Gao Tian, Hu Yuehao, Shan Yu, Xu Zhengquan, Yan Mengning, Li Huiwu, Mao Yuanqing, Zhai Zanjing
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Suzhou Ninth People's Hospital, Department of Orthopedics, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China.
Orthop Surg. 2025 Jun;17(6):1782-1790. doi: 10.1111/os.70037. Epub 2025 Apr 9.
Developmental dysplasia of the hip (DDH) exhibits abnormalities in hip anatomy, so changes in the acetabular and femoral angles hold clinical relevance. This study aimed to investigate the correlations between acetabular anteversion (AAV) and acetabular abduction (AAB), as well as between combined anteversion and combined abduction in patients with DDH, attempting to give evidence for synchronous torsion of the proximal femur and acetabulum. This study also aimed to propose a new method for predicting acetabular anteversion and combined anteversion angles, respectively, based on acetabular abduction and combined abduction angles on conventional pelvic radiographs.
This retrospective study included 202 patients (404 hips) with DDH who underwent THA at our institution from February 2013 to September 2021. Preoperative AAB/femoral neck-shaft angle (FNA) was recorded via radiograph. AAV/femoral anteversion (FA) was recorded via computed tomography and radiography. To assess the correlations between the AAV and AAB and between combined anteversion (sum of AAV and FA) and combined abduction (sum of AAB and FNA), linear regressions and Pearson's coefficients were calculated.
All hips were categorized into five DDH subgroups according to the Crowe classification: 93 normal, 140 Crowe type I, 68 Crowe type II, 59 Crowe type III, and 44 Crowe type IV. Fairly positive correlations were observed between combined anteversion and combined abduction in normal (r = 0.509), type I (r = 0.637), type II (r = 0.423), and type III (r = 0.511) subgroups. AAV and AAB demonstrated a moderate positive correlation in the normal (r = 0.508), type I (r = 0.511), type II (r = 0.516), type III (r = 0.332), and type IV (r = 0.603) subgroups.
The AAV and AAB, as well as combined anteversion and combined abduction, exhibited positive correlations in normal and Crowe type I-III hips, suggesting the torsion of the acetabulum and synchronous torsion of the acetabulum and proximal femur. These findings quantify synchronized twisting of the hip and offer the potential significant implications for the accuracy of preoperative planning in THA, especially in DDH patients.
发育性髋关节发育不良（DDH）表现为髋关节解剖结构异常，因此髋臼角和股骨角的变化具有临床意义。本研究旨在探讨DDH患者髋臼前倾（AAV）与髋臼外展（AAB）之间以及联合前倾与联合外展之间的相关性，试图为股骨近端和髋臼的同步扭转提供证据。本研究还旨在基于传统骨盆X线片上的髋臼外展和联合外展角度，分别提出一种预测髋臼前倾和联合前倾角度的新方法。
本回顾性研究纳入了2013年2月至2021年9月在我院接受全髋关节置换术（THA）的202例（404髋）DDH患者。通过X线片记录术前AAB/股骨颈干角（FNA）。通过计算机断层扫描和X线片记录AAV/股骨前倾（FA）。为了评估AAV与AAB之间以及联合前倾（AAV与FA之和）与联合外展（AAB与FNA之和）之间的相关性，计算了线性回归和Pearson系数。
根据Crowe分类，所有髋关节被分为五个DDH亚组：93例正常，140例Crowe I型，68例Crowe II型，59例Crowe III型，44例Crowe IV型。在正常（r = 0.509）、I型（r = 0.637）、II型（r = 0.423）和III型（r = 0.511）亚组中，联合前倾与联合外展之间观察到相当显著的正相关。在正常（r = 0.508）、I型（r = 0.511）、II型（r = 0.516）、III型（r = 0.332）和IV型（r = 0.603）亚组中，AAV与AAB表现出中度正相关。
在正常和Crowe I-III型髋关节中，AAV与AAB以及联合前倾与联合外展均呈正相关，提示髋臼扭转以及髋臼与股骨近端的同步扭转。这些发现量化了髋关节的同步扭转，对THA术前规划的准确性具有潜在的重要意义，但在DDH患者中更为明显。
