01:30,1,Sep,2010 | (992/0/0) | Original

avascular necrosis of the femoral head


Pathogenesis of femoral head necrosis caused by many reasons, and can be divided into invasive and non-invasive two broad categories, such as traumatic femoral neck fracture, hip dislocation, hip trauma, either directly or indirectly damage the femoral head blood flow , resulting in avascular necrosis; non-invasive induced by many factors, and most disease and its pathogenesis is uncertain, there's even the cause is not clear, said the idiopathic avascular necrosis of femur. Common triggers are: a large number of corticosteroids, chronic alcoholism, kidney transplantation, chronic liver disease, diving disease, sickle cell anemia, pancreatitis, hyperlipidemia, gout, radiation sickness, atherosclerosis and other vascular stenosis disorders, collagen diseases, etc. As for some real cases of idiopathic pathogenesis is not fully understood. Check under the inguinal ligament disease early tenderness, hip adduction, outreach pain, "4" test was positive; to late the activities are limited by the parties, Thomas and positive signs, severe limb shortening, and the emergence of subluxation sign. According to dual-X ray should be 150 to 200 hip internal rotation around the place, and the abduction of the hip flexor 900 breaststroke (Lauenstein) and lateral films, can be observed from two angles necrosis size and location. Symptoms of the beginning of the X-ray films did not change, 6 to 8 months after the bone thinning and density appeared uneven, after cystic subchondral zone in transition and crescent sign, subchondral femoral head bone density increased in area, and its low-density area around the visible point sheet; disease aggravated, there subchondral weight-bearing area fragmentation, collapse, post all or part of the regional uneven hardening, severe collapse, flat irregular femoral head, joint space narrowing, subluxation was , Shenton line is not continuous. CT, MRI can be early detection of lesions, and necrosis observed in various parts of the fault, but the cost is expensive and not specific, for additional inspection after the X ray. 1 auxiliary examination, isotope scanning and γ scintillation camera 2, the bone marrow cavity pressure measurement and angiography 3, medullary core biopsy (Core biopsy) diagnosis is based on 1. May have neck fractures, hip dislocation or trauma, decompression sickness, long-term use of cortical history of alcoholism and other hormones. 2. Of the hip or knee pain, and gradually intensified, limp. 3. Adductor muscle tenderness, limited mobility of hip joints, particularly outreach and internal rotation staggering. Thigh muscle atrophy may have. 4.X-ray findings: The early outline of the normal femoral head, but in lateral phase on the side of discreet area in the femoral head before subchondral bone in the joints, showing a density of 1 ~ 2mm wide arc to reduce the zona pellucida, constitute " crescent sign. " The signs are of great value. Appears discreet area increased subchondral bone density, which can
be seen around the point, plates to reduce the area density and cystic changes. Finally, different degrees of subchondral bone was broken, flat, collapse, flat femoral head changes, cave-like subluxation. Visible changes of osteoarthritis. 5. Isotope bone scan or ECT prompt radiation defect zone in the femoral head. Clinical stage 0: asymptomatic hip, X-ray film no exception, but the opposite has been the onset of symptoms and diagnosis, and bilateral involvement were 85% more than they help, said this silence of the hip (silent hip ), the actual time for the isotope scan, the measured pressure or bone marrow core biopsy, has proved to be changed at this time is a good time to decompression therapy. I: hip joints pain, may, after trauma or exertion, were progressive, heavy night, internal rotation, abduction slightly limited. X-ray film shows some areas sparse, pressure, performance of biopsy were positive. The treatment of decompression is good. Phase II: clinical signs continue to increase, X-ray showed increased bone mineral density and cystic changes, there arc light subchondral bone zone, said crescent-shaped sign (Crescent sign), but the shape of the femoral head is still normal. III: Disease hip pain barriers to mobility, all activities have been significantly limited, X-ray film due to femoral head collapse and overlap the edge of, or have lost their round, hardened area clear. Although easy to set diagnosis, treatment already difficult. IV: the course is to late femoral head deformation, joint space narrowing, acetabular sclerosis, obvious symptoms of osteoarthritis. Treatment principles 1. Non-surgical therapy: suitable for children or adults are early lesions, the scope is less. 2. Strictly avoid weight-bearing limb: one side may crutches with ischial support, walking with a walker; bilateral involvement at the same time, should stay in bed or a wheelchair; such as hip pain, could also lower limb traction bed can often relieve symptoms. This treatment can be with physical therapy, but the duration is longer, usually takes 6 to 24 months or more. Treatment should be regularly taken X-ray examination, to be discreet lesions completely healed. 3. Quadriceps active functional exercise to avoid muscle atrophy. 4. With the blood Quyu, Bushenzhuanggu the herbal treatment. 5 \. Removal of pathogenic factors, such as stopping hormone therapy, the treatment of diseases such as alcohol or radiotherapy treatment of avascular necrosis should be based on etiology, age, lesion, single or double hip hip involvement, etc. for the corresponding treatment, the aims to stop disease continue to develop and improve the femoral head blood supply, promoting necrosis of repair, the maximum retained risk of hip function. Has been developed for severe osteoarthritis, age and larger, viable artificial hip replacement. 1. Conservative treatment of adult femoral head necrosis, II of the disease, a smaller range, can stay in bed, to avoid weight-bearing limb or traction. Such as bilateral lesions should stay in bed or wheelchair car, lose weight. Blood circulation and oral vasodilators, such as Puhuang, Sichuan dome, safflower, Daqingye and so on. Hyderabad Western Qin (Hydergine), coronary heart level (Clofibrate) and other similar effects with Salvia films. Hyperbaric oxygen therapy has a certain effect. X-ray film should be regularly observed disease progress, if any, progress, should be diverted to surgery. 2. Surgical treatment (1) femoral head core decompression technique (2) with a vascular pedicle flap and muscle pedicle graft and vascular bundle implantation (3) the rotation osteotomy of the greater trochanter (4) of the obturator nerve surgery (5) total hip arthroplasty: femoral head destruction in advanced weight, can not be retained, should be total hip replacement (7) The hip joint and soft tissue lysis (8) drilling and bone graft the femoral head (9 ) with femoral neck decompression and external iliac circumflex iliac vascular pedicle flaps grafting; (10) trochanteric rotation osteotomy; (11 hemiarthroplasty (12), total hip replacement surgery; 13) hip arthrodesis (8) obturator neurectomy. Therapeutic approach yi gruel: Coix seed 30g Papaya 10g rice 60g sugar 2 spoons to plantago rice, papaya, cleaned, poured into a small pot, add rice and two bowls of cold water, soak a moment, then low heat slowly stew yi MI Ren Su Lan, add sugar, a little stew can, the daily consumption, informal content. There expelling wind and dampness, relaxing tendons and pain of the power applies to joint severe, adverse events such as wet as the disadvantages of avascular necrosis. Qi snake soup: Astragalus 60g, snake 1000g, Dipsacus 10g, ginger 15g, cooked pork, 30g, cooking wine, pepper, salt, the amount of light blue. Chopping off the head and tail first snake, stripped of visceral washed, cut into pieces; Astragalus, continued off with cold water to wash away impurities from dust, then the net cold water immersion for 1 hour. Heat wok, pour lard 30g, boil and pour it into snake oil stir fry, cooked into the cooking wine, and then the snake into the casserole, add ginger, light blue and salt, stew over low heat 1 hour, add pepper powder, onion ginger can choose to go. Table consumption. Have liver or kidney, benefit qi and blood, dispelling rheumatism of power, for osteonecrosis of the joints pain. Qi Tian Qi Red chicken: fat hen 1, medlar 15g, Panax 10g, lean meat 100g, cabbage heart 250g, flour 150g, rice wine, light blue of the 30g, ginger, monosodium glutamate, pepper, salt and the right amount. Net hair back first hybrid chicken slaughter, remove viscera, chopping off the claws, rinse; Lycium Wash; Panax divided into two, one into powder, a cage steam until soft, cut into thin slices; pork Zhancheng Velvet; cabbage washed with hot boiling water after the cut pieces; flour and water to reconcile, knead the dough dumplings; onions, ginger wash, spring onion cut into fine, the rest cut into sections, ginger cut into large, pieces pounded ginger. Chicken first into the boiling pot will boil for a short, remove, rinse with cold water, drain, and then wolfberry, notoginseng, ginger, onion stuffed chicken abdomen, within the chicken into the Tang Ciwan; put broth, Add pepper, rice wine, then sprinkle the chicken breast on notoginseng powder, with wet tissue paper seal sized, with Wu Huo cage steam about 2 hours. After 1 hour on the cage of chicken, pork and dried can be salt, pepper, rice wine, ginger and a little water, stir into the stuffing, add cabbage and mix well. Pulling the dough into 20 small sub-agent, after skin rolling, put the meat, pack into small dumplings. When the chicken until cooked, and the other into the water pot, boiling, add dumplings, pot cooked. Meanwhile remove the chicken, unfold the paper, and adjust seasoning MSG, the soup, dumplings can be poured into a bowl. Table consumption. There Bugan kidney, blood stasis, swelling and pain of the power for avascular necrosis. Beware of femoral neck fracture avascular necrosis of the femoral head blood supply, the lack of a rich collateral circulation, as was femoral neck fracture displacement, vascular injury, often caused by avascular necrosis. In general, the femoral neck fracture and avascular necrosis of the following factors: (1) children and the prime of life higher than the old rate of femoral head necrosis, because the neck area of children and young adults generally hard and difficult bone fractures , femoral neck fracture caused by violence will be larger, more serious degree of fracture displacement, and therefore more serious damage to the blood supply it. (2) treatment of femoral neck fracture with time delay, the incidence of avascular necrosis also increased. Necrosis rate of early surgery, necrosis was lower than delayed operation. Even cases of necrosis of early surgery is also a partial necrosis, necrosis of the time is late; and delayed surgery, often complete, necrotic, and necrosis appeared earlier. (3) The closer the femoral head fracture line, the necrosis rate is also higher. After the top of the outside through the femoral neck fracture lines were oblique and necrosis rate is highest. (4) the original displacement serious neck fracture, suggesting that the femoral head more seriously broken blood vessels, a higher incidence of femoral head necrosis. (5) reset the bad, such as over-adduction, flexion or valgus shift rotation and separation of such practices, can increase the necrosis, and separation due to rotation can not tighten the blood vessels rupture, or rupture. (6) Most scholars believe that should be closed reduction, the use of multi-pin or screw pin fixation fracture. Some advocates of open reduction and nailing three-Ji. Alignment is good, good healing can reduce head necrosis femoral head necrosis does not mean it does not. Prescription treatment 1, Taohongsiwutang: 21 grams Rehmannia, Angelica 12 grams, 12 grams of white peony, Chuanxiong 9 grams, 6 grams of peach kernel, safflower 3 grams. Addition and subtraction with the disease according to the disease. 2, Liu Wei Di Huang Tang: 24 grams Rehmannia, cornus, dried yam, each with 12 grams Alismataceae, tree peony bark, Poria 9 grams each. 3 Zuoguiwan: Big Rehmannia 24 grams, 12 grams of yam, wolfberry fruit 12 grams, 12 grams cornus, Cyathula 9 grams, 12 grams Dodder, Lujiaojiao 12 grams, 12 grams of turtle shell. Addition and subtraction with the disease according to the disease. Osteonecrosis of femoral head necrosis of the hip joint in the hip is very large, the femoral head necrosis in patients with severe hip flexion, abduction, squatting function will be limited, that is, thigh lift it up, he could not bend over, bent knees, wearing socks; legs separated out; Dundao location can not squat. Resulting in hip joint can not restore these features, seriously affecting the quality of life of patients so that patients can not engage in the work of labor, life is very painful, inconvenient. However, the femoral head necrosis in patients with early collapse of femoral head shape has not yet appeared flat, there is no proliferation of the outer edge of the acetabulum, the femoral head in the activities without any restrictions, so patients with early osteonecrosis of femoral head does not appear in the late necrosis of hip joint dysfunction. Hip joint dysfunction caused by three reasons. The first reason is congenital acetabular dysplasia. Performance of acetabular femoral head is too small can not accommodate them properly, then the event part of acetabular labrum bone necrosis, parts of acetabular labrum to bone cell necrosis and sclerosis in the atrophy of the femoral head can not withstand the acetabulum and femoral subluxation or bone necrosis occurs. Then the femoral head is not in the original position due to the femoral head outwards, upward mobility, walking the more pain the more severe hip dysfunction are more serious. This causes the hip joint dysfunction, sexual life can not be restored. The second reason is due to necrosis of the femoral head cartilage. Necrosis of femoral head cartilage, the surface rough, when in the hip joint synovial membrane will be very likely to cause damage, injury appears synovial synovitis of the hip joint, the acetabulum for a long time by inflammatory stimuli, there will be hip part of the proliferation of acetabular labrum physiological changes, when parts of acetabular labrum to a certain degree of proliferation, the formation of the inclusion of the femoral head is too large, it will affect the scope of activities of the femoral head, resulting in hip joint dysfunction. This causes the hip joint dysfunction, sexual life can not be restored. The third reason is that flat femoral head necrosis caused by hip. Collapse of the femoral head in the process of gradual recovery, occur within the femoral head necrosis of bone cells are absorbed by the formation of new bone cells changing state, with patients walking control unreasonable, under the pressure of the gravity deformation of the femoral head, resulting in shares respect to the deformation of the development of hypertrophy of the bone, forming the so-called flat hips. Flat hip range of activities seriously affecting the femoral head, resulting in hip joint dysfunction. This causes the hip joint dysfunction, sexual life can not be restored.
avascular necrosis of the femoral head

Leading cause of avascular necrosis is very much more common causes are trauma, or the conduct of a large number of long-term alcohol use root hormone drugs, according to a control data showed avascular necrosis almost always occurs in fatty bone marrow within the femoral head with the fatty bone marrow because of the blood supply of the already very low, so the incidence will be very high.
Bone is living bone tissue (bone cells, bone marrow hematopoietic cells, fat cells), with the general view that ischemic necrosis of the femoral head secondary to the destruction of the blood supply and subsequent necrosis. The most sensitive bone marrow cells 6 to 12 hours after ischemia began necrosis, but in adults, because of its much smaller than the proportion of fat cells, so at this time no significant changes in the principles of nuclear magnetic resonance. 12 to 48 hours after the death of bone cells and other cells to ischemia in 2 to 5 days, the marrow fat cells within the necrotic. Totty thought it might be in the form of high signal intensity of normal bone marrow fat cells die, the principle of nuclear magnetic resonance can be changed. However, after the death of fat cells does not immediately lead to signal changes, because the signal intensity depends on the amount of lipids, thus the principle of nuclear magnetic resonance absorption is only the beginning only after the discovery of lipid lesions. Generally speaking, the body usually accompanied by necrosis of bone tissue repair response, which is characteristic of living. Avascular necrosis of the tissue changes of the principle of the process of the Division by the NMR well reflected in the different pathological stages of ischemic necrosis of the principle of nuclear magnetic resonance have different variations.
In the early diagnosis of avascular necrosis, the currently accepted medical examination and nuclear magnetic resonance. Although in theory, radionuclide bone imaging in the femoral head when the blood supply that is affected by changes in symptoms reported in the literature have SPECT bone scintigraphy the sensitivity was 55%, single photon emission CT (SPEcT) 80 % respectively, specificity was 100%, which reflects the femoral head blood supply and radionuclide bone metabolism can be found in the early ischemic lesions, compared with a year earlier x-ray examination found that the bone ischemia. But usually the clinical basis of analysis of radioactive ipsilateral contralateral femoral head defect or concentration or radioactivity to diagnose avascular necrosis. Have lesions on both sides, because they can not control each other and can cause false-negative; when the femoral head necrosis has occurred, the onset of the femoral head after the early possibility of false negative; Furthermore bone scan as a non-specific inspection Many other diseases can also show positive, while in non-traumatic avascular necrosis in 50% to 70% is related to both sides, so the isotope bone scan in the diagnosis of avascular necrosis has certain limits.
And since the early 80s has been used in clinical MRI, the diagnosis of avascular necrosis, especially in early diagnosis has been greatly improved, the diagnosis of femoral head necrosis has a high sensitivity and specificity. Avascular necrosis of the inspection, the mechanism provided by different methods and parameters vary. Such as radiography X ray by the absorption rate of detection; bone scan reflects the bone tissue blood flow; and the principle of nuclear magnetic resonance by magnetic resonance imaging technique is magnetic resonance signal in a direct reflection of a variety of human tissues nucleus, the principle of nuclear magnetic resonance can be diagnosed bone marrow necrosis, nuclear magnetic resonance principle is reflected in the high signal marrow fat necrosis of femoral head part and the sclerotic bone and fibrous tissue necrosis of bone fragments and low-density signal is present, Since the principle of nuclear magnetic resonance of the soft tissue with a clear ability to distinguish and thus reflects the histological lesions change in terms of unique advantages, no false positive.
Also known as aseptic necrosis of femoral head osteonecrosis, or avascular necrosis, a bone necrosis. Bone necrosis is due to a variety of nourishing blood vessels causes damage to bone, and further lead to .
Also known as aseptic necrosis of femoral head osteonecrosis, or avascular necrosis, a bone necrosis. Bone necrosis is due to a variety of nourishing blood vessels causes damage to bone, and further lead to bone ischemia, degeneration, necrosis. Femoral head necrosis femoral head due to many causes poor local blood supply, further ischemia, necrosis, bone fracture, a collapse of femoral head disease, the disease can occur at any age but 20-60 Most years, no gender differences began to show more or around the hip joint pain, dull pain, activity after the increase, further development of the hip joint can lead to dysfunction, serious impact on patients quality of life and ability to work, if not treated in a timely manner, can also lead to permanent disabilities.
Two types of femoral head necrosis is a traumatic and nontraumatic osteonecrosis. Traumatic femoral head necrosis is a common cause of femoral neck and acetabular fracture and hip dislocation. With a variety of non-traumatic osteonecrosis is associated with risk factors, one of the major factors for alcoholism, the use of hormones and fatty liver. Some bone necrosis occurs in very healthy people without risk factors exist, called idiopathic osteonecrosis, the necrosis of unknown etiology. In most cases, violations of this disease for the first time three or four-year-old man, femoral head necrosis is not life-threatening, but the
other one is extremely weak.
At present most of the beginning of osteonecrosis have been misdiagnosed as sciatica caused by disc herniation and delayed diagnosis of rheumatoid. X-ray photographs of early necrosis showed normal by MRI in diagnosis. x-ray photograph is actually not unusual to see the performance itself, but the necrotic sequestrum bone repair the reaction performance. Is generally believed that once the wait for X-ray plain film density changes occur, to enter the irreversible necrosis of femoral head on, not back to normal. Usually that there is no effective treatment, a variety of operations can only delay the development of disease, delay total hip replacement to do the time, can not make normal femoral head bone structure. The development of osteonecrosis faster, this is the time of diagnosis many patients have more serious causes disease.
For more orthopedic knowledge, please contact the National Orthopaedic Hospital forest Beijing Tel :010 -84111167 public.
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