1.What is femoral head necrosis?
Bone ischemic necrosis is the death of the viable components of bone (including bone cells, bone marrow hematopoietic cells and fat cells). This phenomenon occurs in the femoral head area, which is ischemic necrosis of the femoral head, also known as aseptic necrosis of the femoral head. It is associated with trauma to the hip joint, certain drugs (such as adrenocorticosteroids), chronic alcoholism, hip dysplasia, and certain diseases. Regardless of the cause of femoral head necrosis, the common denominator is damage to the blood flow of the femoral head, causing ischemic necrosis due to insufficient blood supply. Most of the patients are above the second stage of ischemic necrosis of the femoral head, which is rare in the early stage. While it is not difficult to diagnose the middle and late stages of ischemic necrosis of the femoral head, the early diagnosis and prognosis are crucial. Early diagnosis and treatment can grasp the timing of treatment and preserve the normal form and joint function of the femoral head. Some statistics show that only 7% of the cases are really diagnosed at an early stage and receive timely treatment, indicating that the early detection and treatment rate is very low.
2, how to early detection of ischemic necrosis of the femoral head?
(1) Early clinical manifestations. Most patients with early ischemic necrosis of the femoral head have no obvious symptoms, and the first symptom is hidden pain or dull pain in the hip, occasionally stabbing pain, often accompanied by tight pain in the adductor muscle. Although there is discomfort reaction in the hip joint after exertion, there is no obstacle to movement and no obvious limp. If you see such symptoms, especially if there is a history of trauma to the hip joint, or if you have used a lot of hormone drugs for a long time due to certain diseases, or if you have congenital hip dysplasia, you should be highly alert and have further examination in time.
(2) The time of symptoms of ischemic necrosis of the femoral head due to different causes varies greatly. Long-term use of hormones usually develops 3 to 18 months after taking the drug, but there is also a short period of time after taking the drug; the onset of alcoholism is difficult to determine, often for several years to decades of drinking history, but there are also binge drinking several times that the occurrence of femoral head necrosis; the exact time of femoral head necrosis due to femoral neck fracture, animal testing has confirmed that most of the cells lose the ability to synthesize 2 hours of ischemia, 12 to 24 hours after the fracture ischemia The majority of cells in the femoral head die within 12-24 hours after fracture, except for cartilage. In humans, the disappearance of bone cells 9 days after fracture indicates the presence of ischemic necrosis. Femoral head necrosis usually occurs six months to five years after the fracture of the femoral neck. However, the timing of femoral head necrosis varies depending on the location of the fracture.
(3) Early X-ray manifestations. Careful observation of the X-ray plain film can reveal changes in the top bone texture of the femoral head. If the texture becomes thin or partially disappears, or if small capsular changes or small crescentic areas with relatively higher density are seen, early necrosis is suspected, i.e. the signal of osteonecrosis. If there are clinical symptoms and the relative increase in density of the bone texture of the femoral head is observed, the diagnosis of early necrosis can be confirmed.
(4) Comprehensive analysis of the causes of misdiagnosis. In years of clinical practice, it was found that the majority of patients failed to receive early diagnosis and treatment. When hip pain is found, it is often considered to be arthritis and is first treated with anti-rheumatic therapy, painkillers or even radical drugs, without further examination for a long time. No attention is paid to the factors inducing femoral head necrosis by taking hormones and long-term heavy alcohol consumption, or no knowledge of this at all, and some patients still do not know to quit drinking when they develop into advanced stages. Lack of high quality x-ray film, the early appearance of necrosis signal can not be observed, there is no condition for imaging (ECT) examination and further diagnosis. Insufficient experience in observing x-ray film, not using strong light to carefully observe suspicious x-ray film, mistakenly thinking that x-ray film is normal.
Clinical practice proves that early diagnosis and early treatment have good prognosis. The real early diagnosis is before the x-ray signs of ischemic osteonecrosis are not obvious, so it is very difficult to diagnose early femoral head necrosis by x-ray plain film alone. The study proved that the early diagnosis of femoral head necrosis is 85.7% with the highest depth imaging (SPECT), 80% with magnetic resonance imaging (MRI), 77% with intraosseous pressure measurement, and only 68.4% with conventional bone scan, and 100% with MRI and SPECT, but SPECT is cheaper. Therefore, it is an economic and effective method for early diagnosis of osteonecrosis of the femoral head.
3.Functional treatment
The main clinical manifestations of patients with ischemic necrosis of femoral head are three aspects: pain, impairment and claudication of the affected hip and lower limbs. The early stage of femoral head necrosis is dominated by pain, and there is generally no obvious functional impairment or claudication. If limitation of activity function and claudication occur, they are caused by pain. In the middle and late stages, with the development of the disease, the duration of the disease is prolonged, the amount of plain activity is reduced, and hip joint dysfunction and claudication gradually appear, which is related to the disuse and atrophy of the soft tissues of the hip joint, including flexion and extension, extension and rotation muscle groups. As a result of long-term braking, these tissues and muscles become less elastic, adhere and develop into stiffness, especially the internal contraction muscles become tense and contracture, which leads to obvious dysfunction and eventually to disability.
Hip exercise method is an adjunctive treatment for ischemic necrosis of the femoral head in Chinese medicine. It is an effective treatment to implement the principle of combining local and overall, movement and static in TCM orthopedics to promote the early restoration of function of the affected hip. The functional exercise of patients with femoral head necrosis should be mainly automatic, supplemented by passive activities. The movements should be coordinated, gradual, from small to large, from little to much, and gradually increased. The specific method should be flexible according to the patient’s condition, physique and age to achieve the purpose of promoting local blood circulation, improving blood flow, adjusting hip joint gap, strengthening muscle strength and finally improving hip joint function.
Methods.
(1) Hip flexion and division method: supine position, place both hands on the outside of the body, keep both feet on the bed, bend the knees and flex the hips at an angle of about 45 degrees, take both feet as the axis, drive the thighs apart as far as possible to both sides with the knees as the main focus, so that the hip joint is fully stretched, then turn, the amplitude gradually increases, and move for 5-10 minutes.
(2) spread hip open law: supine position, legs straight and together, for split legs as far as possible to abduct, in together, or legs straight and abducted for cross activities, the action should be slow, 5-10 minutes each time.
(3) flexion of the knee and hip method: supine position, both legs take turns flexing and extending the knee and hip, the left leg flexion when the right leg should be as straight as possible, the heel against the bed, the activity of large heel can leave the bed. Repeat the activity 20-30 times.
(4) air pedal flexion and extension method: supine position, legs straight up, then alternate hip flexion and knee flexion of both legs, so that the lower leg suspended in the air, like pedaling a bicycle, to flex the hip joint mainly, the amplitude, the number of times gradually increased.
(5) affected limb swing method: supine, legs straight, affected limb straight leg elevation or elevation to a certain limit, for inward and outward activities 8-10 times.
(6) straight leg posterior extension method: the patient lies prone on the bed, legs straight, hands above the chest, single leg posterior extension, alternating bilateral. At the beginning of the stretch can not be harmed, try their best to reach back, the action slowly and gradually increase the magnitude, the number of times, repeat 8-10 times.
(7) pedal activity method: the patient sits steadily on the functional exercise vehicle, like pedaling a bicycle, the movement is slow, the speed is gradually accelerated, and the time is gradually lengthened.
(8) Sitting hip flexion method: the patient sits on the edge of the bed or chair, both lower limbs are naturally separated, the affected leg is repeatedly flexed hip and knee movement, about 8-10 times.
(9) Sitting knee flexion and leg separation method: the patient is sitting on a chair, the affected leg is placed on the opposite leg with knee flexion and abduction in a 4-character return position. The number of up and down movements, the movement should be slow. This action should not be forced, the angle, the number of times can be flexed how much flexion, as much as possible.
(10) lower limb swing method: single or two-handed forward or lateral extension to hold the fixed object, the affected leg forward flexion, backward extension, adduction, abduction slowly swing. The amplitude is as large as possible, swinging 8-10 times.
(11) Internal and external rotation of the lower limbs: hold the fixation with your hands, extend one foot slightly forward and outward, follow the ground with the foot and make internal and external rotation for ten times.
The functional exercises of various hip joints should be used flexibly according to the specific conditions of the patients, not to seek for the whole thing at the beginning, not to rush, to do according to the ability and to strengthen gradually. Active hip joint internal rotation, external rotation, internal retraction, abduction and flexion exercises can help improve blood flow and prevent joint movement disorders, and promote joint function recovery.
4.How to prevent and treat
Femoral head necrosis is also known as ischemic necrosis of the femoral head and aseptic necrosis of the femoral head. The cause of this disease is not clear, but some factors have a certain relationship with the onset of this disease, such as rheumatism (wind, cold, humidity, heat), the use of hormonal drugs, injury, (accidental trauma, strain), etc., can make the femur and hip microcirculatory disorders, metabolic dysfunction, if not treated for a long time or treatment is not the right condition to make the transfer of deterioration, it can lead to necrosis of the femoral head. The early symptoms include weakness in the hips and legs after activity, hip pain (activity plus residence, relieved by rest), basically no change in joint function and bone quality, and the following characteristics: (1) occasional limp shape or slight pain in the affected hip and part after fatigue. Due to the spasm of the muscles in front of the hip, the hip cannot be fully straightened, and it is difficult to extend the leg cross-legged or outward and squat; (2) discomfort or pain and numbness in the lacrimal and inner thighs and buttocks; (3) soreness and weakness of the leg muscles, weakened strength and gradual muscle atrophy; (4) more than 90% of children suffering from this disease have no pain.
Western medicine treatment of femoral head necrosis often takes surgical procedures such as bone replacement and artificial femoral head replacement, but the success rate of surgery is low. In addition, the long-term use of hormonal drugs, the side effects of which often aggravate bone necrosis. According to Chinese medicine, this disease is caused by deficiency of liver and kidney, stagnation of meridians, and external sensation of six evils, which leads to insufficient blood supply, stagnation of blood, and damage to meridians, causing ischemia and necrosis of the femoral head due to lack of blood support, so the treatment should start with tonifying the kidney and strengthening the bone, and clearing the stasis of the meridians.
How to prevent the occurrence of femoral head necrosis? Generally, we should do the following: (1) pay attention to safety when walking and riding in a car, avoid slipping and falling so that the hip lands on the ground and sprains the hip; (2) hip injuries should be treated in time to avoid premature strain on the hip before the injury is healed; (3) prohibit alcoholism and advocate not to drink or drink less; (4) use less or no hormonal drugs under the guidance of doctors after the disease; (5) hip injuries should be treated urgently to prevent patients from (5) treat the hip injury as soon as possible to prevent the disease from metastasizing and causing early femoral head necrosis.
Once diagnosed with femoral head necrosis, in addition to timely treatment, special attention should be paid to medication and life conditioning to: (1) minimize carrying heavy objects or walking too much, and pay attention to walking with crutches when walking in severe cases, so that the blood circulation in the focal area is smooth and promote the repair of dead bone and the growth of new bone; (2) regardless of economic conditions, choose safe, effective and reasonably priced medication according to the condition when consulting a doctor, and adhere to functional exercises under the guidance of the doctor. (3) Pay attention to strengthening nutrition, arranging meals reasonably, eating more fruits and vegetables, and eating less high-protein and high-fat food to prevent overweight and increase the burden on the hip; (4) Avoid drinking too much alcohol to prevent fatty liver from occurring due to high blood lipids, which can lead to bone vessel embolism and affect the recovery of necrotic bone.