I. Etiology of necrosis.
1. Extra-tubular factors.
(1) trauma.
(2) congenital crotch socket dysplasia.
(3) physiological characteristics: the supply of the femoral head is less vascular, easy ischemia after injury.
2. Intravascular factors
(1) intravascular wall changes: vascular inflammation, vascular sclerosis, and smaller vessels.
(2) blood changes: blood viscosity, slow blood flow.
(3) Hormone: long-term large amount of unregulated use of hormones.
(4) Blood disease itself.
(5) Other: air tethering, fat tethering, amniotic fluid tethering.
Second, the treatment of femoral head necrosis and the relationship between acupuncture therapy: hip muscle degeneration and atrophy, vascular occlusion, acupuncture in the muscle starting and stopping point to loosen, blood vessels open, blood oxygen supply is sufficient to achieve the purpose of treatment.
Third, the method: disable painkillers.
1, anti-inflammatory and analgesic fluid configuration: puncture the hip joint cavity, if there is fluid in the retracted joint cavity, flush the joint cavity, fluid preparation: 0.9% saline 500 ml + anti-exudate of trimethoprim 20 mg + 2% lidocaine 10 ml + vitamin B12 500 mcg + vitamin B12 1500 μ or salvia needle 10 ml + safflower liquid 10 ml or Chuanxiongzine 10 ml (elderly)
2. Joint stenosis: Needle knife to loosen the joint ligament starting and ending points.
3. Increased pressure: release the joint capsule to reduce the intracapsular pressure. a. Anterior avoidance of femoral A release, lateral release and posterior release. b. Lateral greater trochanter: after local anesthesia, puncture the bone cortex and fan puncture to release.
Fourth, the seven types of femoral head necrosis.
1, Cortical necrosis type: early magnetic arch vibration and ECT can be diagnosed early.
2, cystic necrosis type: X-ray can be seen on the signs.
3. Cuneiform necrosis type: collapse of femoral head.
4. Core necrosis type.
5. Total head necrosis type.
6. Hypertrophic necrosis type.
7. Atrophic necrosis type.
V. Four phases in the treatment and rehabilitation process.
1, lysis phase: femoral head necrosis is irreversible, treatment and rehabilitation called dead bone resorption, new bone regeneration.
2. Resorption phase: (protein, Ca+, P+) Ca , P total absorption, necrosis.
3. Modification period: the key to the treatment of femoral head necrosis.
4. Modelling period: modification of crawl shape replacement, framework structure supplementation.
Six, the details of acupuncture treatment: loosening the starting and ending points of the joint capsule ligaments is the key to treatment.
(a) Needle knife release of the relevant muscle groups.
1, internal revenue muscle group: lateral edge of pubic bone (needle knife cut 3-5 knife). Other muscle groups: broad fascial tensor muscle release starting and stopping points.
2, pelvic tilt (x-ray observation of bilateral closed hole): treatment of pelvic orthopedics.
3. Skeletal lumbar muscle starting point: lateral to T11-12 and L1-5 lumbar vertebrae, stopping point: above the lesser rotor, release against the bone surface.
4. Flexion contracture: the inner and outer points of the closed-hole muscle, the starting point and stopping point of the medial edge of the upper and lower solitary muscles pear-shaped muscle.
(ii) Alteration of blood viscosity.
1. Oral lipid-lowering medication for 1-3 months.
2. Tonicity.
(1) Application of vasoactive drugs, such as vincristine tablets orally or intravenously with powder tolamin injection in regular doses for 10 days a course of treatment.
(2) Saline + methylprednisolone 40 mg, IV for 3-7 days; saline + compound salvia injection 20 ml or Chuanxiongzin injection 10 ml, IV for 30-40 days and then change to oral.
3. Pharmacological treatment of osteonecrosis (after 3a) or (after 4w).
(1) Bone peptide injection to promote bone repair, oral intramuscular injection.
(2) Gold glucose liquid: produce bone as soon as possible (or long-term non-healing fracture) depending on X-ray.
(3) Local injection (0.5 cm longitudinal stabbing with the fracture line, 2-3 stabs) to promote bone healing, once a week. (Gold glucose liquid is an anti-cancer drug.)
(4) Bone generating injection into the joint capsule, once a month, continuously applied until healing.
VII. Rehabilitation treatment.
(1) Rehabilitation characteristics: Young people get better faster than the elderly, and thin people get better faster than fat people.
(2) Rehabilitation rules: 1.
1. Traction: once in the morning and once in the afternoon, 30-40 minutes/time, about 8kg.
2. Joint exercise: flat bed, bicycle exercise for both lower limbs, 2 times a day, 30 minutes each time.
3. Needle knife release: 1 time in 3-5 days in the early stage, 1 time in 2 weeks in the middle stage, and 1 time per month in the late stage.
4. Active treatment of complications.
(1) Combined lumbar synostosis: relationship between femoral head and lumbar synostosis, pain in one limb of femoral head necrosis, scoliosis of patient’s spine, and protrusion of elastic membrane to the position below the pressure.
(2) Treatment points to note: Treatment of femoral head necrosis must be accompanied by treatment of lumbar disc herniation.
VIII. Precautions in treatment.
(1) Strictly aseptic operation during surgery, avoiding important vascular nerves, needle knife in place mainly, assisted by manipulation.
(2) Understand the purpose of acupuncture: what problems to solve, for the cause of the disease, according to the investigation, the need to solve the problem: positioning, fixed point, fixed knife.
(C) before treatment should check whether the patient has a combination of rheumatism or rheumatoid disease.
IX. Common reasons for treatment failure.
1, the treatment is not effective, whether the selection method is not the right cause or disease.
2, family factors: unity of opinion, arbitrary choice of other treatment methods.
3, orientation is not strong: give up treatment in the middle.