Differenzialdiagnosen der Osteonekrose großer Gelenke
Tóm tắt
Sowohl die subchondrale Insuffizienzfraktur (SIF) als auch das idiopathische Knochenmarködemsyndrom sind stets zu beachtende Differenzierungen gegenüber der Osteonekrose, da sie neben einer abweichenden – in der Regel besseren – Prognose auch eine andere Therapiewahl nach sich ziehen. Die Osteochondrosis dissecans stellt eine in mehrfacher Hinsicht abzugrenzende, eigene Entität dar, die nicht mit der Osteonekrose verwechselt bzw. vereinheitlicht werden darf. Hinter einer rasch progredient verlaufenden, destruktiven Osteoarthrose kann sich nach neuerer Erkenntnis ursächlich eine intraktable SIF verbergen. Septische Gelenk- und Knochenaffektionen können eo ipso zur schweren Gelenkdestruktion, aber auch infolge septischer Gefäßverschlüsse sekundär zu Osteonekrosen führen. Während knochenmarkinfiltrierende Systemerkrankungen – v. a. therapiebedingt – zu Osteonekrosen führen können, stellen Tumorerkrankungen selten ein differenzialdiagnostisches Problem hinsichtlich einer Differenzierung gegenüber der Osteonekrose dar.
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