What Are the Different Types of Skeletal Trauma?
Why is traumatic femoral head necrosis? In the past ten years, with the rapid development of transportation and industry, femoral neck fractures have occurred.
Traumatic femoral head necrosis
Introduction to Traumatic Femoral Head Necrosis
- Why is traumatic femoral head necrosis? In the past ten years, with the rapid development of transportation and industry, femoral neck fractures have occurred.
Traumatic femoral head necrosis
- [1] Intertrochanteric fractures: Simple intertrochanteric fractures have less chance of disrupting blood flow to the femoral head and generally cause less blood supply disturbances.
- Acetabular fractures: Acetabular fractures cause femoral head necrosis. The occurrence of femoral head necrosis is related to the time and quality of the rehabilitation. The earlier the rehabilitation, the better the effect. According to the research of our hospital, the necrosis rate was 5% in those who recovered within 6 hours; the necrosis rate was 10% in those who recovered within 6-24 hours, 12.5% in 48 hours, and within 72 hours. The rate of recovery was 13%, and the rate of recovery within 16 days was 16%. Poor acetabular reduction, poorly flat articular surfaces, or premature weight-bearing are prone to early traumatic arthritis changes, and the risk of femoral head necrosis will be significantly increased.
- Traumatic hip dislocations: Hip dislocations mostly occur in young adults and are mostly caused by strong violence. The dislocation of the femoral head from the acetabulum causes the round ligament of the femoral head to be pulled and broken, and the joint capsule is tense or even torn. Not only the lower metaphyseal artery is ruptured, but the thousands of iliac arteries are often damaged to varying degrees. If hip dislocation is combined with femoral head fracture, the chance of ischemic necrosis of the femoral head is higher. The rate of head necrosis caused by simple hip dislocation is 0% -30%. When combined with fracture, the rate of femoral head necrosis is higher than that of simple dislocation. The incidence of femoral head necrosis caused by combined fracture is 54.6%.
- Femoral neck fractures: Femoral neck fractures are prone to ischemic necrosis of the femoral neck. The time of occurrence is generally considered to be 1 to 5 years after the fracture, and it can occur as early as 2 to 3 months after the injury. The incidence of necrosis is significantly different due to different statistical standards. Generally, the incidence of necrosis of the femoral head is between 20% and 40%. The range of ischemic necrosis of the femoral head occurred in the upper and outer sides of the femoral head in the early stage. It showed localized bone density increased, bone trabecula was not clear, and the area of ischemic necrosis collapsed later. The occurrence of ischemic necrosis due to a femoral neck fracture mainly depends on the degree of damage to the supply blood vessels of the femoral head and the ability of the collaterals to compensate.
Causes of Traumatic Femoral Head Necrosis
- Onset of necrosis of the femoral head continues to disrupt the flow of the neck or buttock due to persistent fracture and dislocation. Blood supply and drainage of the head are broken because the vessel is round in fractures and tears in the ligaments. As a rule, the damage to the outer blood vessels is more severe in young people than in adult animals.
- Effectively, the metaphyseal anastomotic network erases the physical femoral head of the adult rabbit as much as possible, otherwise the consequences will severely block external circulation.
- There are essential differences between rabbit traumatic osteonecrosis and other types of femoral head ischemic necrosis. Viable osteocytes have good stained nuclei, adhere to the fracture line on both sides of the necrotic foci, and die across the living bone-bone interface.
- However, a well-stained nucleus of viable osteocytes is absent when the fracture line passes through already osteonecrosis. Blood flow may partially recover from the cervical medulla of the vessel, but there is insufficient flow until reestablished circulation is restored through the medial femoral circumflex artery and the round ligament.
Traumatic femoral head necrosis
- According to relevant osteopathy experts, many people are suffering from traumatic femoral head necrosis at different levels, but how many people do actually know the harm of traumatic femoral head necrosis? So only those when disaster strikes Only then did I know the regretful person knew the harm of traumatic femoral head necrosis. In view of this problem, let us introduce the harms of traumatic femoral head necrosis that deserve our attention.
- Traumatic femoral head necrosis refers to necrosis of living tissue of human bones. Traumatic necrosis of the femoral head is one of them. Also known as aseptic necrosis of bone tissue, also known as aseptic necrosis. Femoral head necrosis is caused by hip trauma, long-term application of hormonal drugs, alcohol poisoning and other reasons. The blood supply of femoral head necrosis is impaired. Femoral skull tissue cannot receive normal nutrition, so that bone cells, bone marrow hematopoietic cells, Fat cells are formed by necrosis. Chinese medicine believes that weak constitution, low resistance to disease, insufficient liver and kidney essence and blood, leading to osteoporosis, are the potential causes of trauma to the femoral head necrosis, and wind, cold and wetness can also cause it. In short, there are internal and external causes. The common core problem is the blood circulation disorder of the femoral head caused by various reasons, which leads to ischemia, degeneration and necrosis of bone cells.
- 1. Traumatic femoral head necrosis is harmful to the hip joint: The hip is an important hub connecting the human trunk and lower limbs. The hip joint supports the lower torso and the lower limbs. It is the most important and critical part for people to walk, sit and lie. Therefore, the disability of the hip joint has the greatest impact on the human body compared to the disability of other joints. While suffering from illness, patients also suffer from psychological trauma, placing a heavy burden on families, units and society.
- 2. The incidence of traumatic femoral head necrosis is difficult to detect in the early stage. Because the position of the femoral head is deep in the muscular layer, the lesions of the traumatic femoral head are not easy to be detected at an early stage. Once the femoral head is found to be sick, the femoral head is traumatized. Necrotic lesions often have progressed to the extent of osteonecrosis, trabecular bone deformation, atrophy, or the degree of corrosion-like changes and sclerosis. Even some patients have no symptoms at this time, even if they feel pain, patients Traumatic femoral head necrosis symptoms are often treated as rheumatism and rheumatoid rheumatoid therapy, so that the condition is not treated and controlled in time, which leads to disability and paralysis of hip joint dysfunction.
Traumatic femoral head necrosis
- What to pay attention to in the treatment of femoral head necrosis:
- In terms of life: long-term bed rest will cause complications such as atrophy of lower limb muscles and decubitus ulcers. Patients must not stay in bed for a long time. They must follow the doctor's instructions to perform rehabilitation exercises according to the treatment condition; patients should not bear or reduce weight during treatment and rehabilitation, and stand When walking and walking, double crutches should be provided to give the femoral head a better recovery environment.
- Mentality: Patients with femoral head necrosis should get rid of the anxiety and anxiety caused by the disease. Patients should be mentally prepared for long-term treatment and rehabilitation, build confidence in the treatment of disease, strengthen the courage to fight the disease, and maintain an optimistic attitude.
- In terms of diet: no smoking, no alcohol, no spicy food, old food, fat and animal viscera, you can eat more foods such as spleen and kidney, strong bones, calcium and blood.
- In terms of treatment: patients with necrosis of the femoral head must adhere to the course of treatment during treatment, can not be discontinued or intermittent; if you want to choose other treatments and drugs during the treatment, you must consult a doctor, you must not abuse them privately; Patients should use as little or as little as possible; medical images with large radiation can not be frequently checked, and can be taken every 3-6 months.
Factors of traumatic femoral head necrosis
Traumatic femoral head necrosis reduction and fixation method
- In the reduction and fixation mode, the necrosis of the femoral head is directly related to the initial displacement of the stump and the blood flow disorder. At present, most scholars advocate the use of multi-needle fixation with closed reduction. Tripods take up a lot of space, and often cannot be placed in a successful or rough operation, and can easily cause damage to joint cartilage. The open three-wing nail fixation directly cuts the switch capsule, which impairs the blood supply. When the internal fixation is successful once, the femoral head necrosis rate is very high, but if it fails once and the operation is more than two times, the femoral head necrosis rate is higher.
Traumatic femoral head necrosis reset time and alignment quality
- The early surgical necrosis rate is much lower than the delayed surgical necrosis rate. Even if necrosis occurs in the early stage, it is part of the necrosis, and the necrosis appears later.
Traumatic femoral head necrosis fracture
- Those with severe original displacement of fracture ends have a high rate of femoral head necrosis, which has been recognized. According to the size of Linton's angle after fracture, femoral neck fractures were divided into abduction fractures and adduction fractures. Abduction fractures usually belong to non-displacement linear fractures or insert fractures with little displacement. The fractures are relatively stable, the joint capsule is less damaged, the healing rate is higher, the femoral head is less necrotic, and the prognosis is better. Adductive fractures and less insertion, obvious displacement, belong to unstable bones, distal end due to muscle stretching upwards, and external rotation due to lower limb weight, joint capsule and blood flow damage. The healing rate is lower than the former, and the head necrosis rate is high.
The height of the fracture line of traumatic femoral head necrosis
- It is generally believed that the closer the fracture line is to the femoral head, the higher the necrosis rate. According to the fracture line, femoral neck fractures are divided into head type, subhead type, neck type and basal type.
Age of traumatic femoral head necrosis
- Traumatic femoral head necrosis in children and young adults is relatively high, with domestic reports of 33.3% -41.7%, and rarely below 30%. The reason is generally believed to be that: due to the hard bones in the femoral neck area of young adults, the violence during fractures and the large displacement of fracture ends cause serious blood damage. It is more difficult to reset and fix than the elderly, and the reset method is heavier. Increased, local vascular injury worsened, at the same time, insufficient blood supply to the round ligament, anastomotic branches with the joint capsule rarely, resulting in ischemic femoral head and traumatic femoral head necrosis.
Treatment of traumatic femoral head necrosis
Traumatic femoral head necrosis conservative treatment
- Femoral head necrosis in the early stages of femoral head necrosis is generally painful in the early stages. The treatment of traumatic femoral head necrosis is as follows: [2]
- Traditional Chinese medicine dialectics is mostly femoral head necrosis of qi stagnation and blood stasis, and is given traditional Chinese medicine for qi and blood circulation.
- Topical creams or plasters can be given topically to promote blood circulation, clearing qi, and relieve pain.
- Those who have more severe pain can take medicine orally to relieve the pain.
- Tuina and acupuncture are available to improve hip function and relieve pain.
- Decompression of the femoral head is performed. If adductor spasm is available, adductor release can be performed.
- People with limited hip movements should start self-function exercises of hip joints.
- Femoral head necrosis in the middle period Femoral head necrosis in the middle period relieves hip pain, and the treatment options for traumatic femoral head necrosis are as follows:
- The dialectics of traditional Chinese medicine are mostly qi deficiency, blood stasis type, liver and kidney deficiency type, and different Chinese medicines are given according to the symptoms.
- You can still apply ointments and plasters for promoting blood circulation, collaterals, strong tendons, and bones.
- can be equipped with rational therapy, hyperbaric oxygen therapy.
- Traditional Chinese massage and acupuncture treatment can improve hip function, relieve spasm muscles, and reduce pain.
- According to the condition of the disease, femoral head bone graft method, adductor muscle release method can be selected.
Surgical treatment of traumatic femoral head necrosis
- There are many surgical methods, and the more common methods are: small-scale lesions can be used for core decompression; for cases with relatively large lesions or mild collapse, bone graft surgery with blood vessels can be performed; only advanced cases Have a total hip replacement surgery.
- At present, the best way to treat femoral head necrosis in the advanced stage is artificial femoral head replacement. For patients in their 40s or 50s, if the indications for surgery are appropriate, this approach is often adopted. If the patient passes the above treatment, the condition is still developing, and the older patients can consider artificial femoral head replacement.