Aseptic necrosis of the femoral head is the end result of a different etiology that disrupts the blood supply to the femoral head. It is one of the common clinical diseases. It causes severe disability of the hip bone and joint due to the collapse of the femoral head and is more difficult to treat.
First of all, it is important to understand the symptoms and causes of femoral head necrosis are those.
Common causes of femoral head necrosis
① Fracture of the femoral neck;
②Hip trauma without fracture;
③Legg-Clve-perthesse disease;
④Hemoglobinopathy;
⑤Decompression disease;
⑥Long-term application of hormones;
⑦Alcoholism;
⑧ Idiopathic ischemic necrosis;
⑨ Other disorders: such as gout, burns, arteriosclerosis, hyperthermia, etc.
Common symptoms: Ischemic necrosis of the femoral head can be asymptomatic in the early stage, but found when taking X-rays. The earliest symptom is hip or knee pain, which appears earlier in the hip with intraosseous muscle pain. The pain may be constant or intermittent. If both hips are diseased, the pain may be alternating. The nature of the pain is not severe in the early stages, but it gradually increases, or it can be sudden after a minor trauma.
The symptoms may be temporarily relieved by conservative treatment. However, after a period of time, the pain will come back, and there may be limp, walking difficulties, or even walking with crutches. Physical examination: In the early stage, there may be no obvious restriction of hip joint activities, but with the development of the disease, there may be pain in the adductor muscle and restriction of hip joint activities, among which the restriction of internal rotation and abduction activities is the most obvious.
After having the above symptoms, you should go to the hospital for a comprehensive examination and take X-Ray film, CT and MRI to make a clear diagnosis. For femoral head necrosis, it is clinically divided into four stages: the first stage is the femoral head lysis stage. The second stage is the femoral head repair stage. The third stage is the femoral head collapse stage. The fourth phase is the resorption phase of the femoral head. The clinical staging of femoral head necrosis is very important, which can guide the treatment and prognosis prediction.
When the diagnosis is clear, we should choose the correct treatment plan, not to blindly listen to some propaganda advertisements, and thus miss the treatment.
I. Hyperbaric oxygen therapy.
In the hyperbaric oxygen warehouse in the human blood physical dissolved oxygen content than under normal conditions increased by 4-5 times, the body oxygen partial pressure rise is conducive to blood oxygen diffusion to the tissue cells between, so that the osteonecrosis area blood oxygen concentration increases, promoting the absorption and repair of necrotic tissue, applicable to early osteonecrosis, for improving clinical symptoms, relieve pain has a certain efficacy, the treatment time generally takes about 3 months.
Second, interventional radiotherapy.
It has been popularized in recent years in China, and is a kind of non-surgical therapy, using X-ray images, under the display of angiography, inserting catheters into the internal femoral artery, or directly into the femoral head to embolize the vessels, injecting fibrinolytic drugs such as urokinase, salvia, low molecular dextrose, etc., to dissolve the thrombus, recanalize the occluded small arteries and increase the amount of blood circulation, generally done once every 20 days, 2-3 times can be used for stage I and II Femoral head necrosis patients, can play a role in relieving pain and preventing collapse, and there are reports of significant short-term efficacy.
The more popular topics at present are selective arterial thrombolysis and stem cell transplantation for non-traumatic femoral head necrosis. The efficacy is more ideal for stage I and II patients and is highly favored by patients.
Third, femoral head borehole decompression surgery.
According to the theory of increased pressure in the femoral neck. The hole is drilled into the femoral head from the epiphysis of the upper end of the femur or from the thick ridge, generally into the medullary cavity 7-9 cm, and some experts suggest that the hole should be drilled beyond the osteonecrosis area to communicate with the living bone, so that the high pressure in the femoral head can be improved and the resistance to blood circulation can be reduced, and the venous stasis in the femoral head can be relieved, so that the effective blood circulation in the femoral head can be increased. It is suitable for early stage lesions, which can improve clinical symptoms significantly, and late stage patients have poor results, so the indications must be chosen well before surgery.
IV. Osteotomy.
Under the large ridge to the femoral head, the tiny bone flap of the tibia or fibula, together with its small artery, is removed and implanted into the channel, and the small artery is anastomosed with the wound; the fibrous tissue in the nail channel can also be removed, and the iliac bone is taken to fill the implant, these methods are simple and easy, and are also conducive to fracture healing, and are suitable for cases of femoral head or neck fracture secondary to femoral head necrosis.
V. Vascular grafting.
They are a complete set of self-forming reflux system tissues, with high survival rate. Soon after implantation, capillaries proliferate and extend to necrotic tissues, improving the blood circulation in the lesion area and promoting the resorption and repair of osteonecrosis.
VI. Osteotomy.
Through redirection osteotomy, the femoral head can obtain the maximum weight-bearing area, reduce the stress effect on the osteonecrosis area, facilitate the absorption and repair of osteonecrosis, and improve the function of the hip; anterior rotation osteotomy makes the collapsed area shift from the weight-bearing part to the low weight-bearing part, and the normal joint surface moves to the weight-bearing area. This operation is difficult, and the direction and angle of osteotomy must be designed in detail. It is suitable for patients with middle to late stage femoral head necrosis, and there are reports that patients below middle age are not suitable for artificial femoral head replacement, so osteotomy can be done to improve clinical symptoms and hip support function.
Seven, iliac bone flap grafting with tip.
It is a more commonly used procedure, often using the iliac flap terminated by the deep iliac vessels and the ascending branch of the lateral femoral artery as the tip, because the caliber of the vessels there is large, the blood supply is sufficient to ensure the effective blood circulation of the femoral head, the anatomical position is constant and superficial, the vascularity is long, the transfer is convenient, it does not affect the normal mobility of the hip joint, at the same time, the iliac bone is cancellous bone, the same bone quality as the lesion area, easy to heal, and the survival rate is high. High survival rate, suitable for stage I and II femoral head necrosis, in recent years, some experts have adopted this procedure for patients with stage III femoral head necrosis, and the efficacy is still satisfactory.
VIII. Allogeneic bone graft.
The use of fresh fetal cadaveric cartilage tissue as the graft, simple operation, easy to obtain sources, fetal cartilage is a low immune material, strong stability, chondrocytes in the undifferentiated mature stage, after transplantation can quickly become the patient’s own bone tissue, rejection reaction is not obvious, the indications are relatively wide, as long as the acetabulum is intact, more advanced patients can also perform surgery.
Nine, artificial joint replacement.
It is generally believed that this surgery is suitable for older patients with advanced femoral head necrosis, if the acetabulum is basically intact, artificial femoral head replacement can be used, and total hip replacement should be performed if the acetabulum is altered, the biggest postoperative complication is the loosening of the prosthesis, causing many reasons for the loosening of the prosthesis, such as the type of prosthesis, the location of the prosthesis implantation, the degree of anastomosis with the prosthesis after the pulpal cavity treatment, and the rehabilitation activities of the patient, etc. Special attention should be paid to the fact that although the bone cement can stabilize Therefore, in recent years, we have gradually developed non-cemented prostheses, which make use of the microscopic pores of the prosthetic stem to attract capillary growth in the medulla, causing biological embedding and playing an important role in preventing the loosening of the prosthesis.