Wulf Jan, Holzapfel Boris M, Reidler Paul, Lerchenberger Maximilian
Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales UniversitätsZentrum München (MUM), LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland.
Klinik und Poliklinik für Radiologie, Abteilung für Radiologie, LMU Klinikum, München, Deutschland.
Chirurgie (Heidelb). 2025 May 2. doi: 10.1007/s00104-025-02288-x.
Chronic groin pain in adults is often attributable to hip joint pathologies. This article analyzes important orthopedic differential diagnoses, including hip dysplasia, acetabular version abnormalities, femoral torsion anomalies, femoroacetabular impingement (FAI), femoral head necrosis, and osteoarthritis. The pathophysiology of these conditions frequently lead to disrupted joint mechanics, leading to premature degeneration and arthritis. The diagnostics include patient history, clinical examination and imaging modalities such as X‑ray, magnetic resonance imaging (MRI) or computed tomography (CT). Treatment options include conservative measures (e.g., physiotherapy, pain management) or surgical interventions, e.g., arthroscopy for FAI, periacetabular osteotomy (PAO) for dysplasia and total hip arthroplasty (THA) for advanced osteoarthritis. The choice of treatment depends on factors, such as age, disease severity and lifestyle. Preventive measures, early detection of pre-arthritic deformities and regular monitoring of patients at-risk can slow degenerative progression; however, in cases of advanced osteoarthritis THA often remains the last option for preserving mobility and quality of life.
成人慢性腹股沟疼痛通常归因于髋关节病变。本文分析了重要的骨科鉴别诊断,包括髋关节发育不良、髋臼旋转异常、股骨扭转异常、股骨髋臼撞击症(FAI)、股骨头坏死和骨关节炎。这些病症的病理生理学常常导致关节力学紊乱,进而导致过早退变和关节炎。诊断方法包括患者病史、临床检查以及诸如X线、磁共振成像(MRI)或计算机断层扫描(CT)等影像学检查。治疗选择包括保守措施(如物理治疗、疼痛管理)或手术干预,例如针对FAI的关节镜检查、针对发育不良的髋臼周围截骨术(PAO)以及针对晚期骨关节炎的全髋关节置换术(THA)。治疗方案的选择取决于年龄、疾病严重程度和生活方式等因素。预防措施、关节炎前期畸形的早期检测以及对高危患者的定期监测可以减缓退变进程;然而,在晚期骨关节炎的情况下,THA往往仍是维持活动能力和生活质量的最后选择。