L’esame radiografico dell’anca

L’esame radiografico dell’anca riveste ancor oggi un importante  ruolo diagnostico  in quanto consente di valutare la conformazione scheletrica, i rapporti articolari e le eventuali modificazioni strutturali dei versanti ossei-articlari come conseguenza di processi artrosici. Se il vostro medico di base sospetta che abbiate una malattia dell’anca, giungere alla visita specialistica con una radiografia già correttamente eseguita vi permetterà di abbreviare il cammino verso il trattamento e quindi la guarigione.


Generalmente l’esame viene richiesto ed eseguito nelle proiezioni standard considerate l’anteroposteriore del bacino e l’assiale cross-legs

PROIEZIONE ANTEROPOSTERIORE DI BACINO STANDARD: il paziente viene posizionato supino con le anche intraruotate di 15°. L’apice del coccige deve essere in linea con la sinfisi pubica, il tubo rx deve essere ruotato craniocaudalmente, per raggiungere nell’immagine una distanza tra l’apice del coccige e il margine superiore della sinfisi pubica di 1 cm nell’uomo e 2.5 cm nella donna. 

 La radiografia frontale del bacino associata alla radiografia assiale dell’anca dolente è il primo e spesso unico esame strumentale in grado di aiutare lo specialista a formulare la diagnosi. E’ importante che la proiezione frontale sia di tutto il bacino, e non solo dell’anca, per permettere un giudizio comparativo e per garantire l’ottimale focalizzazione dei raggi X.

Immagine AP di dettaglio dell’anca di sinistra

   1, Acetabolo.

   2, Testa femorale.

   3, Grande trocantere.

   4, Piccolo trocantere.

   5, Femore.

   6, Gran forame otturatorio.

   7, Branca discendante dell’osso pubico.

   8, Branca orizzontale dell’osso pubico.

   9, Osso del sacro.

  10, Ala iliaca.

Alla proiezione AP del bacino viene routinariamente richiesta la proiezione laterale ” a  rana” di entrambe le anche (FROG LEGS PROJECTION- Fig qui sotto).

-Rx ASSIALE CROSS-LEG 

il paziente è posizionato perfettamente supino, anche a 45° di flessione, 45° di abduzione e rotazione esterna. I piedi sono uniti per la piante. Attenzione il trocantere si sovrappone con la giunzione testa-collo la proiezione è scorretta.

RX ASSIALE CROSS-TABLE O ASSIALE VERA DELL’ANCA:

il paziente è supino, l’anca malata adgiata sul tavolo, l’anca controlaterale flessa a 90 gradi. La “cassetta” viene posta lateralmente alla’nca malata, a 45 gradi rispetto all’asse longitudinale del paziente. Il tubo è mediale con raggio incidente perpendicolare alla cassetta. A seconda della parte del collo femorale da visualizzare (anteromediale o posterolaterale) si decide la rotazione rispettivamente esterna od interna dell’anca. Se non richiesto, l’anca va messa in posizione neutra.

– Rx ASSIALI DELL’ANCA SECONDO DUNN A 45° E 90°

Si tratta di due proiezioni, una a 45° e una a 90° con paziente supino, anca flessa di 45° o 90° con 20° di abduzione e rotazione neutra. Il tubo RX ha un’inclinazione nulla e viene esattamente dall’alto. Viene generalmente richiesta per la valutazione del profilo del collo e della testa femorale nella diagnosi di conflitto femoro-acetabolare.

– Rx FALSO PROFILO DELL’ANCA SECONDO LEQUESNE

Indagini ulteriori, come la TAC, la Risonanza Magnetica e l’ecografia sono costose e, come nel caso della TAC, possono comportare un’irradiazione considerevole. La loro prescrizione deve essere lasciata all’ortopedico, qualora le ritenesse opportune.

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