Patient: Checked out at the beginning of February this year, symptoms usually manifested as slight pain in the right leg abduction and right knee joint, walking is normal. He has not been treated and is on bed rest and crutches. Please help Dr. Tang to confirm the diagnosis and how to treat it. I want to choose conservative treatment, is it possible?
The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Department of Orthopedics, Tang Liming: Thank you for your trust. From the introduction of your case and the MRI and X-ray data, the preliminary diagnosis is: bilateral ischemic necrosis of the femoral head (stage 3B on the right side, stage 2B on the left side) with a necrosis area of about 30%, no obvious joint collapse, normal joint space, mild bilateral acetabular dysplasia, no subluxation, and a small amount of fluid in the right hip on MRI, and no obvious collapse. (Unfortunately, there is no frog x-ray.) The cause is unclear, but hormonal femoral head necrosis cannot be ruled out.
I suggest: 1: Take additional x-ray frog films to find out whether the femoral head is collapsed or not. 2: Walk with the help of crutches. 3: Take medication for the treatment of osteonecrosis of the femoral head. 4: Observe the changes in your condition and check the x-ray films regularly. 5: Keep in touch. 6: Of course, there are other treatments including interventional and minimally invasive surgical treatments. However, I suggest that conservative treatment is better first.
Patient: Thank you, Dr. Tang. Does conservative treatment mean bed rest, crutches, and medication? If I take medicine, is it Chinese medicine or pure Chinese medicine? Can I swim and ride a bike as an aid?
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: It is a non-surgical treatment, and our medications are three kinds of proprietary Chinese medicines – Shengvei Chengbao Tablets, Chuanxiongzin Tablets and Xianlingbao Capsules. You have to walk with double crutches, it is better not to ride a bike, you can swim.
Patient: Shengvei Chengbei Tablets, Chuanxiongzin Tablets and Xianlingbao Capsules 3
Patient: The baby is 1 year old and 10 months old. On December 19, he felt a little lame walking, especially his right leg looked uncomfortable. He told me to go home and take some anti-inflammatory drugs and rest properly. But I read the information and felt very nervous. I don’t know what medication is appropriate for my child and what to do for the next review. Thank you! The doctor didn’t ask for an X-ray, and another pediatrician even said that no anti-inflammatory medication is needed, just less activity. The child can’t feel any pain in his leg, but today he is walking worse than yesterday. The child can’t lie down, but sitting is fine, right? Should I do any other tests, please? Laboratory and examination results: Last seen at.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: Transient synovitis generally does not require special treatment and should be observed, as pediatric femoral head necrosis also has a synovitis reaction period, and regular hospital checkups are sufficient.
Patient: Don’t you need to take some anti-inflammatory drugs? I have given my child Cefaclor once. The child can’t lie down, but can sit down, right? How often should I go to the hospital for a review? Thank you. “Pediatric femoral head necrosis also has a synovitis reaction phase” sounds scary, were there any signs before?
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.
Transient synovitis is related to trauma and viral infection, and the use of cefaclor makes no sense.
Pediatric femoral head necrosis also manifests as synovitis in early stages, with the same symptoms as transient synovitis.
In addition, some transient synovitis can also develop into pediatric osteonecrosis.
For now, just pay attention to rest and observation, because most of the transient synovitis will recover on its own in 2-3 weeks.
Patient: Thank you for your prompt reply. I am still very worried. Does the child have to be strictly controlled not to walk for the next few days since he is bedridden? How long will it take before the child can start moving around? The doctor didn’t tell me when the review was going to take place, so how often should I go for a review? The child has a problem, so I always put it in my mind and ask a little bit of mythical mythology.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: 2-3 weeks of control is enough, after that it is better to review once in 3-6 months until about a year. Do you need to use all kinds of drugs together? About how long should I take it and how much does it cost?
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: Yes, a course of treatment for 3 months. Depending on the condition, the course of treatment usually takes more than one year. If the condition gets worse during treatment, you can change the treatment method.
Patient: I’ll contact you after taking additional X-ray frog films.
Patient: I took a frog film today, please ask Dr. Tang to take a look again, thank you.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: I saw the frog X-ray of both hips that you took today. The anterolateral aspect of the right femoral head can be seen to be slightly collapsed, about 1-2 mm. In this case, you should pay special attention to protect the right hip joint, because collapse is an important indicator of prognosis. At this stage we recommend medullary decompression peroneal column bracing, but of course, you can also start with conservative treatment and strictly observe the changes in your condition to decide the treatment plan.
Patient: Hello Dr. Tang, thank you for your patience in answering my question. My disease since the discovery of the diagnosis, the mental pressure on me a lot, I also consulted the relevant medical (Zhengzhou People’s Hospital, Chinese Medical College, Luoyang Orthopaedic Hospital), patient personnel, Chinese medicine and Western medicine have their own treatment, judgment is not the same, there are recommendations for medullary decompression, implantation of tantalum rod support, interventional therapy (decompression, injection of drugs), Chinese medicine, Chinese medicine plus physical therapy (fumigation, acupuncture, massage), Zhengzhou Wangguozheng Specialized plaster, etc., to understand the surrounding patients also through various places, various methods to get rid of the double abduction. So far I have not treated, mainly because the treatment plan has not been determined. I want to determine a program, single and comprehensive treatment can, adhere to the treatment, of course, depending on the development of the disease, any program is not necessarily absolute. Recently, through understanding, I have adjusted my mentality, and I still have confidence in the treatment and am prepared for the final result. With my current condition, I would like to ask Dr. Tang to help me analyze what kind of conservative treatment plan is suitable for me? Thanks again. My email: [email protected]
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: Okay. Because there is a lot of content, I will organize it and send it to you.
Patient: Dr. Tang, I know you are busy, I don’t know if you have sent it and I didn’t get it, please send it again. Thank you. My email: [email protected]
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: Okay
Patient: Dr. Tang, I’m really sorry, I don’t know why I still haven’t received it, if it’s convenient, directly back in the page or telephone contact can? Thank you again and anxiously waiting.
The First Affiliated Hospital of Guangzhou University of Chinese Medicine, orthopedic department Tang Liming: Sorry, I’m very busy these days, I’ll call you tomorrow, okay?
Patient: Dr. Tang, I am very touched by your serious and responsible attitude, and it also makes me very down-to-earth. I will definitely visit you in Guangzhou if I have the chance. I wish you good health and happiness.
The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine Tang Liming: Thank you, I will send you the mail order phone number tomorrow
Patient: Hello, Dr. Tang: After a period of recuperation at home, taking medication on time, doing some traction and auxiliary functional exercises, I feel that the right leg abduction is better than before, except for a slight discomfort, the amplitude is the same as the left leg. However, I can hear the sound of the joint when I exercise, and occasionally there is a very slight pinching pain in the hip joint, but no other discomfort. I went to have a film taken a few days ago, so I would like to ask you to see if the condition is controlled or reduced. Thank you.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: From the imaging data, we can understand that the condition is stable and no collapse has occurred. We can continue to follow the treatment plan.
Patient: Thank you, Dr. Tang. Should I continue to take Chuanxiongzin tablets? And should I still not bear weight? Do I need to take calcium supplements?
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: Do not put any weight on it now, and continue to use Chuanxiongzin tablets. If your diet is normal, do not take calcium supplements.
Patient: Thank you, Dr. Tang. We will be in touch later.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine: Okay
Patient: Hello, Dr. Tang: After another six months of recuperation at home, taking medication on time, doing some traction and auxiliary functional exercises, I feel that both legs are functioning normally, but I can still hear the rattling of the joints when exercising, and in the past two months, I sometimes have a slight pain in the hip joint and a slight swelling and pain in the right leg fossa. I went to take a film a few days ago, please see if the condition is under control or has progressed. Thank you. Happy New Year!
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.
The condition is stable, the femoral head is not significantly deformed, and the joint space is normal.
MRI examination is needed to understand the recovery of bad water.
Patient: Hello, Dr. Tang, I had an MRI examination today, please help me again; according to my current condition, can I walk short distances under weight (off crutches)? Thank you.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: The edema of the femoral head is in the round ligament area, which is small in scope, so you can move around without crutches, but you should pay attention to the feeling and not too much activity at first.
Patient: Dr. Tang, I’m really excited to see the news that I can move around without crutches. I would like to say thank you for your selfless help over the past year, and thank you for your tireless response. Dr. Tang, should I continue to take Yuan’s Bone Boosting Tablets, Xan Ling Bone Depot Capsules and Chuan Xiong Zin as the next step in my treatment? If so, how many more months should I take them for review? Thank you.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine.
We should continue to take the above three drugs for treatment and review them in three months.
I wish you a speedy recovery.
Patient: Thank you, Dr. Tang. We will be in touch later. Have a happy Lantern Festival!
Patient: Hello, Dr. Tang. I have been walking off the crutches for the past two months with no significant discomfort. But in the past two weeks, the right metacarpophalangeal joints (index and middle fingers) are swollen and morning stiffness, and the outer side of the big toe and little toe is painful on pressure but not red and swollen, the routine blood test is normal, the sedimentation is 5mm/60 minutes, but the ASO value is 204IU/ml, (normal value 0-160), RF59U/ml, (normal value 0–30). 237RU/ml, (normal value less than 25), thus confirming the diagnosis. But I think every painful joint will be relieved in one to two weeks without any medication, and also, is the inflammation of the throat in the past two days of the test related to this? Do I need to do further tests? Could I have a strong spine? Because I sometimes have pain near my tailbone on the left side. Thank you.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: It should not be ankylosing spondylitis, and if it can be relieved in a week or two, no medication is needed.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: Thank you for your trust. From your information and MRI and X-ray data, the preliminary diagnosis is: bilateral ischemic necrosis of the femoral head (stage 3B on the right and stage 2B on the left) with a necrotic area of about 30%, no obvious joint collapse, normal joint space, mild bilateral acetabular dysplasia and no subluxation. (Unfortunately, there is no frog x-ray.) The cause is unclear, but hormonal femoral head necrosis cannot be ruled out. I suggest: 1: Take additional X-ray frog films to find out whether the femoral head is collapsed or not. 2: Walk with a double crutch. 3: Take the medication for the treatment of osteonecrosis of the femoral head from our hospital. 4: Observe the changes of your condition and check the X-ray films regularly. 5: Keep in touch. 6: Of course, there are other treatments including interventional and minimally invasive surgical treatments. However, I suggest that conservative treatment is better first.
Patient: Hi Dr. Tang, I just had an MRI today, please help me out. With my current condition, can I walk short distances under weight (off crutches)? Thank you.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: If the condition is stable, if you can walk 5 km or 2 hours without significant discomfort, you can continue without medication.