Lauenstein recording
The Lauenstein image is an imaging procedure using X-rays to show the thigh bone ( femur ) and the hip joint . It depicts the femoral head and the femoral neck particularly well. While at least two images are usually carried out in two mutually perpendicular planes in skeletal images, the side view ("lateral" image) is difficult for anatomical reasons at the hip joint The second image of the hip joint for the classic "ap" image (anterior-posterior beam path, ie in the frontal plane) takes place.
The recording technology is named after the German surgeon Carl Lauenstein (1850–1915), the senior physician at the seaman's hospital in Hamburg-St. Pauli , the predecessor of the Hafenkrankenhaus , and doctor at the Hamburg Diakonissenhaus Bethesda.
execution
The patient is supine with the other leg extended. The hip to be examined is bent by 45 ° and spread apart by 45 °, the knee is bent by 90 °. The greater trochanter projects behind the femoral neck. If there is an anti-splay, the mutual hips are raised as far as there is no 45 ° splay. The central beam is directed to the middle of the groin .
More hip x-ray settings
However, there are numerous other recordings on the hip joint that are used for individual special questions. However, oblique recordings have become rare since the introduction of computed tomography , while the recordings according to Dunn-Rippstein and Imhäuser are still used, especially in pediatric orthopedics :
- Photo according to Dunn-Rippstein : very good representation of the femoral neck, especially if a femoral head is suspected . The hip to be examined is bent 90 ° and spread apart by 20 ° without rotation (which can be achieved, for example, by bending the knees by 90 ° and lower legs hanging down on the examination table). This image can also be used to determine the projected anteversion angle and the projected CCD angle of the hip (therefore this image is sometimes also referred to as an anteversion image).
- Image according to Imhäuser : Variation of the image according to Dunn-Rippstein, whereby the spread is calculated using the CCD angle (CCD angle minus 90). In this way, the strength of the slipping of the femoral head backwards when the femoral head slides can be precisely determined. The width of the epiphyseal plate and the extent of a coxa vara can also be assessed.
- Foramen obturator Recording : oblique imaging of the hip joint with a good representation of the acetabular roof and the dorsal pan rim and the foramen obturatoriums between seat and pubic bone.
- Ala image : also angled image, approximately perpendicular to the obturator image with good representation of the ventral edge of the acetabulum and the iliac scoop (hence the name: Ala ossis ilium = iliac scoop).
- Faux-profile image according to Lequesne: angled almost lateral (therefore "false profile") image with good representation of the ventral acetabular roof. The patient stands with his back at an angle of 65 ° in front of the stand and the foot of the side to be examined parallel to the stand level. With this technique, gonadal protection is the only hip adjustment that is not possible.
Indications
The axial image is intended to answer questions relating to the femoral head cap (e.g. in Perthes disease ), or the cartilage joint (e.g. in epiphysiolysis ), or the femoral neck in fractures .
literature
- Andreas B. Imhoff, René Baumgartner, Ralf D. Linke: Orthopedics checklist . Thieme-Verlag Stuttgart 2006, page 39 ( ISBN 3-13-142281-5 )
- Fritz Hefti: Pediatric Orthopedics in Practice . Springer-Verlag Berlin 1997, pages 170–171 ( ISBN 3-540-61480-X )
Individual evidence
- ↑ EA Zimmer, M. Zimmer-Brossy X-ray incorrect settings, hip joint: axial according to Lauenstein Springer-Verlag ISBN 978-3-642-67187-6 doi : 10.1007 / 978-3-642-67187-6_33