1.Why do some patients’ symptoms reduce during treatment, while some patients’ symptoms increase?
Femoral head necrosis patients after systematic treatment, most patients have improved clinical symptoms and signs, but some patients complained of increased pain in the hip joint, the heart pressure, lost confidence in treatment, but the X-ray shows improvement. In fact, hip pain does not exactly mark the aggravation of the disease, but the bone also appears in the process of repair. The necrotic bone near the joint surface is absorbed, producing enzymes and protein breakdown products, and these toxins enter the joint cavity to irritate the synovial membrane, and severe pain is produced. After the dead bone is absorbed, the pain will be reduced and disappear.
2.Why some patients’ symptoms are reduced after taking regular batch of drugs, but the X-ray performance keeps getting worse?
The treatment of femoral head necrosis is a comprehensive process. In the process of using medicine after femoral head necrosis, there is always the process of absorption of dead bone and formation of new bone inside the femoral head. After the medication is administered, the patient may experience a decrease in pain and an increase in the patient’s activity, which increases the stress on the femoral head and slows down both processes, so the patient may experience a decrease in symptoms while the signs continue to worsen. This is a normal condition and is generally less common. It is common for some people to take drugs that contain painkillers and hormones in seemingly regular medicines (including proprietary Chinese medicine preparations, ancestral recipes, etc.), and the symptoms are obviously reduced after taking the drugs, but in fact it is these drugs that work to make you feel no pain temporarily, but the x-ray performance keeps getting worse instead.
Warm tips
The effect of Chinese medicine in general is more than half a month to a month, some drugs in 1 to 2 days after taking the obvious effect, that is, the pain is significantly reduced, get out of bed activities are not so painful, which is mostly because of the addition of painkillers in this drug.
3, how to self-protection patients with femoral head necrosis?
① Bed rest, limit weight bearing, reduce the pressure of the joint capsule, which helps synovial fluid to nourish the cartilage and repair the diseased tissues. Through rest, the pain caused by the irritation of the hip joint can be relieved.
②Traction prevention With the help of traction power, the muscle spasm can be relieved and the pressure on the femoral head can be reduced to the minimum, which helps to shape the femoral head.
4.How to prevent the occurrence of femoral head necrosis?
①Change the habit of drinking alcohol in large doses continuously for a long time.
② Avoid applying overdose or long-term improper use of hormone drugs. If you have to use them, you should supplement the intake of vitamins and limit excessive intake of lipids, you can give a high protein diet or apply traditional Chinese medicine to regulate the level of lipid metabolism.
③ Avoid strenuous overload sports to minimize the chance of hip injury.
④Patients with femoral neck fracture should exercise early and weight-bearing late after surgery.
5.Why do various hospitals say different things about femoral head necrosis?
To be precise, the cause of femoral head necrosis is not yet very clear, and there is inconsistent understanding of it, leading to many different statements. However, these many statements boil down to no more than three.
(1) Relying entirely on medication and guaranteeing that long-term use of this drug can cure the disease. This is an unscientific, false, bragging claims, with a certain fraudulent nature, unrealistic, not credible.
(2) Temporarily do not receive any treatment, do whatever you want, let it develop freely, and then perform joint replacement when the femoral head is completely collapsed. Or tell you that it is better to replace it later than earlier, and strongly advise you to have the artificial joint replacement as soon as possible. Such statements are irresponsible.
(3) According to the different stages of development of the disease, combined with the situation of femoral head necrosis, different methods are used in stages for limited treatment, which can slow down the development process of the disease and prolong the time of surgical treatment as much as possible, and if the femoral head is completely collapsed, it is not too late to perform femoral head replacement again. This is a more scientific program, and is the treatment method we always advocate.
6.Should patients with osteonecrosis of the femoral head rest in bed for a long time?
Many patients think that suffering from osteonecrosis of the femoral head is not able to bear weight, which means bed rest, this idea is not right. The formation of femoral head necrosis is caused by various reasons of local ischemia, necrosis formation, due to pain and other reasons to limit the activities, resulting in a series of changes such as decreased muscle contraction, joint mobility disorders. On this basis, the activity is even reduced, thus forming a vicious circle, which eventually leads to local blood circulation disorders and the necrosis continues to develop. Thus, it seems that the idea of inactivity after the disease is wrong. The activity improves the blood circulation, prevents complications and helps the repair of the femoral head. However, functional activities should be carried out under the premise of non-weight-bearing, not too much irradiation, and not too much force.
7.Do patients with femoral head necrosis need to limit their activities?
Excessive restriction of lower limb activities can easily lead to muscle wasting atrophy and osteoporosis. This in turn is likely to aggravate the femoral head necrosis. Therefore, it is better to carry out some functional exercises without weight-bearing, such as: hip suspension exercise, air boarding wheel, swimming, etc.
8, how to carry out functional exercise for patients with femoral head necrosis?
The functional exercise of patients with femoral head necrosis should implement the principle of combining local and overall, movement and rest, with active activities as the main, passive activities as a supplement, the movement should be coordinated, step by step, from small to large, from less to more, gradually increase. According to the stage and shape of femoral head necrosis, the degree of functional limitation of the soft tissues around the bone and joint, and the physique, a comprehensive analysis should be conducted to select the appropriate standing, sitting and lying exercise techniques and methods. Generally, non-weight-bearing exercise is the main method, and weight-bearing exercise is supplementary.
9.How to predict the collapse of the femoral head?
The difficulty in the treatment of femoral head necrosis lies in the prevention of collapse. We believe that the occurrence of collapse is related to the stage of development of femoral head necrosis, the extent of necrosis (height, width and area of necrosis site), the site of necrosis and the treatment method, and also related to the individual’s mobility and hip joint loading. If the area of necrosis is less than 30% on the X-ray, most of them can be considered not to have significant collapse; if it is between 30% and 60%, we call it the critical collapse area and the chance of collapse increases significantly; if it is greater than 60% and the angle of necrosis is greater than 110º on the plain film, statistically, the chance of collapse is 99%. Therefore, the earlier the stage of lesion, the better the treatment effect; the smaller the extent of necrosis, the better the treatment effect; necrosis in non-weight-bearing parts, the chance of collapse is small, and the treatment result is good.
10.What is shaping therapy?
Shaping therapy used to be mainly used for the treatment of pediatric femoral head necrosis, but in recent years, it is gradually used for the treatment of adult femoral head necrosis. Shaping therapy is to effectively reduce the concentration of local stress on the femoral head by abduction and internal rotation of the hip joint, shift the stress point of the femoral head, make the necrosis avoid the weight-bearing surface and prevent collapse.
11.What is the anti-Drublin walking gait?
When people walk normally, the femoral head is under pressure in the direction of the femoral head, so the necrotic area of the femoral head is most likely to collapse in this area. After the occurrence of femoral head necrosis, we let the patient walk with both lower limbs fixed in the position of abduction and internal rotation, which is exactly the opposite of the walking gait of Chaplin, and we call it the “anti-Choplin” walking gait.
12, what is the thin shell theory of femoral head necrosis?
It is generally believed that the thin shell in the thin shell theory is a thin-walled space structure with a curved surface, if the thickness of the shell is much less than the radius of curvature of the shell, it is called a thin shell. The subchondral bone plate of the femoral head can meet the conditions of thin shell definition, so the thin shell theory is used in the analysis of femoral head necrosis, forming the thin shell theory of femoral head necrosis.
13.What is the coronary artery theory of femoral head necrosis?
In the process of femoral head necrosis, the blood vessels supplying the femoral head are blocked, resulting in the reduction of blood supply to the femoral head, which is one of the important factors causing the occurrence of femoral head necrosis, which is similar to the mechanism of coronary artery blockage leading to myocardial but snowy occurrence in the process of coronary heart disease, so the coronary heart disease theory of femoral head necrosis has been proposed.
Warm tips
(1) Femoral head necrosis is not an incurable disease!
(2) Early detection is the key to treatment!
(3) Depending on the size of the lesion area, the appropriate treatment can be chosen!
(4) Do not treat uselessly if the necrosis is more than 60%!
(5) If there is a critical necrotic area, the aim of treatment is to prevent head collapse!
(6) If there is no joint pain, but significant collapse, do not treat!
(7) If the joint pain is severe and there is significant collapse, surgical treatment is necessary!