Perthes disease is a hip lesion caused by vascular disorders in the femoral head of children.Although the disease is a self-limited disease,but often residualvary degrees of femoral head deformity,leading to early osteoarthritis.It is currently believed that the lesions of Perthes disease are mainly located in the femoral head.However,some studies demonstrated that patients with Perthes disease also appearvary degrees of acetabular morphological changes.In recent years,the acetabular retroversions were found in 31-60％ of patients with Perthes disease.The acetabular retroversion is a pathological anatomical variation of the acetabulum in the horizontal plan.It is related to the occurrence of the femoracetabular impingement and osteoarthritis.Many studies showed that the patients with poor prognosis (Stulberg Ⅲ,Ⅳ or Ⅴ) are associated with a higher prevalence of acetabular retroversion.The grading and the age of onset of Perthes disease are important factors affectingprognosis.Although existing studies illustrate that the lateral column grading,gender and age are not associated with the acetabular retroversion of Perthes disease significantly,the cases of the studies are limited and further researches are expected.Surgery containment therapy is an important wayto treat Perthes disease.The pelvic osteotomy can directly change the shape of the acetabulum and cause the acetabular retroversion,which result inthe femoracetabular impingement.The acetabular retroversion should be avoided as much as possible intraoperatively.Further research should be focused on whether the surgical interventions and the subsequent biomechanical changes could induce the acetabular retroversion.The cause of the acetabular retroversion in patients with Perthes disease is unclear.In order to elucidate the occurrence and development of acetabular retroversionin Perthes disease,some scholars found thataccompanying femoral head deformity,acetabular anteversion angleand inclinationdecreased significantly,and thecoverage angle in the superior,posterior,and inferior quadrants alsogradually reduced in animal studies.This is similar to clinical observations.This article reviews the progress of acetabular retroversion in Perthes disease by summarizing the relevant literatures.We hope to givenew insights for the etiology and pathology of Perthes disease,and provide new ideas for the treatment and prevention of the femoracetabular impingement and early osteoarthritis.

OBJECTIVES: To develop a Chinese version of the Stress Adaption Scale (SAS) and to assess its reliability and validity among Chinese patients with multimorbidity. METHODS: The Brislin model was used to translate, synthesize, back-translate, and cross culturally adapt the SAS. A total of 323 multimorbidity patients selected by convenience sampling method from four hospitals in Zhejiang province. The critical ratio method, total question correlation method, and graded response model (item characteristic curve and item discrimination) were used for item analysis. Cronbach's alpha coefficient and split-half reliability were used for the reliability analysis. Content validity analysis, structural validity analysis, and criterion association validity analysis were performed by expert scoring method, confirmatory factor analysis, and Pearson correlation coefficient method, respectively. RESULTS: The Chinese version of the SAS contained 2 dimensions of resilience and thriving, with a total of 10 items. In the item analysis, the critical ratio method showed that the critical ratio of all items was greater than 3.0 (P<0.001); the correlation coefficient method showed that the Pearson correlation coefficients for all items exceeded 0.4 (P<0.01). The graded response model showed that items of the revised scale exhibited distinct item characteristic curves and all items had discrimination parameters exceeding 1.0. In the reliability analysis, Cronbach's alpha coefficient of the revised Chinese version of the SAS scale was 0.849, and the split-half reliability was 0.873. In the validity analysis, the item-level content validity index and scale-level content validity index both exceeded 0.80. In the confirmatory factor analysis, the revised two-factor model showed satisfactory fit indices (χ²/df=3.115, RMSEA=0.081, RMR=0.046, GFI=0.937, AGFI=0.898, CFI=0.936, TLI=0.915). In the criterion-related validity analysis, the Chinese version of the SAS score was negatively correlated with the Perceived Stress Scale and the Treatment Burden Questionnaire, with correlation coefficients of －0.592 and －0.482, respectively (both P<0.01). CONCLUSIONS The Chinese version of the SAS has good reliability and validity, which can be used to evaluate the stress adaption capacity among multimorbidity patients in China, and provides a reference for developing individualized health management measures.
Humans ; Adaptation, Psychological ; Asian People ; China ; Multimorbidity ; Reproducibility of Results ; Stress, Psychological/psychology* ; Surveys and Questionnaires ; Translating ; Cross-Cultural Comparison