Femoral head necrosis, also known as ischemic necrosis of the femoral head, is a disease in which the blood supply to the femoral head is interrupted or damaged, causing death of bone cells and bone marrow components and subsequent repair, which then leads to structural changes in the femoral head and collapse of the femoral head, causing joint pain and joint dysfunction in patients, and is a common and intractable disease in the field of orthopedics.
Etiology.
1, non-traumatic factors:hormone application, alcoholism, decompression sickness, sickle cell anemia, etc.
2. Traumatic factors: femoral neck fracture and hip dislocation, etc.
Symptoms
1.Joint pain mainly in the groin, hip and thigh area.
2, unfavorable movement, difficulty in sitting up and squatting.
3.Crippling, sometimes lower limbs are seen to be unequal.
Physical signs
1.Limited movement of hip joint, pain is aggravated when activity is induced.
2. Positive 4-character test, longitudinal percussion pain, positive hip rolling test.
3.Some patients have positive single-leg standing test.
Suggested examination
1.Pelvic anterior-posterior radiograph, pelvic frog radiograph
2.CT and magnetic resonance imaging (MRI) examination
Treatment modalities.
1.Non-surgical treatment Mainly applied to patients with early stage of femoral head necrosis.
(1) Protective weight-bearing The use of double crutches can effectively reduce pain, but the use of wheelchairs is not advocated.
(2)Drug treatment Non-steroidal anti-inflammatory drugs, low-molecular heparin, alendronate sodium, etc. have certain efficacy, and vasodilator drugs also have certain efficacy.
(3) Traditional Chinese medicine treatment is guided by the holistic view of traditional Chinese medicine, following the basic principles of “combination of movement, tendon and bone, internal and external treatment, and cooperation between doctors and patients”, emphasizing early diagnosis, combination of disease and evidence, and early standardized treatment.
For patients in the subclinical stage, Chinese herbal medicines are mainly used to activate blood circulation and resolve blood stasis, supplemented by removing phlegm and dampness, and tonifying kidney and bone, which can promote necrosis repair and prevent or reduce collapse; for femoral head necrosis with pain and other symptoms before collapse, on the basis of protective weight-bearing, Chinese herbal medicines are used to activate blood circulation and resolve blood stasis, and promote water and dampness, which can relieve pain and improve joint function; for post-collapse femoral head necrosis, together with surgical repair surgery, can improve surgical effect.
(4) Physical therapy includes extracorporeal shock wave, high frequency electric field, hyperbaric oxygen, magnetic therapy, etc., which are beneficial to relieve pain and promote bone repair.
2.Head preservation treatment
(1)Femoral head medullary decompression The main principle is to improve the microenvironment in the femoral head by reducing the intraosseous pressure to promote lesion repair, which is one of the longest-used and most efficacious surgeries, and can be combined with medullary decompression combined with stem cell transplantation (or concentrated autologous bone marrow single nucleus cell transplantation), mainly used in the early stage of femoral head necrosis.
(2) Autologous bone grafting with/without blood flow The main principle is to promote the repair of femoral head necrosis by removing necrotic bone and transplanting own bone, mainly used in the middle stage of femoral head necrosis.
(3) Osteotomy The main principle is to move the necrotic area out of the weight-bearing area of the femoral head, which is applied in the middle stage of femoral head necrosis.
(3) Artificial joint replacement Mainly applied to the late stage of femoral head necrosis, femoral head collapse, hip osteoarthritis formation, serious loss of joint function or pain, artificial joint replacement should be selected.
Prevention
The application of hormones, alcoholism and trauma are the most important factors, which should be avoided as much as possible. Occupations such as divers can have regular medical checkups to screen for the occurrence of diseases.