53987103 Avascular Necrosis Caput Femoris

Referat Radiologi Avascular Necrosis Caput Femoris Nikhen Noverike 406100073

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AVASCULAR NECROSIS CAPUT FEMORIS

DEFINISI

Avaskular nekrosis (AVN) merupakan suau komplikasi !an" er#a$i $imana %ilan"n!a&erpuusn!a suppl! $ara% pa$a suau 'a"ian ulan" se%in""a men!e'a'kan kemaian ulan" erse'u Sesuai $ne"an anaomi vasular* maka nekrosis avaskular pasarauma serin" er#a$i pa$a apu +emoris !aiu pa$a +rakur ollum +emoris* pa$a naviulare manus $an alus Capu +emoralis a$ala% 'aian !an" palin" renan unuk pen"em'an"an nekrosis avaskular (AVN) Lokasi nekrosis 'iasan!a lan"sun" $i 'a,a% permukaan arikular !an" mena%an 'era u'u% $ari ulan" (!aiu anerolaeral kepala +emoralis)

PATHOLOGY

Tulan" !an" men"alami is%emia a,aln!a a,aln!a men"ikui oklusi areri aau vena !an" memper$ memper$ara ara%in! %in!a* a* apu apu +emoris +emoris $iper$ar $iper$ara%i a%i ole% A irum-l irum-le.a e.a me$ial me$ial $an lae laera rall a'a a'an" n" $ari $ari A +emo +emora rali liss pro+ pro+un un$a $a /oson oson"n "n!a !a lau launa na ose oseo o! !e e menan$akan 'a%,a ulan" ela% mai* akan eapi seara ra$iolo"is "am'aran mun"kin sa#a normal 'ila susunan ra'ekular masi% ina Revaskularisasi 'isa erli%a pa$a peremuan anara sumsum ulan" mai $an %i$up Sumsum ulan" !an" mai akan $i"anikan #arin"an ika kemu$ian men#a$i kalsi-ikasi Seara klinis* pasien $en"an AVN AVN apu +emoris menun#ukkan "e#ala* seperi s eperi 'eriku 0 1

N!eri N!eri $i$aer $i$aera% a% pan""u pan""ull $en"an $en"an aau aau i$ak i$ak n!er n!erii men#alar men#alar %in"" %in""a a pa%a pa%a $an

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luu Penurun Penurunan an kemam kemampuan puan "erak "erak roasi roasi $an #arak #arak per"er per"erakan akan pan""ul pan""ul A$an A$an!a !a resi resiko ko er# er#a$i a$in! n!a a AVN AVN pa$a pa$a sisi sisi !an" !an" lainn lainn!a !a N!eri N!eri 'eri+a 'eri+a $alam* $alam* erus erus mener menerus us $an $an mem'u mem'uruk ruk 'ila 'er"era 'er"erak k 2iasan! 2iasan!a a $i$asari $i$asari ri,a ri,a!a !a rauma* rauma* pen! pen!ala% ala%"una "unaan an seroi seroi$* $* $an alo% alo%ol ol

3ika $aera% vaskular keil $an i$ak 'er$ekaan $en"an permukaan arikular* pasien mun"kin asimomaik4 pen!em'u%an $apa er#a$i seara sponan* aau pen!aki erse'u mun"kin eap i$ak er$eeksi aau $iemukan ke'eulan /epanieraan /linik Ra$iolo"i RS 5usa$a 1 F/ UNTAR Pem'im'in" 0 $r Pariia 6i$#a#a* SpRa$ 7 Novem'er 8979 : ;



selama %asil pemeriksaan unuk kon$isi lain Namun* AVN 'isa 'erkem'an" men#a$i kerusakan mekanis !an" le'i% luas

ETHIOLOGY

AVN palin" serin" er#a$i pa$a usia $ea$e kei"a %in""a keenam $an ; kali kemun"kinann!a le'i% 'esar pa$a pria Pen!e'a' er#a$in!a AVN* anara lain 0 1

Traumai (palin" serin")  Fraure apu $an ollum +emur 
1

Araumai  Pen""unaan korikoseroi$ $an pen!ala%"unaan alko%ol 'erle'i%an  

(palin" serin") I$iopa%i (ono% Le""1Calve1Per%es) Sikle ell anemia* =au%er>s $isease*

lupus*

oa"ulapa%ies*

%!perlipi$emia* ransplanasi or"an* Caisson>s $isease ? pen!aki iroi$

DIAGNOSTIK

2e'erapa rieria unuk penenuan sa$ium AVN* $ianaran!a men""unakan Inernaional Sa"in" o+ AVN o+ %e +emoral %ea$ 0 Stage

Clinical

Radiograpic

9

Symptom !inding" Ne"aive Ne"aive

7

Pain

Ne"aive

/epanieraan /linik Ra$iolo"i RS 5usa$a 1 F/ UNTAR Pem'im'in" 0 $r Pariia 6i$#a#a* SpRa$ 7 Novem'er 8979 : ;
#RI !inding"

Ne"aive or 'one marro, e$ema paern T767 0

Scintigrapic !inding" Ne"aive


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(oasionall! su""esion o+ minimal molin")

Foal* %omo"enous or -lo, (earl!)* %eero"enoues $erease inrease$ in si"nal inensi! upake T867 0 Inrease$ si"nal inensi! a 'one in+ar iner+ae

Pa%! oseopenia* slerosis* an$ !s +ormaion Su'%on$ral luen! (resen si"n)

Similar o sa"e 7* Inrease$ 
Inrease$ upake

8

Pain

B

Pain

;

Pain an$ $isa'ili!

Collapse$ or $e+orme$ +emoral %ea$

Collapse$ ariular sur+ae or +ra"menaion o+ +emoral %ea$




Pain an$ $isa'ili!

Seon$ar! oseoar%riis ,i% aea'ular involvemen

Seon$ar! oseoar%riis ,i% aea'ular involvemen


/rieria ini $i"unakan unuk menenukan pen"o'aan sera pro"nosis pasien

DIAGNOSTIC I#AGING % Radiologi konvensional

Men""unakan -ilm ra$io"ra-i polos* sensiivias unuk men$eeksi a%ap a,al pen!aki ini seren$a% ;7D 3a$i 'ila pa$a +oo polos $iemukan %asil normal 'ukan 'erari i$ak a$a proses AVN !an" er#a$i

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ra$io"ra-i polos mun"kin $apa mem'anu $alam menilai a$a i$akn!a $emineralisasi apu +emoral !an" erkai peru'a%an $e"enerai+ Foo $iam'il $en"an posisi AP $an Laeral
Peru'a%an !an" men"enai apu +emoris le'i% 'esar $aripa$a pen!empian ruan" sen$i aau aea'ular Ra$iolusen* slerosis* "am'aran ulan" kolaps*

ruan"

sen$i

men!empi* $an $i apu +emoris er$apa "am'aran k%as 'enuk 'ulan sa'i !an" ra$iolusen =am'aran su'%on$ral !an" kolaps menan$akan sa$ium lan#u Pem'a"ian sa$ium AVN $ili%a $ari %asil +oo 'er$asarkan Crieria FICAT 0 Stag

Clinical

Radiograpic

#orpologic

e 9

Finding" None

!inding" Normal

cange" 5isolo"i nerosis in %e 'one marro,

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Pain* resrie$ moion

Normal

Nerosis

8

Pain* resrie$ moion

Ra$ioluen!* !si areas* an$ slerosis

Nerosis

B

Inreasin" omplains

Flaenin" o+ %e Nerosis an$ +emoral %ea$* resen su'%on$ral +raure si"n as 1evi$ene o+ su'%on$ral +raure

;

Inreasin" omplains

Nerosis* $e"eneraive ar%riis

Avasular nerosis o+ %e +emoral %ea$ Aneroposerior vie, o+ %e pelvis s%o,s -laenin" o+ %e ouer porion o+ %e ri"% +emoral %ea$ +rom avasular nerosis /epanieraan /linik Ra$iolo"i RS 5usa$a 1 F/ UNTAR Pem'im'in" 0 $r Pariia 6i$#a#a* SpRa$ 7 Novem'er 8979 : ;

!

(arro,)* ,i% a$#aen #oin1spae narro,in"* #u.a1ariular slerosis* an$ oseop%!es represenin" $e"eneraive #oin $isease

Aneroposerior vie, o+ %e le+ %ip in a paien ,i% avasular nerosis $emonsraes alernain" re"ions o+ %e slerosis an$ luen! ,i%in %e superior aspe o+ %e le+ +emoral %ea$ (arro,s)* represenin" %e reparaive sa"e (sa"e 8) o+ avasular nerosis T%e luen areas represen %e sie o+ resorpion o+ neroi marro, an$ ra'eular T%e slerosis represens apposiion o+ ne, 'one on $ea$ ra'eulae

Aneroposerior vie, o+ %e pelvis in a paien ,i% 'ilaeral avasular nerosis o+ %e +emoral %ea$ Mil$ -laenin" o %e superior aspe o+ %e ri"% +emoral %ea$ (open arro,) in$iaes sa"e B $isease T%e le+ +emoral %ea$ %as a normal onour* in$iain" sa"e 8 $isease T%e 'lak arro,s in$iae %e mar"ins o+ %e reparaive one* represenin" ne, 'one +ormaion on $ea$ ra'eulae 6%en avasular nerosis is 'ilaeral* i usuall! ours in ea% %ip a $i++eren imes* an$ %e sa"in" o+ $isease in ea% %ip an 'e* an$ o+en is* a $i++eren sa"es


6

Fro"le" laeral vie, o+ %e ri"% %ip in a paien ,i% avasular nerosis s%o,s %e resen si"n* in$iain" su'%on$ral +raure T%erapeui inervenions are less likel! o %al pro"ression o+ %e $isease one %is si"n appears T%e +ro"le" laeral vie, is 'eer %an aneroposerior (AP) pro#eion +or $emonsrain" %is si"n* 'eause %e anerior an$ poserior mar"ins o+ %e aea'ulum on %e AP pro#eion are superimpose$ over %e superior porion o+ %e +emoral %ea$* %e usual loaion o+ %e si"n (sa"eIII)

Plain -ilm -in$in"s in a paien ,i% 'ilaeral avasular nerosis o+ %e +emoral %ea$ ,%o un$er,en 'ilaeral ore $eompression an$ 'one "ra+in"

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Aneroposerior vie, o+ %e le+ %ip in a paien ,i% avasular nerosis o'aine$  mon%s a+er presenaion s%o,s %a %e paien %as un$er"one ore $eompression 'u %as $evelope$ mil$ -laenin" o+ %e +emoral %ea$* in$iain" pro"ression o+ $isease $espie reamen

CT 1 Resolusin!a memun"kinkan men"analisis -iur mor+olo"i 1 /epekaan CT san $alam men$eeksi nekrosis avaskular a,al (AVN) a$ala%

D* !an" mirip $en"an sensiivias o'a peniraan nuklir planar 1 Le'i% akura $ari ra$iolo"i konvensional unuk sa"in" (eruama sa"e 8 $an le'i% in""i)* kuran" unuk sa"e 9 17 $an kuran" sensiive $i'an$in" MRI 1 Tan$a perama !an" menun#ukkan a$an!a AVN pa$a CT san a$ala% "am'aran oseoporosis* kemu$ian erli%a an$a 'inan" !an" er$isorsi $an men""umpal Pen""umpalan erse'u erli%a se'a"ai spo aau 'enuk 'era"am !an" %!per$ens sera a$an!a slerosis Pene'alan ra'ekula ulan" er#a$i $i en"a% apu +emur seara -isiolo"is $an munul mirip seperi an$a 'inan" /on-i"urasi ini 'erkaian $en"an ekanan 'era u'u% Ca'an" skleroik $ari "am'aran 'inan" erse'u meluas ke permukaan aas apu +emoralis Se'ua% "aris pa$a* meman#an" $ari laeral ke me$ial +emur pa$a peren"a%an apu +emoralis* menun#ukkan pen!auan epip%!sis :A.ial1 (Normal)

A.ial ompue$ omo"rap%! san in a paien ,i% avasular nerosis T%is ima"e s%o,s #oin spae narro,in"* #u.a1ariular slerosis* an$ oseop%!e +ormaion ($e"eneraive #oin $isease) aroun$ %e anerome$ial an$ poserolaeral aspes o+ %e ri"% %ip

A.ial ompue$ omo"rap%% san o+ a paien ,i% avasular nerosis o+ %e +emoral %ea$ s%o,s lumpin" an$ $isorion o+ %e enral ra'eulae represenin" %e aserisk si"n (arro,%ea$) an$ an a$#aen lo,1$ensi! re"ion (arro,) represenin" %e reparaive one

Kedokteran Nuklir 1 2one sini"rap%! men""unakan ala pin%ole ollimaion $an Te%neium !an"

$ila'el analo" p%osp%ae ? sul+ur olloi$ 1 Men$eeksi le'i% $ini $ari ra$iolo"i konvensional* api kuran" sensiive $i'an$in"kan MRI %an!a keika MRI i$ak $apa $ilakukan aau keika MRI %asiln!a i$ak #elas Eksperimenal $an i$ak $i"unakan seara luas $alam sein" klinis 1 Menuru Collier* sensiivias D $en"an peniraan ra$ionukli$a planar unuk nekrosis avaskular (AVN) 1 /uran" 'erman+aa 'ila kasusn!a 'ilaeral* karena perlu per'an$in"an $en"an pin""ul normal

1 Cinin pa$a saa akivias menin"ka menerminkan %iperemi pa$a a%ap a,al $an pen!em'u%an ulan" kemu$ian men"a'urkan kekuran"an nekroik pusa1 +oon $alam kepala +emur* !an" men"in$ikasikan nekrosis avaskular (AVN) 1 Suli unuk mem'e$akan nekrosis avaskular (AVN) $ari pen!e'a' lain !an" #u"a akiviasn!a menin"ka* seperi oseoar%riis* +rakur* $an arriis in-lamasi 1 Proses 0 A,aln!a* serapan menurun $alam per+usi $an +ase sais* !an" merupakan iskemik $ini /emu$ian* pen!erapan menurun $alam kepala +emoralis pa$a +ase per+usi $an menin"ka $isekiar ,ila!a% $in"in $i +ase sais Han" erak%ir ini merupakan ona reaki+ sekiar se"men in+are$ Pen!erapan menin"ka $ari ona reparai+ ak%irn!a men""anikan ka,asan p%oopeni

2one san o+ a paien ,i% avasular nerosis o+ %e +emoral %ea$ s%o,s inrease$ upake in %e superolaeral aspe o+ %e ri"% +emoral %ea$* in$iaive o+ avasular nerosis 'u provi$in" lile in+ormaion onernin" %e sruural ine"ri! o+ %e %ip

Planar 'one san o+ %e pelvis in a paien ,i% 'ilaeral avasular nerosis o+ %e +emoral %ea$ s%o,s marke$ inrease$ upake o+ ra$iop%armaeuial a"en in 'o% %ips MRI T&'&

 5!poinense "aris pin""ir peri+er men"uraikan $aera% pusa sumsum ulan" J reaki+ peremuan anara ona nekroik ? reparai+  K 5!poinense e$ema sumsum ulan" apu $an ollum +emur  Poon"an Sa"ial unuk menilai mor+olo"i apu +emoris (am'a%an unuk peniraan ruin $en"an "am'ar oronal ? aksial)  K 5!poinense e+usi sen$i  In+ark su'%on$ral 'er'enuk ,e$"e$1s%ape$ T('&


T& C )

 Penurunan konras $en"an "a$olinium $i AVN a,al

 Nonvia'le ra'ekula ? sumsum J anpa konras  Penin"kaan ,arna konras sesuai $en"an ona reparai+ "aris %!poinense

T%e MR ima"in" -in$in"s o+ AVN o+ %e %ip ma! 'e lassi-ie$ aor$in" o a s!sem propose$ '! Mi%ell0 * Cla"" A le"ion%

Si"nal inensi! %araerisis analo"ous o %ose o+ +a %a is* %i"% si"nal inensi! on T71,ei"%e$ ima"es an$ inerme$iae si"nal inensi! on T81 ,ei"%e$ ima"es

Coronal T71,ei"%e$ ma"nei resonane ima"e (MRI) o+ %e pelvis in a paien ,i% avasular nerosis o+ %e +emoral %ea$ s%o,s inrease$ si"nal ,i%in %e superior aspe o+ %e +emoral %ea$* represenin" +a T%is is an MRI lass 7 %ip T%ese paiens ma! %ave more %an one !pe o+ si"nal ,i%in %e a'normal avasular area In %is siuaion* %e mos $ominan si"nal is use$ +or MRI lassi-iaion * Cla"" + le"ion%

Si"nal inensi! %araerisis %a are similar o %ose o+ 'loo$* ,%i% %as %i"% si"nal inensi! on 'o% T71 an$ T81,ei"%e$ ima"es

Coronal T71,ei"%e$ ma"nei resonane ima"e o+ %e pelvis in a paien ,i% 'ilaeral avasular nerosis o+ %e +emoral %ea$ $emonsraes $erease$ si"nal ,i%in %e ri"% +emoral %ea$* represenin" -lui$* an$ inrease$ si"nal ,i%in %e le+ +emoral %ea$* represenin" 'loo$
Coronal T81,ei"%e$ ma"nei resonane ima"e o+ %e pelvis in a paien ,i% 'ilaeral avasular nerosis o+ %e +emoral %ea$ s%o,s $erease$ si"nal ,i%in %e ri"% +emoral %ea$* represenin" -lui$* an$ inrease$ si"nal ,i%in %e le+ +emoral %ea$* represenin" 'loo$ T%e ri"% %ip %as a lass C lesion* an$ %e le+ %ip %as a lass 2 lesion * Cla"" C le"ion%

Si"nal inensi! properies %a are similar o %ose o+ -lui$ %a is* lo, si"nal inensi! on T71,ei"%e$ ima"es an$ %i"% si"nal inensi! on T81,ei"%e$ ima"es

Coronal T71,ei"%e$ ma"nei resonane ima"e (MRI) in a paien ,i% avasular nerosis s%o,s $erease$ si"nal ,i%in %e +emoral %ea$ (arro,)* represenin" e$ema T%is is an MRI lass C lesion T%e su'%on$ral a'normali! an also in$iae a +raure Muliplanar reonsrue$ ompue$ omo"rap%! sannin" ,oul$ 'e %elp+ul +or +ur%er invesi"aion

Coronal +a1saurae$ T81,ei"%e$ ma"nei resonane ima"e in a paien ,i% avasular nerosis s%o,s inrease$ si"nal ,i%in %e +emoral %ea$ an$ nek (arro,)* represenin" e$ema S%or au inversion reover! (STIR) an$ +a1 saurae$ ima"in" are e.ellen +or $emonsrain" %is -in$in" * Cla"" D le"ion%

Si"nal is similar o %a o+ -i'rous issue* ,%i% %as lo, si"nal inensi! on 'o% T71 an$ T81,ei"%e$ ima"es )Class A si"nal inensi! en$s o re-le earl! $isease* an$ lass < si"nal inensi! en$s o re-le lae $isease

a.

b.

Avasular nerosis pa$a pan""ul kiri a sa"ial* T71,ei"%e$ SE ima"e ' Coronal* T81,ei"%e$ ima"e Pa$a "am'aran T71,ei"%e$ $aera% nekroik memiliki si"nal inensias !an" sama $en"an "am'aran sumsum ulan" normal Pa$a se"men anerosuperior $aera% nekroik $i'aasi ole% "aris 'erinensias ren$a% Pa$a "am'aran T81 ,ei"%e$ an$a $ou'le line !an" $iper%aikan se'a"ai an$a pao"nomonik avasular nerosis apu +emoris erli%a

a

'

Avasular nerosis pa$a ke$ua apu +emoris a Coronal T71,ei"%e$ SE ima"e ' Sa"ial T71,ei"%e$ SE ima"e pa$a pan""ul kanan Nerosis !an" meluas $en"an peru'a%an inensias erli%a pa$a se'ela% kanan $en"an perluasan ke apu $an ollum +emoris sera $aera% inerro%aneria Pa$a 'a"ian kiri* %an!a area nerosis keil !an" erli%a $i se"men aas apu +emoris !an" $i'aasi "aris inensias ren$a% Poon"an sa"ial pan""ul kanan

1menun#ukan perluasan area apu +emoris* $en"an 8 an$a one nerosis anerosuperior $an $orsal

a '



a Area ,e$"e1s%ape$ pa$a penurunan inensias eri$eni-ikasi pa$a "am'aran oronal ' =am'aran a.ial #u"a menun#ukkan ,e$"e1s%ape$ area pa$a si"nal ren$a% konsisen $en"an avasular nerosis  oom up $ari "am'ar a menun#ukkan li" Teres normal selan#un!a menun#ukkan karakerisik avasular nerosis !pe lesion Li" Teres pa$a posisi laeral erpisa% $en"an pemukaan apu +emoris meskipun AVN $apa erli%a $i area ini

(a) menun#ukkan "am'aran "eo"rap%i rin" pa$a permukaan $en"an $isri'usi vaskuler $ike$ua kanan $an kiri pan""ul Peru'a%an erse'u a$ala% karakerisik avasular nerosis (') $an () poon"an a.ial Ti$ak a$a #oin e++usion !an" eri$eni-ikasi Capu +emoris mempera%ankan 'enuk normaln!a Collum $an orpus +emoris #u"a mempera%ankan si"nal normaln!a

Area !an" er$e-inisi 'aik $en"an inensias ren$a% (a T767)* inerme$iae (' P<67) $an relai+ in""i (T867 FS) erli%a pa$a permukaan apu +emoris

Permukaan arikular !an" kolaps $en"an erli%an!a +ra"menasi a T767* oronal 4 ' T867* FS* oronal

Cinin (a) aau pia (') pa$a inensias si"nal !an" ren$a% memisa%kan $aera% su'arikular pa$a inensias normal $ari sumsum $i apu +emoris !an" i$ak erkena $ampakn!a (T767* oronal) 4 () $an ($) Tan$a 
Avasular nerosis o+ %e +emoral %ea$ Coronal T71,ei"%e$ ma"nei resonane ima"e in a paien s%o,in" %!poinense si"nal ,i%in %e pro.imal +emoral nek an$ inerro%aneri re"ions (arro,s) represenin" %emaopoiei marro, Inrease$ si"nal is presen ,i%in %e "reaer ro%aners an$ +emoral apial epip%!sis represenin" normal +a! marro, See also %e ne. ima"e

Coronal +a1saurae$ T81,ei"%e$ ma"nei resonane ima"e in a paien ,i% avasular nerosis s%o,s inrease$ si"nal ,i%in %e +emoral %ea$ an$ nek (arro,)* represenin" e$ema S%or au inversion reover! (STIR) an$ +a1 saurae$ ima"in" are e.ellen +or $emonsrain" %is -in$in" See also %e ne. ima"e

Coronal T71,ei"%e$ ma"nei resonane ima"e (MRI) in a paien ,i% avasular nerosis s%o,s $erease$ si"nal ,i%in %e +emoral %ea$ (arro,)* represenin" e$ema T%is is an MRI lass C lesion T%e su'%on$ral a'normali! an also in$iae a +raure Muliplanar reonsrue$ ompue$ omo"rap%! sannin" ,oul$ 'e %elp+ul +or +ur%er invesi"aion

DIFFERENTIAL DIAGNOSIS

1 Transien Oseoporosis o+ 5IP (TO5)  Oseoporosis pa$a apu $an ollum +emoris  Proses pen!em'u%an 'erlan"un" le'i% $ari 79178 'ulan   Aea'ulum $an sen$i +emoralis iku erli'a 1
TERAPI

Mana#emen pen"o'aan pa$a AVN er"anun" $ari lokasi $na kepara%an pen!aki* sera usia $an kon$isi umum pasien Ti$ak a$a pen"o'aan !an" san"a e+eki+ unuk mene"a% proses AVN 

Seara konservaive $en"an men#a"a 'e'an u'u% !an" i$eal* selain iu

pen"%ilan" rasa saki (anal"ei) unuk men"uran"i n!eri  Se#umla% peneliian menun#ukkan 2ip%osp%onaes $apa mem'anu unuk memperlam'a proses kolapsn!a apu +emoris $an memperlam'a operasi  Sain $apa mene"a% Corioseroi$1in$ue$ AVN  2e$a% 0 1 Pa$a a%ap a,al AVN (preollapse)* $ekompresi ini $en"an aau anpa an"kok ulan" ini 'iasan!a $ian""ap se'a"ai pera,aan !an" palin" epa

1

Core $eompression 0 menin"kakan sirkulasi $en"an menurunkan ekanan inrame$ulla $an mene"a% iskemia le'i% lan#u $an kerusakan

1

sen$i !an" pro"resi+* e+eki+ pula unuk men"onrol rasa saki 2one "ra+ 0 ermasuk korikal $an me$ulla sera vaskularisasi $en"an

1 1

oo pe$ile aar vaskularisasi 'e'as -i'ula ? Core $eompression 0 men""an""u siklus is%emia ? Eksisi seGuesrum 0 men"%am'a revaskularisasi apu +emur Oseoom! Toal 5ip Ar%roplas! (eruama sa"e B : le'i%)

PROGNOSIS  

2er"anun" pa$a lokasi* kon$isi* sea lokasin!a Le'i% $ari 9D pen$eria %arus melakukan pem'e$a%an seela% B a%un $i$ia"nosis

Pro"nosis 'uruk 0



Usia le'i% $ari 9 a%un Sa$ium lan#u (sa"e B aau le'i%) pa$a saa $i$ia"nosis Nerosis mele'i%i 7&B $aera% apu +emoris !an" Nampak pa$a MRI


me$ial) Fakor resiko !an" i$ak $apa $imo$i-ikasi (orioseroi$1in$ue$ AVN)

  

53987103 Avascular Necrosis Caput Femoris

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