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Bildgebung und Klassifikation der aseptischen Hüftkopfnekrose

Imaging and classification of avascular femoral head necrosis

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Zusammenfassung

Die aseptische Femurkopfnekrose (aFKN) ist im Frühstadium mittels Radiographie schwierig zu diagnostizieren. Da sie zudem nicht selten klinisch okkult ist, bietet der frühzeitige Einsatz der Magnetresonanztomographie (MRT) die einzige Möglichkeit, einen klinischen Verdacht zu verifizieren oder auszuräumen. Die MRT und in einzelnen Fällen die ergänzende Computertomographie sind heute die Eckpfeiler der Diagnose und auch der Klassifikation der aFKN. Die Radiographie des Beckens in der a.-p.-Projektion und einer zweiten Ebene der betroffenen Hüfte dient zwar weiterhin als Basisuntersuchung beim Verdacht auf eine aFKN, hat ihre Bedeutung aber in der Verlaufskontrolle und dem Ausschluss anderer Erkrankungen. Inzwischen ist unbestritten, dass die Entscheidung zur bestmöglichen Therapie von einer genauen Klassifikation der Erkrankung abhängt. In der S3-Leitlinie zur Diagnostik und Therapie der aFKN wird dabei in Deutschland die Verwendung der ARCO-Klassifikation empfohlen. Die vorliegende Übersichtsarbeit vermittelt den aktuellen Stand der Diagnostik und Klassifikation der aFKN des Erwachsenenalters. Dabei werden die Kriterien für die Einordnung in die einzelnen ARCO-Stadien definiert und kritisch kommentiert.

Abstract

Avascular femoral head necrosis (AVNFH) is difficult to diagnose on plain radiographs in early stages of the disease. Since early stages are often clinically occult, early use of MRI is required to rule out or verify a clinical suspicion. MRI and, in some cases, additional CT are the cornerstones of AVNFH diagnosis and classification. Anteroposterior radiography of the pelvis and a second plane of the involved hip remains the primary basic imaging examination for follow-up and to rule out other pathologies. Correct staging of adult disease has been shown to be the key factor in therapeutic decision-making. According to the German S3 guideline on diagnosis and treatment of AVNFH, use of the ARCO classification is recommended for staging. This paper presents the current status of diagnosis and classification of adult AVNFH. The criteria for ascribing disease to a particular ARCO stage are defined and critically discussed.

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Abbreviations

aFKN:

Atraumatische Femurkopfnekrose

ARCO:

Association Research Circulation Osseous

T1-rho:

T1 im rotierenden Rahmen

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Authors and Affiliations

  1. Universitätsklinik und Poliklinik für Radiologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06108, Halle/Saale, Deutschland

    K. Bohndorf

  2. Bereich Endoprothetik/Orthopädie, Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinik Leipzig AöR, Leipzig, Deutschland

    A. Roth

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Correspondence to K. Bohndorf.

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K. Bohndorf und A. Roth geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Bohndorf, K., Roth, A. Bildgebung und Klassifikation der aseptischen Hüftkopfnekrose. Orthopäde 47, 729–734 (2018). https://doi.org/10.1007/s00132-018-3615-7

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