Femoral head necrosis, also known as ischemic necrosis of the femoral head, is one of the common bone and joint diseases. It is mostly caused by rheumatism, blood disease, diving disease, burns, etc. It first destroys the blood supply to the adjacent joint surface tissues and then causes necrosis. The main symptom is the progression from intermittent pain to continuous pain, and then from pain to muscle spasm, joint movement restriction, and finally to severe disability and claudication. Hormonal drugs can also cause this disease. Chinese medicine believes that the cause of the disease is external and internal, and the interaction of internal and external factors, so that the body’s yin and yang out of balance, the loss of constant qi and blood and disease.
I. Etiology.
Traumatic: due to hip trauma, femoral head or neck fracture, hip dislocation, or branch vessel injury without either fracture or dislocation, can cause local ischemia of the femoral head, which further develops into necrosis.
Non-traumatic.
1, long-term or large amount of glucocorticoid application accounted for 43%.
2.Alcoholism.
3, Decompression sickness. Diving and flying personnel under high pressure, the dissolved nitrogen in the blood and tissues increases, when the environmental pressure decreases, the dissolved excess nitrogen needs to be discharged gradually through the lungs, if the pressure decreases too quickly, the nitrogen is too late to discharge, that is, free out in the body, forming bubbles, producing gas embolism, gas embolism in the blood vessels, blood flow is blocked, the local blood supply to the femoral head becomes poor, ischemic necrosis.
4.Other. Hypertension, diabetes, arteriosclerosis, obesity, gout, radiation therapy, and after burns can also cause necrosis of the femoral head.
Medical history
1. History of obvious trauma to the hip joint 2. History of hormonal drug use 3. History of long-term alcohol abuse 4. History of genetic, developmental, metabolic and other diseases 5. Idiopathic (non-traumatic)
Symptoms
1.Progressive hip pain, aggravated by standing or walking. 2.The first symptoms are hip pain, lumbosacral pain, knee pain, hip pain or groin pain respectively. 3.Limited hip movement (especially internal rotation). .4. Pain or chilliness (fear of cold) in the lower limbs. 5. Limping.
Physical signs
1, no obvious redness, swelling, heat, deformity of hip joint, with or without limping gait, with or without muscle atrophy (quadriceps, and gluteus maximus). 2, greater trochanteric buckle angle (+), pressure pain in the central inguinal region (+), pressure pain in the stopping point of the adductor 3, with or without shortening of the affected limb, axial percussion pain of the affected limb (+) 4, early stage: Thomas’ sign (+), “4 “5. Late stage: Allis sign (+), single leg independence test (trendelenburg) sign (+), Ober test (+).
The main symptoms of femoral head necrosis are manifested in the following five points.
1, pain. Pain can be intermittent or persistent, aggravated by walking activities, and sometimes rest pain. The 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. The early symptoms are limited abduction and external rotation activities.
3.Crippling. Progressive shortening limp, due to hip pain and femoral head collapse, or late onset of hip subluxation. Intermittent claudication often occurs in the early stage, and is more obvious in children.
4. Physical signs. Local deep pressure pain, pressure pain at the stopping point of the adductor muscle, positive 4-letter test, positive Gaja s sign, positive Allis sign test. Abduction, external rotation or internal rotation activities are limited, the affected limb may be shortened, muscle atrophy, and even signs of subluxation. Sometimes the axial impulse pain is positive.
5.X-ray performance. The bone texture is thin or interrupted, and the femoral head is cystic, sclerotic, flattened or collapsed.
Femoral head necrosis mostly occurs between 30~65 years old, with men as the most frequent group. 2~12 years old children are also one of the incidence groups.
Through years of research, bone disease experts in the high-risk group of femoral head necrosis research concluded that those who are prone to trigger the symptoms of femoral head necrosis factors.
1, long-term application of glucocorticoids
Patients whose long-term conditions are not controlled or treated effectively need to take large amounts of glucocorticoids for a long time to control their conditions.
2, long-term heavy drinkers
Osteoporosis caused by alcoholism is also one of the causes of osteonecrosis of the femoral head. Friends with long-term heavy drinking habits, such as the two hip joints or hip pain, groin area, age 30 to 50 years old (drinking-induced osteonecrosis of the head of the femur is more likely to age), must be careful, as soon as possible to go to the hospital to do CT or MRI examination, can be seen in some subtle changes in bone quality. Femoral head necrosis has become clinically common and has become a frequent disease that affects people’s health and has a high disability rate. In recent years, the incidence of femoral head necrosis caused by alcoholism has been on the rise, and in some hospitals has accounted for 1/3 of all inpatients with femoral head necrosis, causing very serious harm.
3.People who have a history of hip trauma
Femoral neck fracture, hip dislocation or hip trauma without fracture dislocation caused by carelessness in life, work and sports can cause damage to the blood vessels supplying the femoral head, laying a great hidden danger for future femoral head necrosis. Among them, femoral neck fracture with femoral head necrosis is the most common, accounting for about 30% of such fractures.
4.People suffering from rheumatic diseases (SLE, rheumatoid, etc.)
Rheumatic diseases refer to a large group of diseases with different etiologies but common to involve the joints and surrounding soft tissues, including muscles, ligaments, bursae and fascia. In addition to pain, joint lesions are accompanied by swelling and mobility disorders, with a chronic course of alternating episodes and remissions, and some patients may suffer from joint disability and internal organ failure, making the bone loose, thus triggering bone changes and leading to femoral head necrosis.
5.Other
Diving, flight crew, obesity, hypertension, diabetes, atherosclerosis, gout, radiotherapy, post-burn, hemoglobinopathy, etc., are also high-risk groups prone to femoral head necrosis.
Disease complications
Because of the complex pathological process of femoral head necrosis, if early treatment is not timely and effective, the femoral head will collapse, narrowing the joint space and finally leading to osteoarthritis, which will cause disability and paralysis of the hip joint. Patients suffer from physical pain as well as psychological trauma, which adds a heavy burden to the family, unit and society.
Advantages and disadvantages of treatment methods
There are various methods of treatment for femoral head necrosis, both Chinese and Western, each with its own advantages and disadvantages. At present, the global consensus of doctors: there is no treatment method to reverse the extensive femoral head necrosis, the following list of feasible treatment methods for reference.
1, drilling decompression: some people call osteonecrosis intraosseous hypertension, so there is a drilling decompression therapy, the therapy is currently the most common method used by doctors worldwide before the collapse of the femoral head, the efficiency is about 80%. It is mainly suitable for early pre-collapse patients.
2.Total hip replacement: Total hip replacement surgery has been hailed as one of the greatest surgical advances of the 20th century. It is the most effective treatment after collapse, with a wide range of indications and good results, and has become the gold standard for advanced treatment of femoral head necrosis.
(1) Age limit: In the past, considering the abrasion resistance of the material, it was mostly used for people over 50 years old, but with the improvement of materials, such as metal-to-metal, metal-to-ceramic, ceramic-to-ceramic friction interface prosthesis, there is no age limit, and even 20 years old can be considered for joint replacement surgery (but only in large medical centers with the above-mentioned improved prosthesis), which has been reported to be used for 40 years (2) Young people cannot have this surgery.
(2) young people can not do this surgery” is a misleading, is the previous view, the current metal-to-metal, metal-to-ceramic, ceramic-to-ceramic friction interface prosthesis can generally be used for more than 20-30 years, after this time, most of them can still be used.
(3) Complications: postoperative pain, restricted movement, acetabular wear through, prosthesis fracture, prosthesis infection, fat embolism, pulmonary embolism, etc. However, the incidence is less than 0.5% in large joint replacement centers, while in small irregular hospitals it may be as high as 10% or more, and once it happens, the consequences are serious. Therefore, the key is to be seen in a large regular hospital.
3, the characteristic drug treatment: Miao medicine formula Miao bone Xian Ling oral capsule specifically for the delayed difficult to heal, rapid changes in the disease of necrosis of the femoral head symptomatic development, suitable for all ages of patients with necrosis of the femoral head. It is suitable for patients of all ages with femoral head necrosis.
4.Grafting with blood vessels: the nearby blood vessels are bundled together and implanted in the necrotic area, which is clinically available only for preoperative imaging, without postoperative examination; nowadays, it is rarely used.
5.Bone flap transplantation with vascular tip: the femoral flap of femoral square muscle or spin internal iliac artery bone flap, transplanted into the osteonecrosis area, clinically verified, the effect is still possible, but there are great limitations, and traumatic, not many use.
6, small needle knife: local damage and trauma, may cause infection and other serious consequences; most doctors do not recommend this method at present. Femoral head necrosis daily care points.
(1) Proper exercise, but weight bearing should be reduced.
Only by avoiding weight-bearing can the friction between the femoral head and acetabulum be reduced, which can create conditions for bone trabeculae reconstruction and repair, so that the femoral head can maintain its complete shape without collapsing or further collapsing. However, patients should not enter the misconception that they do not do any exercise.
(2) Develop good lifestyle habits.
During the treatment process, patients should develop good habits, never smoke and drink, otherwise it will aggravate the condition.
(3) pay attention to self-protection.
In life, patients should do a good job of self-protection, do not do rough movements, so as not to cause injury.
(4) Pay attention to diet and nutrition and reasonable mix.
Patients should usually pay attention to dietary nutrition and reasonable diet with the disease can also play an important auxiliary treatment role. Miao doctors suggest that the main food: should be mainly rice, noodles, grains, to achieve a variety of varieties, coarse and fine collocation; side dishes: should eat more calcium-containing food, such as milk, dairy products, goat liver, pig liver, shrimp, beans, seaweed, egg food.