The main symptoms of femoral head necrosis manifest.
1. Pain on the affected side. Pain can be intermittent or persistent, intermittent without any symptoms, but intermittent for up to a year or more. It is aggravated after walking activities, and sometimes it is rest pain. The pain is mostly pins and needles, dull pain or soreness and discomfort, often radiating to the groin area, inner thigh, posterior hip and medial knee, with numbness in the area, but sometimes the pain point cannot be found.
2.Joint stiffness and restricted movement. The affected hip joint flexes and extends unfavorably, has difficulty squatting, cannot stand for a long time, walks with a duck stance, makes a loud noise from the hip joint and even accompanies leg cramps. Early symptoms are abduction and external rotation activities are limited.
3.Crippling. Progressive shortening limp, due to hip pain and femoral head collapse, or late onset of hip subluxation. Intermittent claudication often occurs in the early stage, and is more obvious in children.
4.The skin temperature of the affected hip is lower than the normal temperature, and the affected limb is cold in individual patients.
5.X-ray performance. The bone texture is thin or interrupted, and the femoral head is cystic, sclerotic, flattened or collapsed.
Ischemic necrosis of the femoral head is a type of disease in which the blood circulation of the femoral head is impaired due to various reasons, producing ischemic necrosis of the femoral head. Most patients with ischemic necrosis of the femoral head will continue to develop their disease once clinical symptoms appear, with collapse of the femoral head occurring and eventually leading to severe disability. The incidence of ischemic necrosis of the femoral head and the disability rate are increasing year by year due to the abuse of corticosteroids, alcohol abuse, and uneven development of medical conditions. Many studies at home and abroad have confirmed that there is no effective non-surgical treatment among the existing treatments, and surgical treatments including marrow core decompression, bone grafting with blood vessels and rotational osteotomy between rotors have certain efficacy, but it is difficult to stop the development of such lesions and cure the disease, and many patients eventually have to undergo artificial joint replacement. Many patients eventually have to undergo artificial joint replacement. This brings great harm to the physical and mental health of patients. Therefore, the treatment of ischemic necrosis of the femoral head is still an unsolved problem in orthopedics, and the search for safe, effective and non-invasive treatments for ischemic necrosis of the femoral head has been an important topic and the ultimate goal of orthopedic research.
Causes of femoral head necrosis.
Causes of femoral head necrosis Femoral neck fractures, sprains, falls, hip dislocations, acetabular insufficiency are prone to femoral head necrosis, the incidence is generally in the range of 75%-95% Causes of femoral head necrosis are various, the most common are the following four aspects.
Femoral head necrosis causes.
1, trauma.
Femoral neck fracture, sprain, fall, hip dislocation, acetabular insufficiency is prone to femoral head necrosis, the incidence is generally in 75-95%, most of the fracture surgery can occur after osteonecrosis. Hip injury (including hip dislocation, femoral neck fracture, rotor fracture, etc.) directly affects the local blood supply, especially the femoral head, and causes femoral head necrosis. In hip dislocation combined with fracture, the necrosis rate is as high as 90%. If the fracture dislocation is not rectified for more than 24 hours, necrosis of the femoral head will occur 100%.
2, hormonal drugs.
Long-term use of large amounts of adrenocortical steroids (such as: prednisone, dexamethasone and so on), can cause osteoporosis, arterial vascular obstruction, so that bone cells, bone marrow cells gradually necrosis.
3, rheumatism.
Half of them occur in cold and wet climate areas, widespread in China, less in southern China, gradually increasing towards the north, often combined with ankylosing spondylitis and rheumatoid arthritis.
4, chronic alcoholism.
Alcoholism can cause abnormal lipid metabolism, clinical data confirm that long-term heavy drinkers, the rate of femoral head necrosis is significantly higher. The reason for this is that alcohol can cause increased blood viscosity causing bone microcirculation disorders and necrosis.
How to determine the early stage of femoral head necrosis.
In femoral head necrosis, the earliest symptom that appears is hip joint soreness and sleepiness, sometimes with intermittent pain. This is the main symptom of the disease. There are many causes of hip pain, such as trauma, hip dislocation, degenerative disease, inflammation, tumor, lumbar spine disorders and medical and dermatological diseases. Femoral head necrosis is only one of the many diseases that cause hip pain, and as an independent disease, femoral head necrosis has its own special characteristics.
Self-examination from the following aspects to determine whether you are suffering from osteonecrosis of the femur.
1. Hip pain radiates to the groin area or the posterior, lateral or medial side of the hip or knee.
2.Hip joint stiffness, weakness, restricted movement, inflexible leg lifting, early symptoms of cross-legged or outward skimming legs and squatting difficulties.
3, limp: that is, the affected limb does not dare to put weight on it when walking, like walking on tiptoe.
4.After the healing of fracture, dislocation or hip sprain, intermittent or persistent pain in the hip will appear gradually or suddenly. It increases after walking activities.
Sometimes it is resting pain, and the pain is mostly pins and needles-like or sore, and the above reaction occurs.
5. Long-term or short-term use of hormones or frequent alcoholics have hip pain, mostly vague or dull, often located in the groin, which is obvious when moving and relieved after rest.
6, cold and damp: when the weather is cold, the hip joint is 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, and the pain in the affected hip joint is increased.
If you have the above conditions, you may have osteonecrosis of the femoral head and need to go to the hospital to confirm the diagnosis.
Treatment methods of femoral head necrosis.
1.Conservative treatment
(1) Avoid weight-bearing.
You can rely on cane, axillary cane and other supports to strictly limit weight-bearing, which can restore blood supply to ischemic tissues and protect them from pressure 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 the 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 in scope, the possibility of self-healing is extremely small even without weight-bearing.
(2) Electrical stimulation.
It 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) Drilling and decompression.
It can reduce intraosseous pressure, promote venous reflux, release the spasm of trophoblastic vessels, so that the new blood vessels can follow the bone hole to grow into 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.
②Bone grafting.
It is also called drilling and decompression osteotomy 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.
(iii) Osteotomy.
By changing the corresponding position relationship 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 of the femoral head out of the weight-bearing area, so as to reduce the local stress. At the same time, osteotomy makes the medullary cavity open, which can reduce the intraosseous pressure and improve the blood circulation of the femoral head.
(2) Arthroplasty.
It should be applied to patients with femoral head necrosis with collapsed joint surfaces, and metal cup arthroplasty, joint surface replacement, femoral head replacement, total hip replacement, etc. are feasible.