Imhof H, Czerny C, Gahleitner A, Grampp S, Kainberger F, Krestan C, Sulzbacher I
Univ.-Klinikum für Radiodiagnostik-Osteologie, Waehringer Guertel 18-20, 1090 Wien/Osterreich.
Radiologe. 2002 Jun;42(6):416-31. doi: 10.1007/s00117-002-0750-1.
Osteoarthritis of the hip joint is a very common disease. There is a minor prevalence of males. By etiology one can distinguish primary (idiopathic) from secondary osteoarthritis. Secondary are due to well-known etiologies as overweight, repetitive traumata, malposture, muscle- and tendon-imbalance etc. Osteoarthritis includes not only cartilage abnormalities, but also such of the subchondral-region, synovialis, synovial fluid and periarticular muscles. The cartilage shows in osteoarthritis typically edema and swelling, defects with tears, fibrillation, and "baldness" and (or) cartilagenous repair-islands and joint space narrowing as well, while subchondrally micro-edema, necrosis, ev. microfractures, "cysts", demineralisation followed by sclerosis, osteophyte-formation and deformity is seen. With conventional radiographs and CT joint space narrowing, subchondral cysts, sclerosis and osteophytes and deformities are well delineated, MRI however allows visualization of subtle bone marrow and cartilage abnormalities. Clinically, the diagnosis of pre-osteoarthritis becomes more and more important. This includes e.g. deformities and malpostures, labrum-pathologies and structural imbalances. There are three prognostic different types of hip-osteoarthritis depending on the migration of the head of the hip joint: the most common are the latero-cranial and the medio-caudal ones, while the central one is found very rarely. Basic imaging method are conventional radiographs, and CT, followed by MRI. The diagnosis of an "activated osteoarthritis" is made by bone-scintigraphy or MRI with i.v. application of contrast-media. The labrum- and cartilage diagnosis should be done with MRI or MR-arthrography. Functional computer-animated analysis will be of great diagnostic value in the near future. MRI indications are differences between clinical results and imaging, missing clinical improvement of an "activated" osteoarthritis under standard therapy, unclear joint-pain and before any arthroscopy.
髋关节骨关节炎是一种非常常见的疾病。男性患病率略低。根据病因可将原发性（特发性）骨关节炎与继发性骨关节炎区分开来。继发性骨关节炎是由超重、重复性创伤、姿势不良、肌肉和肌腱失衡等已知病因引起的。骨关节炎不仅包括软骨异常，还包括软骨下区域、滑膜、滑液和关节周围肌肉的异常。在骨关节炎中，软骨通常表现为水肿、肿胀、伴有撕裂的缺损、纤维化和“光秃”以及（或）软骨修复岛，同时关节间隙变窄，而软骨下可见微水肿、坏死、可能的微骨折、“囊肿”、脱矿后硬化、骨赘形成和畸形。通过传统X线片和CT可以很好地显示关节间隙变窄、软骨下囊肿、硬化、骨赘和畸形，然而MRI能够显示细微的骨髓和软骨异常。临床上，骨关节炎前期的诊断变得越来越重要。这包括例如畸形和姿势不良、盂唇病变和结构失衡。根据髋关节头的移位情况，有三种预后不同类型的髋关节骨关节炎：最常见的是外侧-颅侧型和内侧-尾侧型，而中央型非常罕见。基本的影像学检查方法是传统X线片和CT，其次是MRI。“活动性骨关节炎”的诊断通过骨闪烁显像或静脉注射造影剂的MRI来进行。盂唇和软骨的诊断应通过MRI或磁共振关节造影来完成。功能性计算机动画分析在不久的将来将具有很大的诊断价值。MRI的适应证包括临床结果与影像学表现之间的差异、标准治疗下“活动性”骨关节炎临床症状无改善、关节疼痛不明确以及在任何关节镜检查之前。
