Causes, symptoms and treatment of osteonecrosis of the femoral head
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 of bone cells, necrosis, fracture of bone trabeculae, and collapse of the femoral head. There are very many patients with femoral head necrosis diagnosed and treated every year, and the main reasons for this in recent years are the following.
1, the introduction of hormones and their widespread use, many patients treated with hormones can develop this disease, such as rheumatism, systemic lupus erythematosus, asthma, nephritis, etc.
2, necrosis after aging femoral neck fracture.
3, people’s lifestyle changes, such as smoking and alcohol stimulation all make the number of patients with this disease increased dramatically. During the diagnosis and treatment of patients with osteonecrosis of the femoral head, it was found 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 chance of developing the disease increases significantly in those who have a history of hormone application, hip trauma, alcohol abuse, and related diseases.
The earliest symptom of femoral head necrosis is soreness and pain in the hip joint, sometimes intermittently. 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, medical and dermatological diseases, etc., 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 healing of fracture, dislocation or hip sprain, 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-like or sore, and the above reaction occurs.
5, long-term or short-term heavy use of hormones or frequent alcoholics appear hip pain, mostly hidden pain, dull pain, often located in the groin, obvious when moving, alleviated after rest.
6, cold and damp: when the weather is cold, the hip joint is sore and sleepy, the pain is aggravated, and the function is limited.
7, inflammation: when you have a cold and fever, blood sedimentation is accelerated, white blood cells are elevated, and the pain of the affected hip joint is aggravated.
Conservative treatment.
1, avoid weight-bearing: you can first rely on canes, axillary canes 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 self-healing of ischemic necrosis of the femoral head. 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 method for osteonecrosis or as an adjunct to surgery.
3.Chinese medicine.
Surgical treatment.
1, treatment to preserve the femoral head: applicable to early osteonecrosis of the femoral head.
(1) Borehole decompression: it can reduce intraosseous pressure, promote venous reflux, release trophoblastic vascular spasm, so that new blood vessels can grow down the bone hole to 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.
(2) Bone grafting: It is also called drilling and decompression bone grafting because it is necessary to drill holes before bone grafting. There is both drilling and decompression, bone graft to provide mechanical support, and bone graft 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, at the same time, osteotomy opens the medullary cavity, which can reduce the intraosseous pressure and improve the blood circulation of the femoral head.
2.Arthroplasty: It is applied to patients with collapsed femoral head necrosis, and metal cup arthroplasty, joint surface replacement, femoral head replacement, total hip replacement, etc. are feasible.