Ischemia of the femoral head causes necrosis of bone cells, called ischemic necrosis of the femoral head, which is also called aseptic necrosis of the femoral head because this is produced in an aseptic condition, and these are collectively called femoral head necrosis. The hip joint is a large joint in the body and its activity is large, so it is vulnerable to trauma. When ischemic necrosis of the femoral head occurs, the pressure or weight of the body will cause the femoral head to collapse and deform, resulting in limited hip joint activity and causing a series of problems.
I. What factors are likely to lead to femoral head necrosis?
①Trauma. Such as femoral neck fracture, hip dislocation, hip joint sprain and contusion caused by external impact.
②Large amounts of alcohol. The accumulation of alcohol in the body due to long-term heavy drinking causes an increase in blood lipids, which leads to an increase in blood viscosity and slows down blood flow, causing blood coagulation and blocking blood vessels, resulting in insufficient local blood supply and interruption of femoral head nutrition, resulting in femoral head necrosis.
③Large or long-term use of adrenal glucocorticoids, etc.
④Chronic cumulative strain injury.
⑤ Disorders of bone metabolism.
⑥Necrosis secondary to hip joint surgery.
(7) Osteoporosis.
⑧Bone structure changes leading to blood vessel compression resulting in blood flow disorders, such as hip dysplasia.
(9) There is also osteonecrosis in children, the causes of which are unclear, generally occurring between the ages of 4 and 10 years, causing necrosis of the epiphysis, also known as idiopathic osteonecrosis.
Second, how to achieve early diagnosis of osteonecrosis of the femoral head?
The treatment effect of femoral head necrosis has a great relationship with the severity of the disease, early and late detection, and the length of the disease, the earlier the lesion is found, the lighter the disease, the better the treatment effect, so femoral head necrosis should be diagnosed and treated early. Early diagnosis of femoral head should follow the following principles.
① Any adult aged 20 to 50 years old with pain in the groin or hip and radiating to the thigh (or hip pain after activity of one side of knee pain), slow progressive aggravation, obvious pain at night, ineffective by general medication, and history of trauma or alcoholism or other causative factors and diseases causing femoral head necrosis should first consider this disease.
②For all patients with low back pain, the function of the hip joint should be routinely checked during physical examination, and if abduction and internal rotation of the affected hip joint are found to be limited, the existence of this disease should be suspected.
③Patients with femoral neck fracture should be followed up until 3 to 5 years after the injury. If diminishing height of the femoral neck, cystic degeneration of the femoral head and clinical symptoms are found, the disease should be considered.
④For suspicious cases, orthogonal and frog X-ray of the hip joint must be taken first. If there is no abnormality, close observation or further CT, MRI, ECT, intraosseous pressure measurement, arteriography and other examinations should be performed.
III. Staging of femoral head necrosis
Stage 1: Progressive pain in the hip joint, mildly restricted activity, insignificant changes on X-ray and CT or dotted density changes, MRI and isotope scan can be found.
Stage 2: Hip pain is predominant and abduction and internal rotation are mildly restricted. x-ray and CT show that there is still no change in the shape of the femoral head and joint space, and cystic changes can be seen under the cartilage.
Stage 3: Hip and knee pain increased, weight-bearing endurance decreased, limping; X-ray and CT films may show fracture of bone trabeculae and discontinuity of bone cortex, or uneven density, etc. At this time, the femoral head has been cracked, but the shape has not changed much.
Stage 4: Restriction of hip joint movement, difficulty in walking in serious cases, or loss of labor ability; deformation of the femoral head with gap changes or deformation of the hip joint on X-ray and CT films.
Fourth, the common clinical treatment methods of femoral head necrosis
1.Non-surgical treatment
① Avoid weight-bearing: including partial weight-bearing and non-weight-bearing, walking with a car as far as possible, only applied to pre-collapse femoral head necrosis, that is, stage 1 and 2.
②Medication: In the early stage, when the femoral head is not collapsed and deformed, medication can be taken for treatment and pain relief, but when the femoral head is cystically altered and collapsed or deformed, medication cannot be taken. Many advertisements say that it is possible to cure osteonecrosis of the femoral head. Osteonecrosis of the femoral head is a long process, and it is best to receive treatment in a large hospital, and the medication is different in different periods, so it is recommended that patients who choose to treat with prescriptions should be careful.
③ Other treatment methods: such as electrical stimulation therapy, bloodletting therapy, hyperbaric oxygen therapy, etc., but the effect is uncertain.
2.Surgical treatment
①Central decompression: it can reduce the intraosseous pressure and increase the blood flow in the femoral head.
②Osteotomy: change the main weight-bearing area of the femoral head, mainly applicable to patients with stage 2 and 3 and small lesions.
③Osseous grafting: to promote the repair of necrotic femoral head, which can be used for stage 2, early stage 3 patients and patients with failed central decompression.
④Bone graft with blood supply: increase blood supply to the femoral head and accelerate bone healing.
⑤Interventional treatment:improve blood supply to the femoral head.
⑥Artificial hip arthroplasty: for advanced stage 3 or stage 4 patients, artificial total hip arthroplasty is the best choice.
V. Why is the initial stage of femoral head necrosis easily misdiagnosed and missed?
The clinical manifestations of the initial patients are not typical, similar to the symptoms of some other orthopedic diseases. x-ray film is not carefully examined, it is not easy to find where the lesion is, so it is often misdiagnosed and missed. Femoral head necrosis is easily misdiagnosed as: lumbar disc herniation, rheumatism, ankylosing spondylitis, soft tissue injury, etc.
Six, what should patients with femoral head necrosis pay attention to in the treatment process?
① The most prominent feature of femoral head necrosis is that the severity of self-conscious symptoms is not proportional to the degree of femoral head necrosis, so patients should pay special attention to the need to adhere to the course of treatment, not halfway, and not intermittent.
②No misuse of other special drugs and means of treating osteonecrosis of the femoral head.
③Can not use adrenocorticotropic hormone or other drugs that affect the efficacy of treatment.
④Alcohol should be prohibited and smoking should be kept to a minimum.
⑤ Minimize weight-bearing, walk with a car, and should be on crutches if necessary.
⑥Functional exercise according to the treatment stage.
Seven, how do patients with osteonecrosis of the femoral head protect themselves when the weather changes?
Most patients with osteonecrosis of the femoral head have aggravated their condition and hip pain when the weather changes, and the main reasons are humidity and cold. Humidity can cause dysfunction of skin respiration and metabolism in the hip and leg, resulting in increased microvascular congestion, stasis and exudation due to slow blood flow in the local tissues, which aggravates the patient’s symptoms. Therefore, in humid conditions, patients should keep their working and living environment dry in addition to appropriate activities to avoid aggravation of symptoms.
Cold mainly causes blood circulation disorders such as stasis, ischemia and edema in the hip through vasoconstriction of the hip and leg, which aggravates the patient’s condition. Therefore, patients should not sit or sleep in cold places for a long time, and pay attention to more activities and keep warm in winter.
Eight, should patients with osteonecrosis of the femoral head rest in bed?
Many patients think that suffering from osteonecrosis of the femoral head is not able to bear weight, it means bed rest, this idea is not right. The formation of femoral head necrosis is caused by various reasons of local ischemia, necrosis formation, due to pain and other reasons to limit the activities, resulting in a series of changes such as decreased muscle contraction, joint mobility disorders. On the basis of this, the activity is even reduced, thus forming a vicious circle, which eventually leads to local blood circulation disorders and the necrosis continues to develop.
Thus, it seems that the idea of inactivity after the disease is wrong. The activity improves the blood circulation, prevents the complications and helps the femoral head repair. But the functional activities should be carried out under the premise of not bearing weight, and the irradiance should not be too large, the force should not be too violent, and each action should be light and painful in order to achieve twice the result with half the effort.
Why should patients with femoral head necrosis reduce weight-bearing?
Avoiding or reducing weight bearing is the key to the treatment of femoral head necrosis, for three reasons.
① The mechanical strength of the femoral head is maintained by the bone trabecular system. The bone trabeculae at the neck of the femoral head are composed of tension-resistant bone trabeculae, compression-resistant bone trabeculae, intertrochanteric bone trabeculae and secondary bone trabeculae. After head necrosis, the trabeculae atrophy, fracture and disappear, causing the femoral head to fragment, collapse and deform. Only by avoiding weight-bearing can conditions be created for the reconstruction and repair of the osteochondral trabeculae, so that the femoral head can maintain an intact shape without collapsing or further collapsing.
②The elastic cushioning resistance of the osteochondral bone of the femoral head and the maintenance of inter-articular lubrication. in patients with stage 3 or above, the osteochondral bone is necrotic and disappeared, and only by avoiding weight-bearing can the friction between the femoral head and the acetabulum be reduced, which is conducive to the repair of the osteochondral bone.
(③) Venous stasis and elevated intraosseous pressure are the main pathogenesis of head necrosis, reducing weight bearing can reduce venous stasis, reduce intraosseous and joint cavity pressure, and promote bone repair.
Why do some patients have less pain and some patients have more pain during the treatment?
After systematic treatment of patients with femoral head necrosis, most patients have improved clinical symptoms and signs, but some patients complained of increased hip pain and lost confidence in treatment, but the X-ray showed improvement. In fact, hip pain does not exactly mark the aggravation of the disease, the bone in the process of repair will also appear this phenomenon. The necrotic bone is absorbed close to the joint surface, producing enzymes and protein breakdown products, and these toxins enter the joint cavity and irritate the synovial membrane, resulting in severe pain. After the dead bone is absorbed, the pain will be reduced and disappear.
XI. What should patients with osteonecrosis of the femoral head pay attention to?
Because of the high pressure in the hip joint of femoral head necrosis, so patients with femoral head necrosis should not stand or walk for too long, which will increase the pressure in the hip. However, it is important to do some outdoor activities that are easy to do. It can improve the function of the hip joint, relieve muscle spasm and reduce pain.
Patients with osteonecrosis of the femoral head should walk with the help of crutches, bilateral osteonecrosis of the femoral head walk with the help of double crutches. If the condition allows good physical condition can ride a bicycle or tricycle to adhere to daily outdoor activities. “Sunshine”, because “sunshine” can be synthesized in the skin and body vitamin D, vitamin D can promote the body’s absorption of calcium, phosphorus, reduce the loss of calcium and phosphorus components in the bones, to maintain the amount of bone in the femoral head, promote the regeneration and repair of necrotic bone is a great It is beneficial to maintain the bone mass of the femoral head and promote the regeneration and repair of necrotic bone. However, it should be noted that in the process of activity, prevent falls and fractures, because the hip joint of femoral head necrosis is restricted, the bone is fragile, so the reaction ability is reduced and fractures are easy to occur.
Patients with femoral head necrosis can do some simple functional exercises in bed, because simple functional exercises can improve hip joint activities and increase the range of hip joint activities, while reducing the pressure on the femoral head, improving the blood circulation of the femoral head, relieving the spastic muscles of the hip and thigh, thus reducing the pain caused by muscle spasm, promoting the absorption of sterile inflammation around the hip joint and releasing the surrounding adhesions.
Exercise for patients with osteonecrosis of the femoral head is not easy to be too strenuous and too strenuous, but should be more comfortable. For example, lying on the bed, lifting the legs to do the bicycle movement, or holding the lower part of the knee joint with both hands, extremely flexing the knee joint and flexing the hip joint to the maximum range. But should not be excessive, should be able to tolerate as much as possible.
Twelve, the use of crutches for patients with femoral head necrosis?
Reducing the load on the affected hip and protective weight-bearing is the minimum intervention treatment, and applying partial weight-bearing with crutch support is the best measure to reduce symptoms and delay structural damage to the femoral head. X-rays should be taken periodically during treatment and weight bearing should not be allowed until the disease has healed.
(1) Crutches can effectively reduce the load on the lower limbs, and in principle, double crutches should be used. The crutches are controlled with the upper limbs and hands, and the appropriate height is from the bottom of the foot to the armpit, which is 40 cm less than the height, and from the 15 cm of the front outer side of the little toe to the height of 2 to 3 horizontal fingers of the armpit when standing.
(2) Walking with crutches method are.
① two-point walking: right foot and left abduction, left abduction and right foot alternate walking with each other;
②Three point walking: two crutches and the affected foot three points walking, the healthy side of the foot independent walking;
③ four-point walking: foot and crutches alternate walking.
Thirteen, femoral head necrosis patients how to adjust their mindset?
Once the necrosis of the femoral head occurs, the entire medical community feels the difficulty of treatment, the general hospital advocates the replacement of artificial femoral head; if the patient chooses conservative treatment, the effect is very different, all day long for the disease, so that the body is devastated. What is more serious is that the psychological burden of the patient is high, and the long-term worry and anxiety affects the sleep and physical quality, thus forming a vicious circle, and the symptoms and signs of femoral head necrosis become more and more serious.
Therefore, we believe that once the diagnosis of femoral head necrosis is confirmed, the patient should not be overly nervous and face the reality, first of all, we should increase some general knowledge in this area, make some preliminary understanding of the causes and treatment of femoral head necrosis, and decide whether to take surgery or conservative treatment first. In short, with the continuous development of medicine, the treatment methods and effects will be better and better. Patients should communicate more with other similar patients, actively adjust their mindset, stay optimistic and enhance their physical fitness, which will play a very good role in improving the treatment effect.