臼顶向尾侧移动，开放和闭合Y形软骨组均更加前倾（p < 0.001）。在股骨头中心，开放组女孩的平均前倾角度（±标准差）为15°±3°，闭合组为19°±5°（p < 0.001）。在男孩中，平均前倾角度从开放组的14°±4°增加到闭合组的19°±4°（p = 0.003）。在上方、后上方和后方平面，闭合Y形软骨组的髋臼扇形角大于开放组，男孩和女孩均如此，其中男性后上方平面增加最大（约20°）（所有p < 0.05）。
本研究表明，由于后壁生长，男性和女性受试者的髋臼前倾和髋臼扇形角均随骨骼成熟而增加。这表明髋臼后倾的影像学表现可能并非归因于前壁过度生长，而是后壁生长不足，这对钳夹型撞击症的临床治疗具有启示意义。
