Ischemic necrosis of the femoral head (AvascularNecrosis) is a common clinical disease, which is due to various different etiologies that destroy the blood supply to the femoral head leading to ischemia, necrosis and collapse of the femoral head, mostly invading middle-aged people, often leading to severe hip dysfunction, and is one of the common and difficult to treat diseases at present.
Traumatic diseases such as femoral neck fracture, hip dislocation and hip trauma can directly or indirectly damage the blood supply to the femoral head, leading to ischemic necrosis of the femoral head; non-traumatic diseases are triggered by more factors, and most of them are not sure about their pathogenesis, and some are not even clear about the cause, which is called idiopathic ischemic necrosis of the femoral head. Common predisposing factors include: heavy hormone application, long-term alcoholism, kidney transplantation, chronic liver disease, diving disease, sickle cell anemia, pancreatitis, hyperlipidemia, gout, radiation disease, arteriosclerosis and other vascular stenosis disorders, collagen diseases, etc. As for the real pathogenesis of some idiopathic cases, it is not fully understood.
Diagnostic basis
1, there may be a history of femoral neck fracture, hip dislocation or trauma, decompression disease, long-term use of corticosteroids or alcoholism, etc.
2.Pain in the hip or knee, gradually increasing, limping.
3.Pressure pain in the adductor muscle and restricted movement of the hip joint, especially abduction and internal rotation. There may be thigh muscle atrophy.
4.X-ray: In the early stage, the outline of the femoral head is normal, but in the lateral phase, a 1~2mm wide curved transparent band with reduced density can be seen in the subchondral bone of the anterior femoral head in the weight-bearing area, which constitutes the “crescent sign”. This sign is of great value. This is followed by an increase in subchondral bone density in the weight-bearing area, which is surrounded by punctate and lamellar hypodense areas and cystic changes. Finally, the subchondral bone is fragmented, flattened, and collapsed to varying degrees, and the femoral head becomes flattened, collapsed, and subluxated. Osteoarthritic changes may be seen.5. Isotope bone scan or ECT suggests a radiologically defective area in the femoral head region.
Clinical staging
Stage 0: The hip joint is asymptomatic, and the X-ray film is not abnormal, but because the opposite side has symptoms and confirmed the diagnosis, and the bilateral invasion of more than 85%, help call this stage silent hip (silenthip), the actual isotope scan, measurement of intraosseous pressure or marrow core biopsy, has proved that there are changes, this is a good time to decompression treatment.
Stage I: There is pain in the hip joint, which may occur after trauma or exertion, is progressive, heavy at night, and slightly limited in internal rotation and abduction. x-ray films show some areas of sparing, and positive pressure measurement and biopsy. Decompression therapy is more effective in this stage.
Stage II: The clinical symptoms continue to worsen, and the X-ray shows increased bone density and cystic changes, and the subchondral bone appears as an arc-shaped translucent band, called Crescentsign, but the femoral head is still normal in shape.
Stage III: The pain of the diseased hip hinders the movement, and the activities of all parties have been significantly limited. The edge of the femoral head has overlapped due to collapse, or has lost its round shape, and the sclerotic area is obvious. Although the diagnosis is easy to determine, the treatment is difficult.
Stage IV: The disease has reached an advanced stage, with deformation of the femoral head, narrowing of the joint space, sclerosis of the acetabulum, and obvious signs of osteoarthritis.
Treatment principles
1.Non-surgical treatment: Applicable to children or adults with early and small lesions.
2.Strictly avoid weight-bearing on the affected limb: unilateral person can hold crutches, bring sciatic brace, walk with walker; if bilateral involvement at the same time, bed rest or wheelchair should be used; if the hip is painful, bed rest and lower limb traction can often relieve the symptoms. This treatment can be combined with physical therapy, but it lasts longer, usually 6~24 months or more. X-rays should be taken regularly during treatment, and weight should be held only after the lesion is completely healed.
3.Actively carry out functional exercise of quadriceps muscle to avoid muscle atrophy.
4.Treat with herbal medicine that activates blood circulation and removes stasis, tonifies kidney and strengthens bones.
5.Remove the causative factors, such as stopping hormone therapy, alcohol consumption or radiotherapy, etc.
At present, no drugs have been found worldwide to treat this disease, restore hip joint movement and allow reconstruction of bone trabeculae of necrotic femoral head. Therefore, conservative treatment is mostly for blood circulation and pain relief, so that patients can choose a more suitable time for surgery. 99% of patients eventually have to choose “total hip arthroplasty” to reconstruct the joint and resume normal life. The surgical effect can be achieved by using imported materials.
Special reminder: At present, many so-called hospital doctors, under the banner of conservative treatment, exaggerate the only effect of blood circulation and analgesia, and give their high prices to cheat patients and make illegal profits, so please remember what I said, conservative treatment is only for the effect of blood circulation and analgesia, and no conservative treatment has been found to be mature and effective for hip reconstruction!