Femoral head necrosis, known as aseptic necrosis of the femoral head or ischemic necrosis of the femoral head, is a lesion caused by localized poor blood flow to the femoral head for various reasons, which leads to further ischemia, necrosis of bone cells, fracture of bone trabeculae, and collapse of the femoral head. The main reasons for this are as follows: 1. the introduction of hormones and their widespread use, many patients treated with hormones can develop this disease, such as rheumatism, systemic lupus erythematosus, asthma, nephritis, etc. 2. necrosis of the femoral neck after fracture in old age. 3. changes in people’s lifestyles, such as stimulation by smoking and alcohol, have led to a dramatic increase in the number of patients with this disease. The number of patients with this disease has increased dramatically. Summarizing the patients diagnosed and treated in our hospital, I found that there is no significant gender difference in the occurrence of osteonecrosis of the femoral head, which can occur at any age. Combined with clinical experience and the majority of Internet users concerned, I will be the main content of the femoral head necrosis summarized into a question and answer for your reference: a. How to determine the early femoral head necrosis disease? Femoral head necrosis disease, the earliest symptom is the hip joint soreness, sleepy, sometimes intermittent pain. This is the main symptom of the disease. There are many causes of hip pain, including trauma, hip dislocation, degenerative disease, inflammation, tumor, lumbar spine disorders, medical and dermatological diseases, etc., which can cause hip pain. Femoral head necrosis is only one of the many causes of hip pain, and as an independent disease, it has its own specificity. Self-examination from the following aspects can determine whether you have osteonecrosis of the femoral head: (1) Hip pain radiating to the groin area or to the back of the hip, lateral or medial knee. (2) Stiffness, weakness and limited movement of the hip joint, inflexibility in lifting the leg, early appearance of symptoms such as planking or outward skimming of the leg as well as difficulty in squatting. (3) Limping: the affected limb does not dare to put weight on it when walking, like walking on tiptoe. (4) After the fracture, dislocation or sprain of hip joint heals, intermittent or persistent pain in the hip appears gradually or suddenly. The pain is aggravated after walking activities, sometimes it is resting pain, and the pain is mostly pins and needles or soreness, and the above-mentioned reaction occurs. (5) Hip pain occurs in people who use a lot of hormones for a long time or for a short time or who often drink alcohol, and it is mostly vague or dull pain, often located in the groin, obvious when moving and relieved after rest. (6) Cold and damp: When the weather is cold, the hip joint becomes sore and painful, and the function is limited. (7) Inflammation: When you have a cold and fever, the blood sedimentation is accelerated and the white blood cells are elevated, which increases the pain in the affected hip joint. If the above-mentioned conditions occur, it is possible to suffer from osteonecrosis of the femoral head, and it is necessary to go to the hospital to confirm the diagnosis. Second, how to stage femoral head necrosis and what are the clinical manifestations? The first conscious symptom of femoral head necrosis is pain, and the pain is around the hip joint, inner thigh, front side or knee. In the early stage, the pain starts as vague, dull or intermittent pain, which is aggravated by more activities and can be relieved or reduced by rest. However, there are also cases of continuous pain, regardless of exertion or rest, even when lying in bed. Moreover, the pain gradually increases. In this case, although there is no obvious abnormal morphological change on the X-ray, the function of the hip joint is already limited to different degrees. For example, the patient’s hip joint on the affected side is limited in abduction and rotation, and cannot squat in place. In the advanced stage of femoral head necrosis, the femoral head collapses, fractures and deforms, and some of them may cause hip dislocation, and the pain is directly related to hip joint activities and weight bearing. The pain is directly related to the movement and weight bearing of the hip joint. The pain is caused by the bony friction in the joint when moving, but the pain is not obvious when the friction between the head and socket does not occur at rest. Therefore, the pain is aggravated by walking and activity, while the pain is relieved by movement. In short, the early stage is mainly pain with functional limitation; the late stage is mainly functional impairment with pain. Femoral head necrosis stage I (ultrastructural variant stage): X-ray film shows that the trabecular structure in the bearing system of the femoral head is disordered and broken, and the edge of the femoral head appears hairy, clinically with or without limited mild pain. Femoral head necrosis stage II (sensitized stage): X-rays show small cystic shadows inside the femoral head with uneven density of the ring area around the cystic area. The bone trabecular structure is disturbed, sparse or blurred. Small collapses may also appear, and the area of collapse may be 10-30%. The clinical condition is accompanied by significant pain and slight restriction of movement. Stage III femoral head necrosis (necrotic stage): X-ray shows morphological changes of the femoral head, including incomplete, worm-like or flattened edges, partial loss of trabecular structures, uneven bone density, widening or narrowing of the acetabulum and femoral head gap, and formation of superfluous bone. In stage IV of femoral head necrosis (disabling stage), the morphology and structure of the femoral head are obviously changed, with large irregular collapse or flattening, and the structure of the bone trabeculae is mutated. The gap between the acetabulum and the femoral head disappears, etc. Clinical manifestations are pain, functional impairment, stiffness and inability to walk, dislocation or subluxation, and limitation of functional activities of the involved knee joint. Since osteonecrosis often involves both sides, most patients end up with joint deformity and secondary osteoarthritic changes. Although there are numerous treatment methods available, none of them are sure of their efficacy, making treatment quite tricky. However, practice has proved that the earlier the treatment, the better the effect. Third, what are the treatment methods of femoral head necrosis? 1, conservative treatment (1) avoid weight-bearing can rely on cane, axillary cane and other supports, and strictly limit weight-bearing, which can restore blood supply to ischemic tissues and protect them from pressure, in order to control the development of lesions, prevent collapse, and promote the healing of ischemic necrosis of the femoral head by itself. However, it is generally believed that weight-bearing restriction cannot save the development of femoral head necrosis. This method is mainly applied to elderly patients who are not suitable for surgical treatment, poor general condition, progressive ischemic necrosis and patients with poor prognosis. The possibility of self-healing is related to the size of the lesion and its distance from the joint surface: if the lesion is small or far from the joint surface, it can mostly heal by itself; if the lesion is adjacent to the joint surface or if the lesion is large, the possibility of self-healing is extremely small even without weight-bearing. (2) Electrical stimulation has osteogenic effect and can promote fracture healing. Electrical stimulation can be used as an independent treatment for osteonecrosis or as an adjunct to surgery. 2.Surgical treatment (1) treatment to preserve the femoral head, applicable to early osteonecrosis of the femoral head. (1) Borehole decompression It can reduce intraosseous pressure, promote venous reflux, release trophoblastic vascular spasm, so that the new blood vessels can grow along the bone hole to the ischemic area. It is mainly used for patients without joint surface collapse in the early stage, and is the simplest surgical method to treat osteonecrosis. Bone grafting is also called drilling and decompression bone grafting because it is necessary to drill holes before bone grafting. It involves both drilling and decompression, bone grafting to provide mechanical support, and bone grafting with myotome to increase the blood supply to the femoral head. (3) Osteotomy By changing the corresponding position between the femoral head and the femoral stem, it can increase the weight-bearing area of the femoral head, reduce the pressure on the femoral head, and move the necrotic lesion out of the weight-bearing area, thus reducing the local stress, and at the same time, osteotomy opens the medullary cavity, which can reduce the intraosseous pressure and improve the blood circulation of the femoral head. (2) Arthroplasty is applied to patients with collapsed femoral head necrosis, and metal cup arthroplasty, joint surface replacement, femoral head replacement, total hip replacement, etc. are feasible. How to treat osteonecrosis of the femoral head in Guangzhou? Patients with osteonecrosis of the femoral head in Guangzhou are most often aged 31-60, with no gender difference, and of course there are many teenagers with the disease.