Blum A, Raymond A, Teixeira P
Service d'imagerie Guilloz, CHU de Nancy, 54000 Nancy, France.
Service d'imagerie Guilloz, CHU de Nancy, 54000 Nancy, France.
Orthop Traumatol Surg Res. 2015 Feb;101(1 Suppl):S85-99. doi: 10.1016/j.otsr.2014.11.002. Epub 2015 Jan 15.
Diagnostic imaging strategy in painful hip depends on many factors, but in all cases, plain X-ray is the first investigation. It may be sufficient to reach diagnosis and determine treatment options. More effective but more expensive exploration is indicated in two circumstances: when plain X-ray is non-contributive, and when diagnosis has been established but more accurate imaging assessment is needed to guide treatment. Following radiography, the choice of imaging techniques depends not only on the suspected pathology but also on the availability of equipment and its performance. MRI is probably the technique that provides the most comprehensive results; recent improved accessibility has significantly simplified the diagnostic algorithm. CT remains invaluable, and current techniques have reduced patient irradiation to a level similar to that of standard X-ray. Finally, cost is an important consideration in choosing the means of exploration, but the overall financial impact of the various strategies for diagnosis of painful hip is not well established. This article aims to provide a simple and effective diagnostic strategy for the assessment of painful hip, taking account of the clinical situation, and to detail the most typical semiologic patterns of each disease affecting this joint.
髋关节疼痛的诊断成像策略取决于多种因素，但在所有情况下，普通X线检查都是首要的检查方法。它可能足以做出诊断并确定治疗方案。在两种情况下需要更有效但更昂贵的检查：一是普通X线检查无诊断价值时，二是已确立诊断但需要更准确的成像评估来指导治疗时。进行X线摄影后，成像技术的选择不仅取决于可疑的病理情况，还取决于设备的可用性及其性能。MRI可能是提供最全面结果的技术；最近其可及性的提高显著简化了诊断流程。CT仍然具有重要价值，并且当前技术已将患者的辐射剂量降低到与标准X线相似的水平。最后，成本是选择检查方法时的一个重要考虑因素，但各种髋关节疼痛诊断策略的总体财务影响尚未明确。本文旨在提供一种简单有效的诊断策略，用于评估髋关节疼痛，同时考虑临床情况，并详细阐述影响该关节的每种疾病最典型的症状模式。
