I. Definition
Ischemic necrosis of the femoral head is caused by the destruction of the blood supply to the femoral head by different etiologies. Femoral head necrosis is called aseptic necrosis of the femoral head, or ischemic necrosis of the femoral head. The hip joint is the largest mortar and pestle joint in the human body, and the acetabulum is formed by the iliac bone, pubic bone and the sit bones together, like a bowl with the mouth inverted downward, with the mouth downward and in front and outward, and the femoral head is like a mortar and pestle, mostly located in the acetabulum, forming a mortar and pestle joint with the acetabulum. The acetabular surface and the surface of the femoral head are covered with articular cartilage, and the acetabular lip deepens the acetabular depth, which is conducive to increasing joint stability.
Second, the etiology of.
1.Femoral neck fracture
2, no fracture of the hip joint trauma
3, decompression disease
4, long-term application of hormones
5.Alcoholism
III. Clinical manifestations
The first symptom usually appears as hip or knee pain. The pain may be continuous or intermittent. If the lesion is bilateral, the pain may be alternating.
Diagnosis
X-ray examination The most commonly used examination, divided into four stages.
1, Stage (subchondral lysis stage) The femoral head is intact in shape and the joint space is normal, but a 1-2cm wide arcuate translucent band is visible in the subchondral bone of the articular cartilage in the femoral head holding area, which constitutes the ¡°crescent sign¡±.
2.Stage (femoral head repair stage) The femoral head is intact and the joint space is normal, but the bone density under the weight-bearing area of the femoral head is increased
3.Stage (femoral head collapse stage) The femoral head loses its round and smooth shape, and the joint gap still maintains its normal width.
4.Stage (femoral head dislocation stage) The femoral head is severely collapsed in the weight-bearing area and the femoral head becomes flat, while the bone beneath the femoral head is generally not collapsed. The joint space can be narrowed, and there is often bone spur formation on the outer upper edge of the acetabulum.
MRI can show a definitive osteonecrosis signal as early as 12-48 hours after fat cell death.
V. Staging.
0, stage With osteonecrosis, but without clinical findings and normal x-ray.
1, stage With clinical signs and symptoms, but normal x-ray.
2, stage x-ray already shows bone density reduction, cystic changes, osteosclerosis, etc.
3, stage x-ray visible ¡° crescentic sign¡± subchondral bone collapse.
4.Stage x-ray shows flattening of the femoral head and normal joint space.
5.Stage x-ray shows narrow joint space and altered acetabulum.
VI. Treatment
Arthroplasty is suitable for patients with short lesions, collapsed femoral head and advanced stages, joint replacement can eliminate pain and improve function. The entire lower extremity is sterile, and the skin preparation is checked for chronic infectious lesions.
Postoperative care close observation of vital signs position, postoperative decubitus lying flat for 6h, such as general anesthesia patients at the same time should be head to the side, timely removal of secretions in the mouth to prevent asphyxia. The affected limb should be elevated 20°~30° and abducted in neutral position to promote venous and lymphatic reflux and reduce swelling. Observe the skin temperature of the affected limb, capillary filling, and the movement and sensation of the toes.
Diet psychological care observation of incision pain, exudation, and drainage functional exercise prevention of complications care of complications prevention of complications care of lower limb deep vein thrombosis postoperative infection hip dislocation lower limb deep vein thrombosis is related to the patient’s post-injury bed rest, affected limb braking, and increased blood viscosity. Lower limb antithrombotic pressure band air pressure therapy elevate the affected limb encourage the patient to carry out early bed activities of the affected limb, help the patient to carry out passive activities of the limb observe the skin temperature, color, the degree of swelling of the limb .
Symptoms of subcutaneous injection of low molecular heparin pulmonary embolism back pain, back pain, sweating, blue lips, dyspnea, decreased blood pressure, coughing foamy sputum dimer, arteriography, chest X-ray ECG postoperative infection fresh air in the ward good oral care instruct patients to breathe deeply, effective cough, assist in turning and knocking back, prevent lung infection keep the bed dry and flat, patient skin clean, assist in turning, timely massage If there is indwelling catheterization, change the urine bag daily and keep the perineum clean. Instruct patients to drink more water, prevent incision infection and keep the dressing clean and dry.
There are many reasons for this, such as surgical access, intraoperative prosthesis placement, incorrect patient position, improper limb activity or incorrect turning can cause hip dislocation and result in surgical failure.