Femoral head necrosis is a disorder that causes collapse of the femoral head and hip joint dysfunction due to various reasons, which destroys the blood supply to the femoral head and causes the death of bone cells, which then leads to structural changes in the femoral head.
I. Etiology
1.Traumatic femoral head necrosis, such as after femoral neck fracture.
2, non-traumatic: caused by the use of hormones and alcohol abuse and other diseases.
Clinical manifestations Early stage pain in the hip or knee joint medially. Restricted hip movement in the later stage.
Staging Ficat-Arlet staging four stages
Stage I: No abnormal findings on X-rays.
Stage II: X-ray film shows cystic change or sclerosis in the femoral head.
Stage III: flattening of the femoral head and crescentic sign.
Stage IV: collapse of the femoral head, reduction of joint space and degenerative degeneration of the acetabulum.
IV. Treatment
1.Non-surgical treatment: Applicable to children or adults with stage I and II lesions.
(1) Protective weight-bearing.
(2) Low-molecular heparin, prostaglandin E and vasodilating herbal treatment.
(3) High frequency magnetic field therapy.
(4)Extracorporeal shock wave.
2.Surgical treatment.
(1)Myocardial decompression. Or add autologous bone marrow stem cell transplantation.
(2)Femoral head lesion removal, anastomosis vascular fibula grafting.
(3) Lesion removal, plus bone grafting.
(4)Osteotomy, head and neck inversion.
(5)Focal lesion removal, various bone transfers with blood vessels.
3, artificial hip arthroplasty Femoral head collapse, hip osteoarthritis stage is suitable for artificial hip arthroplasty.
This includes artificial femoral head, metal-to-metal surface replacement and artificial total hip replacement (ceramic, cemented, non-cemented and hybrid).
(1) Femoral head necrosis with cystic degeneration in the subhead weight-bearing area.
(2) The femoral head has been repaired and the cystic degeneration area disappeared 6 months after the quick transfer repair of the greater trochanter bone.
(3) Intraoperative excision of the greater trochanteric bone block with vascular tip.