L’algodistrofia dell’anca

L’edema transitorio della testa del femore (BMES, conosciuto anche come osteoporosi transitoria della testa del femore o algodistrofia della testa del femore) è una patologia ad eziologia ignota che causa dolore e severa inabilità all’anca ed è assolutamente indistinguibile da una necrosi della testa del femore in fase iniziale. L’affezione è caratterizzata dall’insorgenza acuta di dolore, senza causa apparente e persistente anche a riposo, con durata compresa tra i 2 e i 12 mesi.

Alla radiografia compare un’area di marcata osteorarefazione a carico della testa del femore di destra. Questo segno, peraltro, sfumato, è pero’ tardivo. Nelle fasi iniziali pur essendoci un’intensa sintomatologia dolorosa, con impotenza funzionale, la radiografia risulta quasi sempre negativa. Occore pertanto in questi casi procedere ad indagini diagnostiche di II livello, nello specifico la Risonanza Magnetica.

Fig 1 Edema transitorio della testa del femore destro alla radiografiaFig 1 Edema transitorio della testa del femore destro alla radiografia

La Risonanza Magnetica evidenzia una diffusa alterazione di segnale a carico dell’epifisi, talora anche della regione trocanterica, espressione dell’edema dell’osso spongioso.

In questo altro paziente affetto da algodistrofia, le frecce indicano l’alterazione del trofismo ossea della testa femorale di sinistra causata dall’esteso edema spongioso che si distribuisce diffusamente all’intero polo femorale, al collo, spesso fino alle regione intertrocanterica. Non sempre facile è la distinsione di questa forma rispetto alla fase edemigena dell’osteonecrosi, ma successivamente l’assenza di aree di sofferenza ischemica sutto la superficie articolare orientano la diagnosi per l’algodistrofia.

Probabilmente l’edema transitorio della testa del femore e l’osteonecrosi sono patologie che condividono lo stesso momento patogenetico iniziale, l’insulto ischemico dell’osso sub-condrale; mentre però nell’edema transitorio il tessuto osseo superstite riesce comunque a garantire una restitutio ad integrum ed a riacquisire le caratteristiche meccaniche e biologiche dell’osso sano, nella necrosi questo non avviene ed il tessuto devascolarizzato accumula progressivamente alterazioni strutturali alla base della progressione della patologia. Studi recenti hanno inoltre evidenziato forti indizi su un ruolo patogenetico diretto da parte della componente nucleata del tessuto midollare ospitata nell’osso spongioso della testa del femore. Le cellule staminali mesenchimali (MSC), contenute in gran parte nella cresta iliaca ma presenti in piccola parte anche nell’epifisi prossimale femorale mostrano infatti attività e vitalità alterata fin dai primissimi stadi in entrambe le patologie.

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