A. Causes of femoral head necrosis.
There are many causes of femoral head necrosis, and there are three main common clinical causes of femoral head necrosis: namely, drug causes (taking glucocorticoid drugs), alcohol stimulation (long-term heavy drinking) and traumatic (femoral neck fracture). The most painful of these is often drug-induced osteonecrosis of the femoral head. I have often encountered young patients who have been using informal drugs for a long time because of minor lesions in the eyes or throat, and these drugs have added glucocorticoids to increase their efficacy without being indicated in the instructions, resulting in patients unknowingly suffering from osteonecrosis of the femoral head. Alcohol itself can cause osteonecrosis of the femoral head, so patients with early onset osteonecrosis of the femoral head must abstain from alcohol to avoid aggravating the condition. Femoral neck fractures, especially head down fractures, have a very high chance of femoral head necrosis. Patients with femoral neck fractures after internal fixation are reminded to return to the hospital for regular review so that early detection and early treatment can be achieved. Guan Mingqiang, Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine.
Second, the symptoms and signs of femoral head necrosis.
1, pain.
Pain can be intermittent or persistent, increased after walking activities, sometimes for rest pain. 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.
2.Joint stiffness and activity limitation.
The affected hip joint flexes and extends unfavorably, has difficulty squatting, cannot stand for a long time, and walks with a duck walk. Early symptoms are limited abduction and external rotation activities and obvious claudication. Progressive shortening limp, due to hip pain and femoral head collapse, or late onset of hip subluxation.
3. Local deep pressure pain.
The pressure pain at the stop point of the adductor muscle, positive 4-character test, positive gamma currys sign, positive A11is sign, positive TKdele latuq test. The joint movement is limited, the affected limb may be shortened, muscle atrophy, or even signs of subluxation. Sometimes the axial stroke pain is positive.
Third, the diagnosis of femoral head necrosis.
1.Magnetic resonance imaging (MRI): It is the most sensitive diagnostic tool for early stage of femoral head necrosis.
2.X-ray film: combined with MRI can better assess the condition of early femoral head necrosis; it can more intuitively assess the condition of middle and late stage femoral head necrosis (such as the degree of femoral head collapse, etc.).
3, CT: generally only used for patients with untimely diagnosis and serious destruction of hip bone, which can more comprehensively evaluate the destruction of hip bone and guide the surgical treatment.
4.Differential diagnosis of femoral head necrosis.
1. temporary osteoporosis sign (ITOH).
It can be seen in middle-aged male and female patients with temporary painful bone marrow edema. x-ray shows reduced bone volume in the femoral head, neck and even rotor. mri shows uniform low signal in T1-weighted phase and high signal in T2-weighted phase, which can range to the femoral neck and rotor, without banded low signal, which can be differentiated from ONFH. This disease can be healed within 3-6 months.
2. Subchondral incomplete fracture.
Most commonly seen in elderly patients over 60 years old, without obvious history of trauma, showing sudden onset of hip pain, inability to walk and restricted joint movement. x-ray shows slight flattening of the upper outer part of the femoral head, T1 and T2-weighted phase of MRI shows subchondral hyposignal lines with surrounding bone marrow edema, and T2 lipid suppression phase shows lamellar high signal.
3. pigmented villous nodular synovitis.
Mostly in the knee joint, hip joint involvement is rare. CT and X-ray may show cortical bone erosion of the femoral head, neck or acetabulum, and mild to moderate narrowing of the joint space; MRI shows extensive synovial hypertrophy with uniform distribution of low or moderate signal.
4. Femoral head contusion.
Most commonly seen in middle-aged patients with a history of hip trauma, manifesting as hip pain and claudication.MRI is located within the femoral head with moderate intensity signal in T1-weighted phase and high signal in T2-weighted phase, more medially.
5, osteoarthritis.
At present, the diagnosis of osteoarthritis of the hip as osteonecrosis of the femoral head has become an almost nationwide common phenomenon. Osteoarthritis of the hip joint occurs in middle-aged and elderly female patients, often combined with acetabular dysplasia (DDH), with joint space narrowing as the first manifestation on X-ray, while osteonecrosis of the femoral head often has subchondral fracture and collapse and deformation of the femoral head as the first manifestation.
V. Treatment of femoral head necrosis.
Before femoral head collapse: first of all, we should remove the causative factors, such as alcohol consumption and medication, then avoid strenuous activities and weight bearing to avoid femoral head collapse as much as possible, then we can consider treatment measures such as drilling and decompression and autologous bone graft.
After femoral head collapse: At this time, conservative treatment is often difficult to achieve the desired effect, and hip arthroplasty has become the preferred treatment measure. As one of the most successful surgeries in the 20th century, the effect of hip arthroplasty in treating femoral head necrosis has long been widely recognized worldwide.
VI. Precautions for patients with osteonecrosis of the femoral head.
It is necessary to reflect on the cause of the disease, and only by removing the cause can we expect to achieve the desired effect; it is necessary to go to a regular hospital to receive regular treatment, because of the high incidence of femoral head necrosis in recent years, false advertisements about the treatment of femoral head necrosis are very prevalent at present; for patients with femoral head collapse, there is no need to deliberately delay the time of surgical treatment, the current design of artificial hip prosthesis has made great progress, and the service life of the prosthesis The majority of young patients only need to undergo surgery once in their lifetime; build up confidence in life, after regular treatment of femoral head necrosis, most of them can adhere to normal work and life and ensure quality of life.