El-Hajj Gerard, Abdel-Nour Hicham, Ayoubi Rami, Maalouly Joseph, Jabbour Fouad, Ashou Raja, Nehme Alexandre
Department of Radiology, Saint George Hospital University Medical Center, University of Balamand, P.O. Box 166378, Achrafieh, Beirut 1100 2807, Lebanon.
Department of Orthopedic Surgery and Traumatology, Saint George Hospital University Medical Center, University of Balamand, P.O. Box 166378, Achrafieh, Beirut 1100 2807, Lebanon.
Adv Orthop. 2020 Aug 18;2020:1826952. doi: 10.1155/2020/1826952. eCollection 2020.
Radiological diagnosis of acetabular retroversion (AR) is based on the presence of the crossover sign (COS), the posterior wall sign (PWS), and the prominence of the ischial spine sign (PRISS). The primary purpose of the study is to analyze the clinical significance of the PRISS in a sample of dysplastic hips requiring periacetabular osteotomy (PAO) and evaluate retroversion in symptomatic hip dysplasia.
In a previous paper, we reported the classic coxometric measurements of 178 patients with symptomatic hip dysplasia undergoing PAO where retroversion was noted in 42% of the cases and was not found to be a major factor in the appearance of symptoms. In the current study, we have added the retroversion signs PRISS and PWS to our analysis. Among the retroverted dysplastic hips, we studied the association of the PRISS with the hips requiring PAO. We also defined the ischial spine index (ISI) and studied its relationship to the coxometric measurements and AR.
In hips with AR, the operated hips were significantly associated with the PRISS compared to the nonoperated ones ( = 4.847). Additionally, the ISI was able to classify acetabular version (anteverted, neutral, and retroverted acetabula). A direct correlation between the ISI and the retroversion index (RI) was found, and the highest degree of retroversion was found when the 3 signs of acetabular retroversion were concomitantly present (RI = 33.6%).
The PRISS, a radiographic sign reflecting AR, was found to be significantly associated with dysplastic hips requiring PAO where AR was previously not considered a factor in the manifestation of symptoms and subsequent requirement for surgery. Moreover, the PRISS can also serve as an adequate radiographic sign for estimating acetabular version on pelvic radiographs.
髋臼后倾（AR）的放射学诊断基于交叉征（COS）、后壁征（PWS）以及坐骨棘突出征（PRISS）的存在。本研究的主要目的是分析PRISS在需要髋臼周围截骨术（PAO）的发育性髋关节样本中的临床意义，并评估有症状的髋关节发育不良中的后倾情况。
在之前的一篇论文中，我们报告了178例接受PAO的有症状髋关节发育不良患者的经典髋臼测量数据，其中42%的病例存在后倾，且未发现后倾是症状出现的主要因素。在当前研究中，我们在分析中增加了后倾体征PRISS和PWS。在存在后倾的发育性髋关节中，我们研究了PRISS与需要PAO的髋关节之间的关联。我们还定义了坐骨棘指数（ISI），并研究了它与髋臼测量数据和AR的关系。
在有AR的髋关节中，与未手术的髋关节相比，接受手术的髋关节与PRISS显著相关（=4.847）。此外，ISI能够对髋臼方向（前倾、中立和后倾髋臼）进行分类。发现ISI与后倾指数（RI）之间存在直接相关性，当髋臼后倾的3个体征同时出现时，后倾程度最高（RI = 33.6%）。
PRISS是一种反映AR的影像学体征，被发现与需要PAO的发育性髋关节显著相关，而此前AR未被认为是症状表现及后续手术需求的一个因素。此外，PRISS还可作为骨盆X线片上评估髋臼方向的合适影像学体征。
