I. What is called femoral head necrosis?
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 a variety of reasons, resulting in further ischemia, necrosis of bone cells, fracture of bone trabeculae and collapse of the femoral head. Since 1888, when the disease was first recognized by the world medical community, osteonecrosis of the femoral head has been transformed from an uncommon disease to a common and frequent disease. Especially since the introduction of hormones and their widespread use, the incidence of femoral head necrosis has gradually increased. In addition, the increase in the number of accidents after the change of transportation and the change of people’s life style have made the number of patients with this disease increase dramatically. According to incomplete statistics, there are currently 30 million people with osteonecrosis of the femoral head worldwide, and about 4 million in China. The latest survey shows that there is no significant gender difference in the occurrence of osteonecrosis of the femoral head, and the disease can occur at any age, while the incidence of the disease increases significantly in people with a history of hormone application, hip trauma, alcoholism, and related diseases.
Femoral head necrosis can occur at any age, but it is most common at the age of 31-60 years old, with no gender difference. It starts with hidden pain and dull pain in the hip joint or its surrounding joints, which is aggravated by activities.
Second, the stages and clinical manifestations of femoral head necrosis
The first conscious symptom of femoral head necrosis is pain, and the location of pain is around the hip joint, inner thigh, anterior side or knee. In the early stage, the pain is vague, dull and intermittent, and the pain is aggravated by more activities, and can be relieved or reduced by rest. However, there are also cases of persistent pain, regardless of whether the pain is caused by 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 varying 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 caused by bony friction in the joint when moving, but the pain is not obvious when there is no friction between the head and socket at rest. Therefore, the pain is aggravated by walking and activity, while the pain is stopped or reduced by movement. In short, the early stage is dominated by pain with functional limitation; the late stage is dominated by functional impairment with pain.
Femoral head necrosis stage I ultrastructural variation stage
X-rays show that the trabecular structure in the bearing system of the femoral head is disorganized and fractured, and the edges of the femoral head appear hairy, with or without limited mild pain clinically, it is recommended to perform MRI examination if possible, which can be detected and treated early.
Femoral head necrosis stage II with sensory phase
X-rays show small cystic shadows inside the femoral head and uneven density in the annulus 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.
Femoral head necrosis stage III necrosis stage
X-rays show 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 space, and formation of bone superfluous bone.
Femoral head necrosis stage IV 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 include 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, it has been proved that the earlier the treatment, the better the effect, because ischemic necrosis of the femoral head is common and difficult to deal with.
Third, how to determine early femoral head necrosis disease
Femoral head necrosis, the earliest symptom is soreness and sleepiness of the hip joint, sometimes with 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 and medical and dermatological diseases, all of which can cause hip pain. Femoral head necrosis is only one of the many causes of hip pain, and as an independent disease, femoral head necrosis has its own specificity.
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 fracture, dislocation or sprain of hip joint heals, intermittent or persistent pain in the hip will appear gradually or suddenly. It is aggravated after walking activities, sometimes it is resting pain, and the pain is mostly pins and needles or soreness, 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 the above situation occurs, it is possible to suffer from femoral head necrosis and need to go to the hospital to confirm the diagnosis.
Four, femoral head necrosis treatment methods
1.Conservative treatment
(1) Avoid weight-bearing
It is possible to 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, 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
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.
The treatment of preserving the femoral head is applicable to early osteonecrosis of the femoral head.
(1) Drilling and decompression
It can reduce intraosseous pressure, promote venous reflux and release trophoblastic vascular spasm, so that the new blood vessels can grow into the ischemic area along the bone hole. It is mainly used for patients without joint surface collapse in the early stage, and is the simplest surgical method to treat osteonecrosis.
(2) Osteotomy
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.
(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.
(4) 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.
3.Our treatment methods.
Silver needle therapy + interventional therapy + physical factor therapy + Chinese medicine four-in-one comprehensive treatment. It mainly targets the early and middle stage 1, 2 and 3 of ischemic necrosis of femoral head.
Aseptic necrosis of the femoral head or ischemic necrosis of the femoral head is a common clinical disease, but its etiology and pathogenesis have not yet been clarified. There are more research theories on the pathogenesis of aseptic necrosis of the femoral head, such as vascular lesions, increased pressure in the joint cavity, increased pressure in the bone marrow cavity, decreased mechanical strength of the bone structure, and lesions of the femoral head, but the core problem is the lack of arterial blood supply due to impaired blood circulation in the femoral head, which eventually leads to osteonecrosis, of which the use of corticosteroids and alcohol abuse are the two main risk factors, and 9O% of the lesions are related to them. The use of hormones and heavy alcohol consumption cause damage to the endothelium of fine veins, exposure of collagen in the canal wall, local aggregation of platelets and release of TXA2; on the other hand, due to damage to the vascular endothelium, the release of PGA2 is reduced, leading to local vascular contracture, thrombosis and other reactions. The use of hormones, alcohol consumption and other factors can also cause disorders of fat metabolism and increase of free fat droplets in the veins, forming fat embolism locally. These changes cause venous reflux disorder, local bruising, tissue fluid exudation, and edema around the ilium, resulting in stagnation of intra-medullary microcirculation and increase in intraosseous pressure, which, together with the accumulation of local metabolites, leads to vasospasm and endocytic damage, eventually leading to intravascular coagulation and formation of microcirculatory thrombus, resulting in local ischemia, impaired bone nutrient metabolism, and atrophy and death of bone cells. Therefore, improving the blood circulation of the femoral head becomes the theoretical basis for the treatment of aseptic necrosis of the femoral head.
Silver needle treatment is superior for both intra-articular decompression, reconstruction of damage to the lesions around the femoral head, and elimination of pain-causing aseptic inflammation. Silver needle treatment has an outstanding effect on improving arterial spasm around the femoral head and reducing the direct compression of the artery by muscle spasm, thus indirectly reducing the intra-articular pressure in the bone marrow cavity. In addition, silver needle loosening can indeed loosen adhesions, promote blood flow, improve function, reduce pain, unblock bone channels, and adjust yin and yang.
Interventional therapy is aimed at the last link of the pathophysiology of the disease, applying highly concentrated thrombolytic and vasodilating drugs to release vascular spasm, dissolve microvascular emboli, increase arterial perfusion, improve venous reflux, and lower intraosseous pressure, thus effectively improving the local blood microenvironment in the femoral head area, effectively promoting and communicating with the establishment of collateral circulation, increasing blood flow to the femoral head, and reestablishing blood circulation to the femoral head, which is conducive to This will improve the local blood microenvironment in the femoral head area, effectively promote and communicate with the establishment of collateral circulation, increase the blood flow to the femoral head, rebuild the blood circulation in the femoral head, and facilitate the growth of new bone and repair of dead bone, thus preventing the collapse of subchondral bone in the femoral head and delaying the progress of joint degeneration.
Physical factors and Chinese medicine mainly improve the internal and external blood supply, and according to the theory of Chinese medicine that the kidney is the master of the bone, the kidney is the main supplement, combining Chinese and Western internal and external.