Femoral head necrosis, also known as aseptic necrosis of the femoral head or ischemic necrosis of the femoral head, is different from that caused by bacterial infection. It is one of the common but difficult to treat chronic diseases in orthopedic clinics. As the advanced stage of femoral head necrosis often causes serious disability of the hip joint, it is getting more and more attention.
1, why the incidence of femoral head necrosis will increase year by year?
(1) With the continuous development of modern transportation, traffic accidents are increasing year by year, and the resulting fractures of the femoral neck are increasing.
(2) The aging of society and the prevalence of osteoporosis in the elderly, which can lead to femoral neck fracture by a slight external force.
(3) Increasing clinical application of corticosteroids (e.g., prednisone, dexamethasone, hydrocortisone, etc.), such as transplantation of vital organs, lymphoma, adjuvant treatment of myeloid diseases, treatment of respiratory and central nervous system diseases, and treatment of hematological cachexia all require massive application of hormones.
(4) Long-term alcohol abuse.
2.What are the causes of femoral head necrosis?
There are many causes of femoral head necrosis, which are usually divided into two major categories: one is traumatic, with femoral neck fracture being the most common. The second is non-traumatic, with long-term application of hormones and long-term alcohol abuse is more common. In addition, there are also complications due to ankylosing spondylitis and acetabular dysplasia.
3.What kind of pathological process is femoral head necrosis?
Femoral head necrosis is caused by various factors that increase the pressure in the femoral head, and the bone tissue in the femoral head cannot get the normal blood supply from the nutrient blood vessels, so that the bone cells, bone marrow hematopoietic cells and other cells in the femoral head tissue become necrotic and lead to necrosis.
4.Why is the early stage of femoral head necrosis easy to miss diagnosis and lose the best time for treatment?
The earliest symptoms of femoral head necrosis are mostly hip, thigh or lumbar pain and discomfort, and after CT examination, more reports of “lumbar disc bulge”, not knowing that normal people will also have lumbar disc bulge. The clinical doctor is inexperienced, very easy to misdiagnose as lumbar disc herniation, can not attract the attention of patients, losing the best early treatment time.
5.How to detect femoral head necrosis at an early stage? What does early diagnosis depend on?
In the early stage of femoral head necrosis, the earliest pain symptoms, patients with lumbar hip pain as the main complaint should ask detailed questions about life hobbies, past medical history, pain location, etc., according to the medical history should be suspected of the existence of the disease.
At present, MRI is considered the most advanced method for early diagnosis. However, due to its high price, it is not yet popular in China. In addition, MRI is not recommended when there is a metal internal fixation in the hip. X-ray plain film and CT examination of the hip are unable to detect early.
6.What aspects should the treatment of femoral head necrosis start from?
(1) Solve the obstruction of blood circulation and promote the repair of osteonecrosis.
(2) Drilling and decompression to reduce intraosseous pressure.
(3)Reducing weight-bearing and preventing collapse is the key to preserving hip function and avoiding osteoarthritis.
(4) Correct collapse and hyperplastic deformation.
7.What is the current treatment for osteonecrosis of the femoral head?
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 do not treat early, wait until the joint function is lost to 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 tendency is to think that a certain treatment method can achieve the purpose of cure without using other treatment methods. These are wrong.
(1) Non-surgical treatment: This includes treatment for the cause of the disease such as stopping taking hormones and quitting alcohol, as well as symptomatic treatment such as traction, reducing or prohibiting weight-bearing, physical therapy, etc. The internal treatment method of Chinese herbal medicine helps to reduce symptoms and promote repair.
(2) Surgical treatment: For adolescents and early stage patients, intervention, decompression, bone flap implantation with blood vessels, vascular bundle implantation, etc. are mostly used; for late stage patients who cannot take care of themselves, collapsed femoral head, joint fusion, and are older than 60 years old, artificial joint replacement is mostly used.
8.What is interventional therapy?
Interventional treatment is to inject drugs with the effect of thrombolysis and blood circulation into the blocked blood vessels through the interventional catheter, so that the blood vessels can be opened, the pressure in the femoral head can be reduced and the blood supply can be normalized. 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.
9.What is the efficacy of using bone flap implantation with blood vessels?
Clinical studies have confirmed that bone flap implantation with vascular tips provides the lesion site with surviving bone, osteoblasts and osteoinduced growth factors, provides abundant blood flow, expands necrotic trabecular apposition new bone formation, and accelerates bone tissue repair. In contrast, bone grafting without a vascularized tip has no significant benefit for bone repair.
However, the method has certain indications, and early stages of femoral head necrosis can mostly be completely cured. It can only relieve the symptoms and delay the joint collapse.
10.What is the role of medicine in the treatment of femoral head necrosis?
In the early stage, Chinese medicine can play the role of activating blood stasis, relaxing the tendons and opening the channels, and in the middle and late stage, it has a certain effect on the repair of bone. Western medicine is helpful to the metabolism of bone and improve the organic composition of bone. But clinically rely solely on drug treatment, can not achieve the desired effect.
11.Why is the treatment of femoral head necrosis difficult?
(1) by its anatomical structure: the hip is the hub connecting the human trunk and the 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.
(2) The pathological mechanism of femoral head necrosis is still unclear. Conservative treatment methods for femoral head necrosis are effective for early osteonecrosis, but the mechanisms that relieve pain and increase the life span of the femoral head remain unclear. Head collapse, deformation and fragmentation cannot be avoided during treatment so that the head cannot regain concentric structure.
(3) The drug cannot reach the site completely.
12.How can I treat femoral head necrosis correctly?
Treatment should be selected according to the stage of development of femoral head necrosis, pathological changes, and the extent of necrosis: simple ischemia
Early conservative treatment + intervention, drilling decompression method 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. Those who have severe deformation affecting normal life can undergo artificial joint replacement.
13.What are the current foreign treatments for femoral head necrosis?
Before 1980, foreign countries mostly used the method of avoiding weight-bearing. Since 1964, Arlet and Ficat proposed medullary decompression of the femoral head, which gradually became popular after 1980. To date, medullary decompression, bone grafting and artificial joint replacement are still the main means of treating femoral head necrosis.
14.Is there any difference in the treatment of traumatic and alcoholic femoral head necrosis?
There is a difference. Traumatic femoral head necrosis is more limited in scope, alcoholic femoral head necrosis can not only affect both sides, and the scope is larger. 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.
15.Will femoral head necrosis cause disability?
Due to the late collapse and fragmentation of the femoral head, it becomes flat and loses concentric structure, the joint space becomes smaller, the limb is shortened, and the hip joint activity is obviously limited. In severe cases, the hip joint function is completely lost. Disability rate is extremely high.
16.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.