Ischemic necrosis of the femoral head is a common and frequent disease in orthopedics, and there is a saying among the people that femoral head necrosis is the bone cancer that does not kill people, which shows how much pain this disease brings to the patients.
The hip joint is one of the largest joints in the human body, and its main function is to bear weight and lower limb walking function. The femoral head is the axis of the hip joint movement and is also its main moving part. Diseases involving the femoral head will lead to lower limb walking impairment, seriously reducing the ability to work and even unable to take care of themselves. The femoral head is a very important part of the human skeleton, so if there is a problem with the femoral head, it will bring a lot of inconvenience to people’s lives and even seriously affect their quality of life.
The main causes of femoral head necrosis are as follows.
1, traumatic.
2, hormonal.
3. alcoholic; 4.
4, decompression sickness.
5, hyperlipidemia-related diseases.
With the change of people’s living standards and habits, femoral head necrosis now tends to be younger, not only in the elderly group, recently my department admitted a number of young patients with early femoral head necrosis, the youngest is only 16 years old, is a veritable “after 90”, fortunately, these patients are because early to regular large hospitals The treatment is not delayed. The treatment of femoral head necrosis, although there are many methods, but no more than “head preservation” and prosthetic replacement. For the treatment of femoral head necrosis, except for a small number of non-surgical and interventional therapies, patients are generally treated with surgical methods, including medullary core decompression, medullary core decompression with blood tubular implantation, bone grafting, osteotomy, hip fusion, femoral head repair and reconstruction, and artificial joint replacement. Orthopedic surgeons refer to arthroplasty as a “cure-all” or “no cure”. Patients with almost useless joints must have an arthroplasty.
Femoral osteonecrosis can occur at any age, but is more common in patients between the ages of 31 and 60. The former includes long-term or heavy application of glucocorticoids, alcoholism, decompression sickness (ischemic necrosis of the femoral head due to poor local blood supply under high pressure in diving and flying personnel), hip dysplasia, blood disorders, hypertension, diabetes, arteriosclerosis, obesity, gout, and after radiation therapy. The latter mainly refers to the local ischemia of the femoral head caused by trauma to the hip (e.g., femoral head or femoral neck fracture, hip dislocation), which further develops into necrosis.
Prevention of femoral head necrosis In daily work and life, the following points can be done.
1, strengthen the awareness of self-protection of the hip, appropriate physical exercise, and actively prevent and treat osteoporosis.
2. Avoid falling when walking, and try not to let your hip land when you slip and fall. When walking on snow and ice in winter, pay attention to the soles of your shoes to prevent slipping.
3.Before physical activities, do hip preparation activities to feel warm and flexible.
4.When carrying and carrying heavy objects, avoid hip sprains and try not to do too heavy work. Pay attention to the ground level when doing work.
5, if the hip injury should be treated in time, do not walk too much before the injury is healed, so as not to repeatedly damage the hip joint.
6.Avoid alcohol abuse in life, and advocate drinking less or not drinking.
7.Use hormone-containing drugs under the guidance of a physician, and use them sparingly or not at all.
8.Control your weight properly to avoid overweight.
9.After femoral neck fracture, do not get out of bed early, do not put on weight, do not drink alcohol and alcoholic beverages;
10.Low fat and low cholesterol diet.
Diagnosis of femoral head necrosis
The treatment effect of femoral head necrosis has a great relationship with the severity of the disease, the early and late detection, and the stage of the disease, the earlier the lesion is found, the lighter the disease is, the better the treatment effect is. Although imaging examinations such as MRI of hip joint, CT of hip joint and isotope bone imaging are more expensive than X-ray, they can often help physicians to detect femoral head necrosis earlier.
Non-surgical treatment
It is mainly applied to young adults in the early stage of the disease, as they have a good potential for self-repair and the femoral head may be able to be reconstructed through growth and development. Treatment mainly involves avoiding joint weight-bearing under the guidance of a physician, performing appropriate joint function exercises, and taking medications that promote bone growth. Physical therapy helps to relieve symptoms and promote the recovery of blood flow to the femoral head. X-rays, CT or MRI should be reviewed regularly during conservative treatment.
Surgical treatment
Since femoral head necrosis is often difficult to repair on its own, surgical intervention is an important part of the treatment of femoral head necrosis. Patients in the early stage of the lesion, if the femoral head is not yet severely deformed, can consider femoral head drilling for decompression,
Bone grafting with vascular tip, rotational osteotomy and other surgeries can be considered to promote femoral head repair and improve symptoms. Our orthopedic director Yang Shuhua’s original femoral head brace technique not only promotes femoral head reconstruction but also has the effect of preventing femoral head deformation and relieving pain, which is well received by domestic and foreign experts. For patients with advanced lesions, total hip replacement surgery should be considered to obtain a pain-free, stable joint with good or mobility. Hip surface replacement surgery is a typical example of minimally invasive hip replacement techniques.
It is a typical example of a minimally invasive hip replacement technique and is becoming the current trend in hip replacement surgery because of its greater stability and better long-term outcome. The application of navigation technology in artificial joint replacement surgery can help the surgeon to implant the artificial joint more precisely and avoid complications caused by poorly positioned prosthesis.