1.What are the treatment principles of femoral head necrosis?
Femoral head necrosis is a more serious disease, with a long course, difficult treatment and serious consequences.
Treatment should do the following.
(1) early diagnosis, timely treatment;
(2) Early and active conservative treatment;
(3) Proper and correct choice of surgical treatment.
Most of its treatment starts from the following four aspects.
First, to solve the blood circulation disorder and promote the repair of osteonecrosis, which is also the basic method of treating this disease;
Secondly, to reduce the intraosseous pressure;
Third, to prevent collapse, preserve the function of the hip joint, and prevent the occurrence of advanced osteoarthritis;
Fourth, correct collapse and hyperplasia deformation, improve the quality of life, which is the treatment method for patients in advanced stage.
2, what are the treatment methods of femoral head necrosis?
The treatment of femoral head necrosis can be summarized into two categories.
(1) Conservative treatment: including stopping hormones, quitting alcohol and other treatments for the cause of the disease, as well as symptomatic treatments such as traction, reducing or prohibiting weight-bearing, physiotherapy, etc. The internal treatment method of Chinese herbal medicine helps to reduce symptoms and promote repair.
(2) Surgical treatment: for adolescents and early patients, intervention, decompression, bone flap implantation with blood vessels, vascular bundle implantation, etc. are mostly used; for advanced patients who cannot take care of themselves, have collapsed femoral head, joint fusion, and are older than 60 years old, artificial joint replacement is mostly used.
3.What is the difficulty in the treatment of femoral head necrosis?
(1) by its anatomical structure: the hip is the hub connecting the human trunk and lower limbs, and has the role of conveying the gravity of the trunk to the lower limbs, and all the forces have to be conveyed through the femoral head, so the difficulty in the treatment of femoral head necrosis is the prevention of collapse.
(2) Conservative treatment methods of femoral head necrosis are effective for early osteonecrosis, which cannot avoid head collapse, deformation and fragmentation during its treatment, so that the head cannot recover concentric structure.
(3) Necrotic bone cannot be well repaired.
4.How to choose the correct treatment method?
The treatment method should be selected according to the stage of development of femoral head necrosis, pathological changes and necrosis scope: for simple ischemia, early conservative treatment + intervention and drilling decompression is used to avoid weight bearing. For more limited necrosis site, lesion scraping and live bone implantation with blood vessels are used. For those with large necrosis in the middle and late stages, the treatment is relatively tricky, and if not properly protected, collapse, fragmentation and deformation are likely to occur. For those who have severe deformation affecting their normal life, artificial joint replacement can be performed.
Warm Tips
When it comes to the treatment of osteonecrosis of the femoral head, two undesirable tendencies must be discarded. One tendency is that femoral head necrosis is an incurable disease, no matter which conservative treatment method is used, the femoral head will collapse and form osteoarthritis, advocating that patients should not be treated at an early stage and wait until the joint function is exhausted for artificial joint replacement, and some even advocate early artificial joint replacement. Clinical studies have found that after active treatment, some femoral head necrosis does not collapse, and some children with femoral head necrosis have a tendency to heal themselves. Another wrong tendency is to think that a certain treatment method can achieve the purpose of cure without using other treatment methods. These are all mistakes.
5.What are the conservative treatments?
Conservative treatment methods are as follows.
(1) avoid weight-bearing: including partial weight-bearing and non-weight-bearing, only applied to the collapse of the former femoral head necrosis, that is, Ficat I and II stage, from the literature, simply take to avoid weight-bearing treatment is not ideal, the success rate is less than 15%, and for the lesion is located in the femoral head medial not in the weight-bearing area of the femoral head necrosis can be considered to apply this method;
(2) Drug therapy: including internal and external use, the application of drugs for the treatment of osteonecrosis of the femoral head has been reported more often, but the effectiveness of drug therapy for this disease is widely varying, and there is no accurate standard to measure, but because of its non-invasive nature, it is still a clinically important treatment method;
(3) Other treatment methods: such as traction therapy, electrical stimulation therapy, bloodletting therapy, hyperbaric oxygen therapy, etc., more methods are reported, and the effect needs to be further determined.
6.What are the advantages of Chinese medicine in treating ischemic necrosis of the femoral head?
Traditional Chinese medicine is the treasure of China and occupies a larger position in the world medical field.
(1) Discriminatory treatment Chinese medicine treatment is valuable in discriminatory, can be based on different causes, such as trauma, hormone drugs, alcohol poisoning, etc., the cause of discriminatory medication; can also be based on different stages of the disease, such as early, middle and late, the disease stage discriminatory medication; in addition to different symptoms of the disease can also be discriminatory treatment. With flexible and targeted medication, good therapeutic effect can be achieved.
(2) Both internal and external treatment can be combined with internal and external treatment by using Chinese medicine. That is, the combination of internal medicine and external medicine can achieve the same purpose.
(3) Combination of systemic treatment and local treatment This is another characteristic of Chinese medicine treatment, which can be used both systemically and locally. The systemic medicine acts on the local area, while the local medicine benefits the whole body, and the two are combined with each other to achieve better curative effect.
(4) The diversity of dosage forms of Chinese medicine is flexible and diverse, not only the traditional pills, pans, creams and pans, but also soups, water and solutions, and can be made into injections, etc., which can be used in different ways. The external application of Chinese medicine is also in full bloom, such as paste, compress, smoke, steam, wash, bake and other methods, which can be applied to different parts to achieve the purpose of treatment.
7.How does Chinese medicine treat ischemic necrosis of the femoral head?
Chinese medicine is its advantage in treating ischemic necrosis of the femoral head, which can reduce trauma, reduce patient pain, and restore the function of the affected hip. In view of the complex pathogenesis of femoral head necrosis and the many changes in the symptoms, we classify it into the following five types for dialectical treatment.
(1) Qi stagnation and blood stasis type: mostly caused by late trauma, treatment should be to move Qi and activate blood stasis;
(2) Tendon and bone strain type: Mostly due to chronic strain, treatment is recommended to tonify the liver and kidney and strengthen the tendons and bones;
(3) Cold and dampness stagnation type: mostly due to cold and dampness, treatment is appropriate to disperse cold and warm the meridians and open the veins;
(4) Internal damage type: Mostly due to long-term use of hormones, because this type of patients are often cold deficiency, clinical observation also has a lot of Qi deficiency and phlegm, so the treatment should be used to benefit the Qi and blood, resolve phlegm and penetrate dampness;
(5) Qi and blood deficiency, liver and kidney deficiency type: most of them are caused by the disease for a long time, so the clinical treatment should be based on the different severity of Qi and blood, liver and kidney deficiency, with the treatment of nourishing Qi and blood or nourishing liver and kidney respectively. In addition, the direct cause of femoral head necrosis is ischemia caused by venous stasis (blood stasis leads to tissue ischemia), and blood stasis is the main and most basic pathological mechanism of the disease; at the same time, the deficiency of the liver and kidney is easy to cause deficiency in the middle and late stages of the disease, so in the treatment of the disease, the basic treatment should be to activate blood and remove blood stasis, and attention should be paid to nourishing the liver and kidney and warming the meridians.
In summary, Chinese medicine believes that femoral head necrosis belongs to the category of bone impotence and bone erosion; the cause of the disease is a combination of internal factors such as liver and kidney deficiency, Qi and blood deficiency, and external factors such as trauma, strain and injury, and external evil, and often develops due to injury and evil, and deficiency of positive energy; the key to the pathological changes is blood stasis and liver and kidney deficiency; the treatment is based on the method of activating blood stasis, warming the meridians and channels, dispersing cold and relieving pain, tonifying the liver and kidney, and clearing heat and dampness.
8.What is the mechanism of traction therapy?
Through traction, the tension of the muscles is countered, the pressure between the femoral head and the acetabulum is reduced, the pressure on the necrotic area is released, the spasm of the muscles is relieved, the pressure in the joint capsule is reduced, the blood circulation in the femoral head is promoted, and the reconstruction and repair of the bone is facilitated. At the same time, for the early aseptic inflammation period, it is beneficial to eliminate the swelling, congestion and edema of the synovial membrane and joint capsule. Therefore, traction therapy is one of the effective adjuvant treatment methods for femoral head necrosis.
9.What is the mechanism of action of Chinese medicine?
The mechanism of applying traditional Chinese medicine to treat osteonecrosis of the femoral head is to combine traditional Chinese medicine into targeted preparations to activate blood circulation, remove blood stasis, dredge meridians, relieve swelling and pain, remove decay and bone, nourish liver and kidney, strengthen tendons and bones, etc., so as to promote the regeneration of blood vessels and the formation of collateral circulation, promote bone crawl replacement and new bone formation, and finally achieve the treatment of osteonecrosis of the femoral head. The purpose of the treatment of femoral head necrosis.
10.Is it possible to use medication alone?
In the early stage, Chinese medicine can help to activate blood circulation and remove blood stasis, and in the middle and late stage, it can help to repair the bone. Western medicine is helpful for bone metabolism and improvement of bone formation. However, clinically, except for the early stage, relying solely on drug treatment cannot achieve the ideal efficacy.
11.What are the effective herbal medicines at present?
Qi management drugs: orange peel, green peel, Citrus aurantium, aromatic herb, mucuna pruriens, and large belly skin;
Blood circulation and blood stasis activation drugs: Ox knee, Chuanxiong, Yanhuoso, Boswellia, Myrrh, Salvia, Peach kernel, Safflower, Chrysanthemum, Strychnine, Sumac, Hypericum, Curcuma, Turtle worms, Trigonella, etc;
Rheumatism drugs: Doklamia, Fenfeng, Wailingxian, Chuanwu, Leigongteng, Wujiapi, Baihua snake, Mulberry, Qianxianjian, Dog Chi, etc;
Dampness-boosting drugs: Job’s tear, pig ling, zedoary, calamus, patchouli, perilla, dahurica, atractylodes, etc;
Drugs for strengthening the spleen and resolving phlegm: Angelica, Radix Codonopsis, Atractylodes Macrocephala, Radix Panax notoginseng, Radix et Rhizoma Tenuifolia, Radix et Rhizoma Macrocephala, Radix Platycodon grandis, Radix et Rhizoma Chuanbei, etc;
Warming drugs: Radix et Rhizoma Polygonati, Radix et Rhizoma Ginger, Cornu Cervi Pantotrichum, etc;
The medicine of tonifying qi and blood and strengthening tendons and bones: Astragalus, Angelica, Danshen, Radix Rehmanniae, Radix Rehmanniae, Radix Paeoniae Alba, Radix et Rhizoma Polygonati, Radix antler, Radix Bacopa Monnieri, Semen Spleen, Radix Rehmanniae Sinensis, Rhizoma Cistanches, Semen Cuscutae, Cortex Eucommiae, Rhizoma Chuanbao, Radix Ziziphi, Radix Salviae Miltiorrhizae, Tortoise Plate, Turtle shell, Deer horn gum, Fructus Lycii, Radix et Rhizoma Polygonati.
12.What is the function of Marrow Filling Capsule?
The main drugs include strychnine, salvia, turtle worms, white mustard, and penetrating nail, etc. In the formula, strychnine is used to remove paralysis, salvia activates blood circulation and blood stasis, and activates the meridians, turtle worms search the wind and open the meridians, white mustard dispels the phlegm outside the skin and membrane, and penetrating nail opens the orifices. The combination of these herbs can warm the blood, relieve cold and disperse clotting, activate blood circulation, strengthen bone and marrow, dispel paralysis and relieve pain, so that the pain will stop when the clotting is removed, and the bone will be nourished when the veins are open.
13.What is the current research direction of Chinese medicine?
At present, the treatment of femoral head necrosis is mostly based on compound Chinese medicine preparations. Should be based on traditional Chinese medicine theory, combined with modern medical research on the pathogenesis of the disease, some of the representative prescriptions, then a multifaceted study, to find out a variety of drugs in the treatment of necrosis of the femoral head in the amount-effect relationship, to find out the active ingredients of drugs and multi-molecules in different states of mutual synergistic or antagonistic effect, as well as the effect of the time and the relationship between the pathway, in order to screen out the effective In order to select effective prescriptions and treatments and develop convenient and reliable dosage forms.
For the prevention and treatment of this disease, Chinese medicine is effective in the early and middle stages, but surgical treatment is still necessary for patients with advanced disease. Therefore, in order to completely solve the treatment problem of this disease, we should establish perfect and accurate diagnosis, staging and typing standards, and find out the indications of Chinese medicine, Chinese and Western medicine combination, and surgery for treatment. At the same time, it is more important to strengthen the research of the late Chinese medicine external treatment method and the research of functional exercise to promote the rehabilitation of the patient’s limb function.
14.What are the drugs that have effects on this disease? What is the role of each?
The clinical application of Western medicine alone for the treatment of femoral head necrosis is rare, and can be summarized into the following three categories.
(1) Lipid-lowering drugs, the main role is to reduce the concentration of cholesterol in the blood and prevent the blockage of fat particles in the microscopic arteries. There are two main classes of drugs, namely statins and fibrates, and their representatives are: lovastatin, fluvastatin, atorvastatin and clinostat;
(2) Anticoagulants: The main function is to reduce the excessive fibrinogen concentration, inhibit the platelet agglutination rate, reduce the tendency of coagulation, improve the microcirculation in bone, correct the tendency of thrombosis and low fibrinolytic state, the main drugs are urokinase, platelet activating factor, low molecular dextran, aspirin, sodium bis(alginate), etc;
(3) Chinese medicine injection class: the main drugs are Chuanxiongzin injection, Danshen injection, allicin, etc.
15.Is there any meaningful conservative treatment for severe collapse?
The purpose of treatment of ischemic necrosis of the femoral head is to restore the function of the hip joint to the maximum extent. When the collapse of the femoral head is serious, conservative treatment cannot change the morphological structure of the femoral head, so it is not obvious to improve its function. Therefore, conservative treatment for severe collapse is not significant. However, for those who have obvious collapse but not obvious pain symptoms, conservative treatment can also be used.
Warm Tips
When necrosis occurs in the femoral head, it is like a house with a fallen pillar, it will collapse. However, if only one pillar or one wall collapses, the whole house will not collapse, but if three pillars or three walls collapse, the whole house will completely collapse. If only a part of the femoral head is necrotic, the femoral head will not collapse, but if the area of necrosis exceeds 60% of the femoral head, the chance of collapse is almost 100%!
16.What are the surgical treatment methods?
Surgical treatment
(1) Medullary decompression: The theory of medullary decompression for ischemic necrosis of the femoral head is based on the theory of increased intraosseous pressure of osteonecrosis, which can reduce intraosseous pressure and increase blood flow in the femoral head through medullary decompression, and medullary decompression can open the sclerotic zone, stimulate the growth of blood vessels in the decompression tunnel, and promote the crawling replacement of necrotic bone.
(2) Osteotomy: The purpose of osteotomy is to change the main weight-bearing zone of the femoral head and replace the necrotic bone with normal bone as the main weight-bearing zone. This method includes trans-rotor rotational osteotomy, inter-rotor internal osteotomy and inter-rotor external osteotomy, etc. It can also be combined with bone grafting treatment, which is mainly suitable for patients with stage II and III Ficat and small lesions.
(3) Osteotomy: Osteotomy includes autologous cancellous bone graft, autologous cortical bone graft and allogeneic bone graft, which can be combined with other treatment methods such as medullary decompression, electrical stimulation and osteotomy. Among them, autologous cancellous bone and cortical bone graft are more frequently used. Autologous cancellous bone has good osteogenesis induction and can promote the repair of necrotic femoral head, while cortical bone plays a supporting role for articular cartilage and subchondral bone in the necrotic area during the repair of femoral head. Bone grafting methods include bone grafting after medullary decompression, slotting bone grafting at the craniocervical junction, opening a window in the articular cartilage of the femoral head, lifting cartilage bone grafting and then resetting the cartilage. Bone grafting can be used in patients with Ficat stage II, early stage III and patients with failed medullary decompression. The recent efficacy of this method is relatively certain, but the long-term efficacy is still controversial. However, it is worthwhile to accelerate the repair of the femoral head with the help of bone graft and shorten the bed rest time, and the combination of growth factors, electrical stimulation and other methods to promote bone healing can improve its efficacy.
(4) Bone graft with blood supply: There are more methods of bone graft with blood supply, the graft bone can come from the iliac bone, greater trochanter or fibula, and it can be with myofibular or vascular tip, the bone graft with blood supply can increase the blood supply to the femoral head and accelerate the bone healing compared with the common bone graft. The clinical results are reported in the literature, but the x-ray improvement is not ideal, and a significant proportion of patients still need arthroplasty in the long-term follow-up. ⑤ Hip arthroplasty: For patients with advanced Ficat stage III or IV, total hip replacement is the best choice.
17.What is medullary decompression?
Medullary decompression is to drill away the sclerotic bone in the area of femoral head necrosis through the medullary cavity of the femoral neck to reduce the pressure inside the femoral head, thus allowing the blood flow of the femoral head to be re-established through the tunnel. It reduces intraosseous pressure, promotes blood circulation, and relieves pain, and the trauma during decompression acts as a stimulus favoring vascular renewal. It is now a popular treatment both at home and abroad for patients with early to mid-stage collapse of femoral head necrosis that is not severe. It has more advantages.
(1) Good pain relief due to the obvious decompression effect;
(2) The surgery does not cut the joint capsule and does not affect the peripheral blood flow of the femoral head;
(3) The surgery is relatively less invasive and does not interfere with other surgeries in the future. However, the mechanical strength of the femoral head is reduced after decompression, and the greatest disadvantage is that the head cannot be weight-bearing for at least 2 months after surgery, otherwise collapse is likely to occur. However, the advantages and disadvantages of this method are still controversial.
18.What is vascular implantation?
Vascular implantation is the process of separating the blood vessels near the femoral head and planting them in the necrotic femoral head like the growth of tree roots to reconstruct and increase the blood flow to the femoral head, reduce the intraosseous pressure and improve the venous return. However, its clinical application is limited due to the lack of strength of the implanted bone.
19.What is vascularized bone flap grafting? What is the effect?
There are three types of bone flap grafting with vessels: iliac flap transfer with the ascending branch of the lateral femoral vessel, greater trochanteric flap transfer with the transverse branch of the lateral femoral vessel, and iliac flap transfer with the deep iliac vessel.
Clinical studies have confirmed that bone flap transfer with vascular tip provides the lesion site with surviving bone mass, osteoblasts and osteoinduced growth factors, provides abundant blood flow, expands the apposition of necrotic bone trabeculae, new bone formation, and accelerates bone tissue repair.
20.What is bracing therapy?
Bracing therapy includes bone grafting bracing therapy and device bracing therapy. Osseous implant bracing therapy is to open a bone groove through the posterior side of the femoral neck and reach into the femoral head, remove the dead bone, implant the iliac bone marrow mass in the cavity of the femoral head, and lift up the collapsed part with the help of metal rods, after implanting the matchstick iliac bone strip, implant the iliac bone column and the bone column with the femoral square muscle tip. Instrumented bracing therapy uses a new internal fixation device with an in vivo hip spreader that reduces the pressure between the acetabulum and the femoral head and still meets the normative movements of the human body during the treatment. In recent years, inspired by the method of treating femoral neck fractures, a clinical practice of driving two cancellous bone screws into the necrotic femoral head through the medullary cavity of the femoral neck has emerged to prevent the femoral head from collapsing.
21.What is the living portal technique?
The living portal technique is to detach the femoral head from the anterior side, turn up the broken or folded cartilage and subchondral bone into living portal-like, remove the necrotic tissue completely, sclerotic bone drilling until bleeding, fill the necrotic area with autologous iliac bone or biological material, return the cartilage plate, two absorbable screws to fix it, weight-free for 3-6 months, and early functional exercise. It has been reported that the procedure has ideal results within one year.
22.What is the principle of interventional therapy?
Interventional treatment is to inject drugs with the effect of thrombolysis and blood vessel unblocking through the interventional catheter to the site of blood vessel blockage inside the femoral head, so that the blood vessel will be unblocked, the pressure inside the femoral head will be reduced and the blood supply will be restored to normal. The treatment is effective in relieving early symptoms, but further observation is needed to improve the increased density within the bone, head collapse, and narrowing of the joint space.
23.Interventional treatment can be used for what period of femoral head necrosis?
In the selection of indications, patients with Ficat stage I-II, i.e. patients with femoral head necrosis without collapse, should be selected. The biggest advantage of interventional treatment is that the operation is relatively simple and less invasive. The difficulties are.
(1) Children have thin blood vessels, and if the corresponding catheter and general anesthesia in radiology can be solved, it will significantly expand the treatment scope and thus expand the treatment indications;
(2) Due to the one-time administration, the duration of drug action is relatively short, but some drugs can be given orally or intravenously to make up for it after surgery.
24.How to choose the indications for surgical treatment?
For those who have more serious heart disease, diabetes, cerebrovascular pathology, coagulation mechanism and other pathologies are its strict contraindications, for the physical condition can not withstand large trauma, signs of infection, serious cold and other cases can be carefully selected. The indications for different types of surgery vary.
(1) Medullary core drilling and decompression is mostly applied to early femoral head necrosis in Ficat stage I and II with sclerotic femoral head necrosis without obvious collapse, and this method is still a simple and effective treatment method if the indications are chosen correctly.
(2) Dead bone scraping and bone grafting can significantly induce vascular regeneration and new bone formation in the necrotic area, and has the effect of preventing collapse in stage II and III patients with traumatic femoral head necrosis.
(3) Bone flap grafting with myotome or vascular tip is suitable for stage II and early stage III. The purpose is to provide living bone to improve blood supply and also to provide mechanical support to the femoral head to prevent collapse.
(4) Intertrochanteric osteotomy is suitable for stage II and III patients with a small extent of necrosis or no more than 2/3 of the total area of the femoral head. The osteotomy will make the hard part without necrosis to bear the pressure and avoid the pressure on the lesion, so as to create conditions for self-repair.
25.When is artificial joint replacement used?
Artificial total hip arthroplasty is suitable for patients with late stage of femoral head necrosis, for patients with Ficat stage IV, with obvious joint movement dysfunction, severe pain, obvious head deformation or more head and neck resorption, and extremely poor quality of life.
26.Why should artificial joint replacement be performed for severe ischemic necrosis of the femoral head?
For early ischemic necrosis of the femoral head, there are more non-surgical hip preservation therapies available, and they have certain efficacy, weight-free treatment, coupled with the application of Chinese medicine, most of them can delay or stop the development of ischemic necrosis of the femoral head. However, for patients with advanced Ficat stage III or IV, there are more clinically reported treatment methods, but the efficacy of bone grafting with blood supply is not satisfactory, and many patients eventually develop into massive femoral head collapse and joint dysfunction, which seriously affects patients’ quality of life. There are two types of total hip prosthesis, cemented and non-cemented, both of which have their own advantages and disadvantages, and the long-term effect is similar. However, with the application of modern bone cement technology, the loosening rate of the prosthesis was significantly reduced, especially the cemented femoral stem prosthesis achieved satisfactory results, making the cemented prosthesis popular again, but the loosening rate of the cemented acetabular prosthesis is still high. The non-cemented prosthesis has gradually gained attention since the 1980s, but there are problems of early micro-movement and subsidence of the prosthesis and high incidence of postoperative claudication and thigh pain, while the non-cemented acetabular prosthesis has achieved good early clinical results. The uncemented prosthesis is mainly used for young, well-boned or rehabilitated patients, while the cemented prosthesis is mainly used for older, osteoporotic patients. Since the postoperative results of cemented femoral stem prosthesis are better than those of non-cemented type, and non-cemented acetabular prosthesis is better than cemented type, the hybrid fixation of cemented femoral stem prosthesis and non-cemented acetabulum has gradually become popular in recent years. Unipolar or bipolar femoral head prosthesis hemi-acetabular replacement for femoral head necrosis has been discarded due to progressive wear of acetabular cartilage and loosening of the prosthesis, and the invasion of the bone marrow cavity is not conducive to rework. Due to the relatively young patients with femoral head necrosis, total hip replacement still needs to be repaired eventually. Some people advocate that for Ficat III stage acetabulum is more complete and younger patients to perform femoral head surface replacement, because this method preserves the complete bone bed, it is easy to carry out reworking, and can postpone the total hip replacement, so it is a good excessive therapy.
27.How to get out of the misunderstanding of artificial joint?
Artificial joint can relieve pain and correct deformity, and there is a consensus. The difference is that for younger patients, they are afraid to consider arthroplasty because of the fear of secondary surgery.
If you’re 35 years old and you’re building up your wealth and career, do you want to be the one who is always in need of care, depleted of family money and suffering from disease? Or do you want to take the decisive step of joint replacement to relieve your pain and give yourself at least 20 years to create wealth and enjoy life?
A person’s life is not only about survival itself, but the quality of life is more important. It is totally worthwhile to take the risk and endure the pain of surgery in order to improve the quality of life. What is the value of the life of a patient who is completely bedridden and has lost his confidence in life if he continues conservative treatment, even if he lives to the age of 100? If the patient is allowed to stay in bed until the age of 60 in order to reduce the number of surgeries, then how much more meaningful is surgery? This is really a question of cost to benefit ratio. Even after 10 to 20 years, if something goes wrong with the artificial joint, it can still be repaired. In addition, with the development of society and the progress of technology, we have every reason to believe that by then, the artificial joint technology will be more perfect.
28.Is there any difference between the treatment of traumatic and alcoholic femoral head necrosis?
There is a difference. Traumatic osteonecrosis of the femoral head is more limited in scope, while alcoholic osteonecrosis of the femoral head not only affects both sides, but also has a larger scope. The outcome of treatment is also often different. In the former, the lesion is limited in extent and may remain stationary at a certain stage without developing or develop relatively slowly. The prognosis is better with live bone implantation using lesion removal. The latter tend to develop continuously and are more difficult to treat. The prognosis is not good.
29.Why should an arthroplasty be performed for subtrochanteric fractures of the femoral neck in the elderly?
Elderly femoral neck fractures, especially subtrochanteric and comminuted fractures, have a high incidence of non-union and ischemic necrosis of the femoral head, and nowadays, artificial femoral head replacement is used for clinical treatment. Artificial femoral head replacement is suitable for patients with femoral neck fractures, whether fresh, old or pathological. For older patients and patients with poor physical condition, artificial femoral head replacement should be the first choice of treatment if they can tolerate surgery after adjustment by medical treatment, so as to avoid complications such as pneumonia and decubitus ulcers due to long-term bed rest. However, for patients with old fractures and those who are less than 65 years old and in good health, it is clinically advisable to perform total hip replacement. The early release of the patient from bed after surgery can prevent the occurrence of bedridden complications.
30.What is individualized treatment?
Individualized treatment plan is to develop different treatment methods according to the actual situation of different patients. For example, for a patient with mild symptoms of early femoral head necrosis, bed rest and herbal supplementation are the main options, and local medication is used. For those patients with obvious femoral head necrosis and heavy symptoms, when the patient’s femoral head collapse is not obvious, it is best to choose drilling decompression surgery, which not only can preserve the femoral head from the pain of surgery, but also has ideal results. However, for those who have obvious joint movement dysfunction, severe pain and obvious head deformation, which affects the quality of life, artificial joint replacement should be applied.
31.What is comprehensive treatment?
A large number of clinical experience shows that various treatments for the pathogenesis of femoral head necrosis are effective, but except for the early stage (before the fracture occurs under the cartilage) and the limited lesion, a single treatment method can cure, there is no which treatment method can finally solve the problem of femoral head necrosis treatment. So the treatment should be comprehensive.
We advocate that: Chinese medicine treatment should be used throughout the treatment process; in the early stage (before the fracture occurs under the cartilage), interventional therapy is mainly used. After the formation of the sclerotic zone, although the intervention alone can increase the blood supply, it has limited effect on relieving pain; it should be combined with medullary decompression to open up the pathway between normal bone tissue and dead bone and accelerate the repair. When performing medullary decompression, it should be combined with autologous fibula or resorbable hollow screw implantation, especially for large necrosis, to increase blood supply and reduce intramedullary pressure while increasing strength and preventing collapse. For the non-weight-bearing area necrosis and necrosis of smaller scope, because the chance of collapse is small, so the treatment does not need to require increased mechanical strength, as long as to solve the blood supply and reduce the intramedullary pressure can be.
32.What are the current foreign treatments for femoral head necrosis?
Before 1980, most foreign countries used the method of avoiding weight-bearing. Since 1964, Arlet and Ficat proposed medullary decompression of the femoral head, and it gradually became popular after 1980. So far, marrow core decompression, bone graft and artificial joint replacement are still the main means of treating femoral head necrosis.
33. Can a non-weight bearing necrotic femoral head avoid collapse?
People’s conventional understanding is that bed rest means no weight-bearing and no stress stimulation can avoid collapse. However, this understanding is not entirely correct. Because people’s muscles are in a constant state of muscle tone contraction, it can give normal stress between the acetabulum and the femoral head. When patients perform functional exercises in bed, if they perform the wrong movements, the compressive stress on the femoral head is significantly higher under the effect of strong muscle pulling and femoral head collapse occurs. We performed a follow-up of 219 patients with early to mid-stage femoral head necrosis treated conservatively, and 27 patients (12.33%) developed collapse during bed rest.