髋关节发育不良患者髋臼覆盖面特征的性别差异是什么?

IF 4.2 2区 医学 Q1 ORTHOPEDICS Clinical Orthopaedics and Related Research® Pub Date : 2024-11-01 Epub Date: 2024-07-12 DOI:10.1097/CORR.0000000000003126
Hiroto Funahashi, Yusuke Osawa, Yasuhiko Takegami, Hiroki Iida, Yuto Ozawa, Hiroaki Ido, Shiro Imagama
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(3) What is the relationship between the rotation of the ilium and ischium and the acetabular coverage at each height in females and males with DDH?</p><p><strong>Methods: </strong>Between 2016 and 2023, 114 patients (138 hips) underwent eccentric rotational acetabular osteotomy at our hospital. We excluded patients with Tönnis Grade 2 or higher, a lateral center-edge angle of 25º or more, and deformities of the pelvis or femur, resulting in 100 patients (122 hips) being included. For female patients (98 hips), the median (range) age was 40 years (10 to 58), and for the male patients (24 hips), it was 31 years (14 to 53). We used all patients' preoperative AP radiographs and CT data. The crossover sign, posterior wall sign, and pelvic width index were evaluated in AP radiographs. The rotation of the innominate bone in the axial plane was evaluated at two different heights, specifically at the slice passing through the anterior superior iliac spine and the slice through the pubic symphysis and ischial spine in CT data. Furthermore, we evaluated the anterior and posterior acetabular sector angles. Comparisons of variables related to innominate bone measurements and acetabular coverage measurements between females and males in each patient were performed. The correlations between pelvic morphology measurements and acetabular coverage were evaluated separately for females and males, and the results were subsequently compared to identify any sex-specific differences. For continuous variables, we used the Student t-test; for binary variables, we used the Fisher exact test. A p value less than 0.05 was considered statistically significant.</p><p><strong>Results: </strong>In the evaluation of AP radiographs, an indicator of acetabular retroversion-the crossover sign-showed no differences between the sexes, whereas the posterior wall sign (females 46% [45 of 98] hips versus males 75% [18 of 24] hips, OR 3.50 [95% confidence interval (CI) 1.20 to 11.71]; p = 0.01) and pelvic width index less than 56% (females 1% [1 of 98] versus males 17% [4 of 24], OR 18.71 [95% CI 1.74 to 958.90]; p = 0.005) occurred more frequently in males than in females. There were no differences in the iliac rotation parameters, but the ischium showed more external rotation in males (females 30° ± 2° versus males 24° ± 1°; p < 0.001). Regarding acetabular coverage, no differences between females and males were observed in the anterior acetabular sector angles. In contrast, males showed smaller values than females for the posterior acetabular sector angles (85° ± 9° versus 91° ± 7°; p = 0.002). In females, a correlation was observed between iliac rotation and acetabular sector angles (anterior acetabular sector angles: r = -0.35 [95% CI -0.05 to 0.16]; p < 0.001, posterior acetabular sector angles: r = 0.42 [95% CI 0.24 to 0.57]; p < 0.001). Similarly, ischial rotation showed a correlation with both acetabular sector angles (anterior acetabular sector angles: r = -0.34 [95% CI -0.51 to -0.15]; p < 0.001 and posterior acetabular sector angles: r = 0.45 [95% CI 0.27 to 0.59]; p < 0.001). Thus, in females, we observed that external iliac rotation and ischial internal rotation correlated with increased anterior acetabular coverage and reduced posterior coverage. 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引用次数: 0

摘要

背景:实施偏心旋转髋臼截骨术是为了预防髋关节发育不良(DDH)引起的骨关节炎。要实现充分的髋臼覆盖,就必须了解 DDH 髋臼覆盖的特点。然而,DDH 男性患者的髋臼覆盖特点仍不清楚。问题/目的:(1)女性和男性 DDH 患者的髋臼覆盖率有何差异?(2)女性和男性 DDH 患者的髂骨和髂嵴旋转有什么不同?(3)女性和男性DDH患者髂骨和髂胫骨的旋转与髋臼各高度的覆盖率之间有什么关系?2016年至2023年间,我院共有114例患者(138髋)接受了偏心旋转髋臼截骨术。我们排除了Tönnis 2级或以上、外侧中心-边缘角25º或以上、骨盆或股骨畸形的患者,最终纳入100例患者(122髋)。女性患者(98 个髋关节)的年龄中位数(范围)为 40 岁(10 至 58 岁),男性患者(24 个髋关节)的年龄中位数(范围)为 31 岁(14 至 53 岁)。我们使用了所有患者的术前 AP X 光片和 CT 数据。通过 AP X 光片评估了交叉征、后壁征和骨盆宽度指数。我们在两个不同的高度评估了髂骨在轴向平面的旋转情况,特别是在通过髂前上棘的切片处,以及在 CT 数据中通过耻骨联合和峡部脊柱的切片处。此外,我们还评估了髋臼前后扇形角。我们还比较了每位患者中女性和男性的腹股沟骨测量值和髋臼覆盖测量值的相关变量。我们分别评估了女性和男性骨盆形态测量值与髋臼覆盖率之间的相关性,然后对结果进行比较,以确定是否存在性别差异。对于连续变量,我们采用了学生 t 检验;对于二元变量,我们采用了费雪精确检验。P值小于0.05即为具有统计学意义:结果:在评估 AP X 光片时,髋臼后移的指标--交叉征在性别上没有差异,而后壁征(女性 46% [98 例中的 45 例] 髋关节与男性 75% [24 例中的 18 例] 髋关节,OR 3.50[95%置信区间 (CI) 1.20 至 11.71];P = 0.01)和骨盆宽度指数小于 56%(女性为 1%[98 例中的 1 例],男性为 17%[24 例中的 4 例],OR 18.71 [95% CI 1.74 至 958.90];P = 0.005)的发生率男性高于女性。髂骨旋转参数没有差异,但男性的骶骨外旋更多(女性为 30° ± 2°,男性为 24° ± 1°;p < 0.001)。在髋臼覆盖方面,女性和男性的髋臼前扇形角没有差异。相反,男性的髋臼后扇形角值小于女性(85° ± 9° 对 91° ± 7°;p = 0.002)。在女性中,髂骨旋转与髋臼扇形角之间存在相关性(髋臼前扇形角:r = -0.35 [95% CI -0.05 to 0.16];p < 0.001,髋臼后扇形角:r = 0.42 [95% CI 0.24 to 0.57];p < 0.001)。同样,髋臼旋转也与两个髋臼扇形角相关(髋臼前扇形角:r = -0.34 [95% CI -0.51 to -0.15];p < 0.001;髋臼后扇形角:r = 0.45 [95% CI 0.27 to 0.59];p < 0.001)。因此,在女性中,我们观察到髂骨外旋和骶骨内旋与髋臼前部覆盖增加和后部覆盖减少相关。相反,虽然男性的髋臼覆盖率与髂骨旋转有相关性(髋臼前扇形角:r = -0.55 [95% CI -0.78 to -0.18];p = 0.006;髋臼后扇形角:r = 0.74 [95% CI 0.48 to 0.88];p < 0.001),但与骶骨旋转没有相关性:结论:在男性中,髋臼后倾的发生率高于女性,这是因为男性的髋臼后覆盖面较小。在女性中,髋臼后覆盖面的增加与骶骨外旋角度相关,而在男性中,骶骨旋转与髋臼后覆盖面之间没有相关性。在通过偏心旋转髋臼截骨术治疗男性DDH患者时,必须调整骨片以防止髋臼后方覆盖不足。未来的研究可能需要调查不同肢体位置下男性和女性髋臼覆盖率的差异,并考虑骨片旋转的方向。
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What Are the Sex-Based Differences of Acetabular Coverage Features in Hip Dysplasia?

Background: Eccentric rotational acetabular osteotomy is performed to prevent osteoarthritis caused by developmental dysplasia of the hip (DDH). To achieve sufficient acetabular coverage, understanding the characteristics of acetabular coverage in DDH is necessary. However, the features of acetabular coverage in males with DDH remain unclear. We thought that the differences in acetabular coverage between females and males might be associated with the differences in pelvic morphology between the sexes.

Questions/purposes: (1) What are the differences in the acetabular coverage between females and males with DDH? (2) What are the differences in the rotations of the ilium and ischium between females and males with DDH? (3) What is the relationship between the rotation of the ilium and ischium and the acetabular coverage at each height in females and males with DDH?

Methods: Between 2016 and 2023, 114 patients (138 hips) underwent eccentric rotational acetabular osteotomy at our hospital. We excluded patients with Tönnis Grade 2 or higher, a lateral center-edge angle of 25º or more, and deformities of the pelvis or femur, resulting in 100 patients (122 hips) being included. For female patients (98 hips), the median (range) age was 40 years (10 to 58), and for the male patients (24 hips), it was 31 years (14 to 53). We used all patients' preoperative AP radiographs and CT data. The crossover sign, posterior wall sign, and pelvic width index were evaluated in AP radiographs. The rotation of the innominate bone in the axial plane was evaluated at two different heights, specifically at the slice passing through the anterior superior iliac spine and the slice through the pubic symphysis and ischial spine in CT data. Furthermore, we evaluated the anterior and posterior acetabular sector angles. Comparisons of variables related to innominate bone measurements and acetabular coverage measurements between females and males in each patient were performed. The correlations between pelvic morphology measurements and acetabular coverage were evaluated separately for females and males, and the results were subsequently compared to identify any sex-specific differences. For continuous variables, we used the Student t-test; for binary variables, we used the Fisher exact test. A p value less than 0.05 was considered statistically significant.

Results: In the evaluation of AP radiographs, an indicator of acetabular retroversion-the crossover sign-showed no differences between the sexes, whereas the posterior wall sign (females 46% [45 of 98] hips versus males 75% [18 of 24] hips, OR 3.50 [95% confidence interval (CI) 1.20 to 11.71]; p = 0.01) and pelvic width index less than 56% (females 1% [1 of 98] versus males 17% [4 of 24], OR 18.71 [95% CI 1.74 to 958.90]; p = 0.005) occurred more frequently in males than in females. There were no differences in the iliac rotation parameters, but the ischium showed more external rotation in males (females 30° ± 2° versus males 24° ± 1°; p < 0.001). Regarding acetabular coverage, no differences between females and males were observed in the anterior acetabular sector angles. In contrast, males showed smaller values than females for the posterior acetabular sector angles (85° ± 9° versus 91° ± 7°; p = 0.002). In females, a correlation was observed between iliac rotation and acetabular sector angles (anterior acetabular sector angles: r = -0.35 [95% CI -0.05 to 0.16]; p < 0.001, posterior acetabular sector angles: r = 0.42 [95% CI 0.24 to 0.57]; p < 0.001). Similarly, ischial rotation showed a correlation with both acetabular sector angles (anterior acetabular sector angles: r = -0.34 [95% CI -0.51 to -0.15]; p < 0.001 and posterior acetabular sector angles: r = 0.45 [95% CI 0.27 to 0.59]; p < 0.001). Thus, in females, we observed that external iliac rotation and ischial internal rotation correlated with increased anterior acetabular coverage and reduced posterior coverage. In contrast, although acetabular coverage in males showed a correlation with iliac rotation (anterior acetabular sector angles: r = -0.55 [95% CI -0.78 to -0.18]; p = 0.006 and posterior acetabular sector angles: r = 0.74 [95% CI 0.48 to 0.88]; p < 0.001), no correlation was observed with ischial rotation.

Conclusion: In males, acetabular retroversion occurs more commonly than in females and is attributed to their reduced posterior acetabular coverage. In females, an increase in the posterior acetabular coverage was correlated with the external rotation angle of the ischium, whereas in males, no correlation was found between ischial rotation and posterior acetabular coverage. In treating males with DDH via eccentric rotational acetabular osteotomy, it is essential to adjust bone fragments to prevent inadequate posterior acetabular coverage. Future studies might need to investigate the differences in acetabular coverage between males and females in various limb positions and consider the direction of bone fragment rotation.

Clinical relevance: Our findings suggest that males with DDH exhibit acetabular retroversion more frequently than females, which is attributed to the reduced posterior acetabular coverage observed in males. The smaller posterior acetabular coverage in males might be related to differences in ischial morphology between sexes. During eccentric rotational acetabular osteotomy for males with DDH, adequately rotating acetabular bone fragments might be beneficial to compensate for deficient posterior acetabular coverage.

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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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