What Is Osteonecrosis?
The hip joint is the largest joint of the human body, supporting the weight of the entire torso, and the pressure between the head and the mortar must increase. Maintaining such a large pressure for a long time not only easily causes structural damage, but also affects the local blood ring.
skeleton - It is one of the diseases, and the so-called osteonecrosis refers to the necrosis of the components of human bone tissue. Osteonecrosis is called osteonecrosis in Chinese medicine. Many parts of the human body can cause osteonecrosis. There are many causes of osteonecrosis. Femoral head necrosis is most common in clinical practice, and most of them focus on introducing the causes, symptoms, treatment, exercise, and prevention of femoral head necrosis. As for osteonecrosis, the human body may occur in any part of the body. Only 40 ischemic necrosis have been found, and the highest incidence of femoral head necrosis is mainly determined by biomechanical and anatomical characteristics. Because the femoral head is a fan-shaped 20 to 25 branches of terminal blood vessels, arterial and venous rings are formed at the junction of the head and neck, which originate from the internal and external femoral arteries.
Osteonecrosis Overview
Osteonecrosis weight
- The hip joint is the largest joint of the human body, supporting the weight of the entire torso, and the pressure between the head and the mortar must increase. Maintaining such a large pressure for a long time not only easily causes structural damage, but also affects the local blood ring.
- skeleton
Osteonecrosis shear force
- The hip joint is different from other weight-bearing joints in that the joint lines of force at the two bone ends are perpendicular. A 132-degree angle is formed between the femoral shaft and the femoral head and neck. , Forming a shear force. Therefore, the physiological pressure on the head and neck is much greater than other joints.
Osteonecrosis activity range
- The range of motion of the hip joint is second only to that of the shoulder joint, and it includes stretching, adduction, abduction, and rotation. Can complete all axial movements, and there are more opportunities for injury.
Osteonecrosis blood supply
- The blood supply of the femoral head mainly depends on the lateral support band and medial support band arteries issued by the extracapsular arterial ring. The anastomotic branch of the blood vessel is small and weak. When one blood vessel is blocked and the other fails to pay for the time, it will Causes blood supply problems to the femoral head.
Osteonecrosis symptoms
- Femoral head necrosis has a slow onset and a long course of disease, and the patient has no obvious symptoms for a long time. The most common clinical symptoms are hip discomfort or pain, which is noticeable after exertion or prolonged pain, and relieves after rest. During the onset of femoral head necrosis, lumbosacral or knee pain often occurs, and it is easy to misdiagnose lumbar disc herniation, spinal stenosis, sciatica, rheumatoid arthritis, synovitis and so on. The most prominent feature of this disease is the severity of the symptoms and the
- Osteonecrosis of lower limb
Causes of osteonecrosis
- It is clinically divided into affirmative and probable causes. Affirmative etiology is that part of the etiology relationship is clear and accepted by the clinical orthopedist, including the following:
Osteonecrosis and trauma
- Femoral neck fractures, sprains, falls, hip dislocations, and acetabular hypoplasia are prone to necrosis of the femoral head. It is generally believed that most of them occur within 1 to 5 years after the fracture, and can be as early as 2 to 3 Months appear, the incidence is generally 75% to 95%, most of bone fractures can occur after surgery. Hip injuries (including hip dislocations, femoral neck fractures, trochanteric fractures, etc.) directly affect local blood supply, especially inadequate blood supply to the femoral head, and cause necrosis of the femoral head. Hip dislocation with fracture, the necrosis rate is as high as 90%. If the fracture is not restored for more than 24 hours, 100% of the femoral head will become necrotic.
- Hip osteonecrosis
Osteonecrosis hormones
- Long-term use of a large amount of adrenal corticosteroids (such as prednisone, dexamethasone, etc.) can cause osteoporosis, arterial vascular obstruction, and gradually cause necrosis of bone cells and bone marrow cells.
Osteonecrosis and rheumatism
- It usually occurs in cold and humid climates. It is widespread in China, less in South China, and gradually increases to the north. It is often combined with ankylosing spondylitis and rheumatoid arthritis.
Osteonecrosis chronic alcoholism
- Long-term heavy drinking can cause many complications such as: A, lipid metabolism disorders; B, fatty liver and hyperlipidemia; C, local vasculitis; D, osteoporosis, all of the above pathological changes are responsible for osteonecrosis The culprit.
Osteonecrosis osteoporosis
- Due to changes in the internal structure of bone tissue, partial degeneration of trabecular bone, blood circulation to the bone is blocked, and femoral head necrosis is likely to occur.
Osteonecrosis hyperlipidemia
- The composition of blood lipids is too high. Blood lipids include cholesterol, triglycerides and phospholipids. As the lipid content in the blood increases, the viscosity of the blood itself will inevitably increase, and the flow rate will slow down, thereby forming small emboli and clogging the small arteries and veins, leading to osteonecrosis.
Osteonecrosis congenital dysplasia
- Due to dysplasia of the acetabulum and asymmetry of the acetabulum, the stress distribution of the femur is abnormal, and long-term effects cause acetabular necrosis and death of the femoral head.
Osteonecrosis decompression disease
- (Such as divers, caissons, flight crews, etc.) due to changes in environmental pressure, improper decompression, that is, the decompression speed is too fast and the amplitude is too large, so that the gas (mainly inert gas nitrogen) that has been dissolved in the body before decompression is released and dissolved State, caused by the formation of air bubbles and emboli or compressing tissue.
Osteonecrosis bone dystrophy
- Due to poor long-term diet, insufficient intake of calcium and phosphorus in the body, can not meet the metabolism of bone tissue, growth and development, etc., which can cause circulation blockage, and the femoral head can cause necrosis due to insufficient blood supply.
- Probable causes are that these causes may be related to a later process of osteonecrosis or increase the incidence of a particular disease, but have not yet been proven. Including: gout; hyperuricemia; venous disorders; pregnancy; dysplasia; lipid metabolism disorders; connective tissue disease; patella softening and so on.
Causes of Osteonecrosis in Traditional Chinese Medicine
- Liver and kidney deficiency: The congenital essence lies in the kidney, the kidney hides essence, raw marrow, and main bones. If the congenital endowment is insufficient, the kidney essence is deficient, and the kidney qi is insufficient, then the bones are lost. The liver and kidney are homologous, the main vein, the kidney qi is both deficient, and the liver is inadequate. Therefore, it is often seen in the clinic, and it is manifested as the same disease.
- Deficiency of Qi and Blood: The spleen and stomach are the foundation of the day after tomorrow. The spleen and stomach are out of luck, so Mizutani can't turn angry blood to feed the body,
- Ischemic osteonecrosis
- Six senses of exogenous feelings: cold is yin and evil, and it is easy to hurt yang. If yang is injured, qi and blood will be lost and the operation will be delayed, which will eventually lead to stasis. Shu, Yang deficiency and yin failed to metamorphose, the bones lost their support, and gradually the bone marrow was reduced, and the disease was based on the disease.
- Emotional factors: Too much emotion, dysfunction of internal organs, dysfunction of sacral meridians, dysfunction of qi and blood, yin and yang of the human body lose balance and coordination, and lead to disease.
Necrosis of the femoral head
Definition of osteonecrosis
- Femoral head necrosis, also known as femoral head ischemic necrosis or femoral head aseptic necrosis. Its main clinical manifestations are hip pain and nagging behavior. However, it is often only misdiagnosed in the early stage as pain in the knee joint and inner thigh. The treatment effect of femoral head necrosis has a lot to do with the severity of the disease, the discovery of the disease sooner or later, and the stage of the disease. The earlier the lesion is discovered, the lighter the disease, and the better the treatment effect. Therefore, early diagnosis and early treatment of femoral head necrosis should be achieved. Early diagnosis of femoral head necrosis should follow these principles:
Osteonecrosis diagnosis
- (1) Adults aged 20-50 who have pain in the groin or hip and release it to the thigh (or hip pain after one knee pain activity) slowly and progressively increase the pain at night, which is not effective after general drug treatment. Those with a history of trauma or alcohol abuse or history of hormone application or other causes and diseases that cause femoral head necrosis should first consider this disease.
- Osteonecrosis
- (3) Patients with femoral neck fractures should be followed up to 3-5 years after injury. If femoral neck height decreases, nail marks and cystic changes are found, and there are clinical symptoms, femoral head necrosis should be considered.
- (4) For suspicious cases, firstly take X-ray films of the hip joint and frog. If there are no abnormalities, they should be closely observed, or further examined by CT, MRI, ECT, intraosseous pressure, and arteriovenous angiography.
Causes of osteonecrosis
- There are two main causes of femoral head necrosis: one is traumatic, most of which are caused by hip injury, femoral head fracture, femoral neck fracture, hip dislocation, and hip soft tissue injury without fracture dislocation. Among them, femoral neck fractures that develop into femoral head necrosis are the most common, accounting for about 30% of femoral head and neck fractures, and the younger the patient, the greater the chance of femoral head necrosis, which is mainly due to the trauma causing the femoral head Nourishment of blood vessels due to interruption or stasis, femoral head ischemia; the other is non-traumatic, including long-term heavy use of glucocorticoids (because of the treatment of certain diseases, and sometimes misuse of hormones), alcoholism , Decompression sickness, etc., some of these factors can cause blood viscosity to increase, can also lead to thickening of blood vessel walls, narrowing of the lumen. Regardless of the traumatic and non-traumatic factors, the end result is one of insufficient arterial blood supply, and the other is venous stasis, which in turn can cause increased intraosseous pressure, further aggravate insufficient arterial blood supply, and eventually lead to femoral head deficiency. Blood, hypoxia, degeneration of bone cells, necrosis.
- Osteonecrosis
- Relationship with alcoholism: There are many causes of femoral head necrosis. Common causes of trauma are trauma, mainly hip fractures and dislocations. The second reason is the cause of hormones. There are many cases of necrosis of femoral head caused by drug hormones in recent years. The third reason is ankylosing spondylitis. Ankylosing spondylitis, a special disease, can cause bone changes throughout the body and eventually lead to necrosis of the femoral head. The fourth reason is poor congenital development, which is called congenital hip dysplasia.
- Another reason is drinking alcohol. Drinking a lot of alcohol is also called alcoholism. In recent years, necrosis of the femoral head caused by alcoholism has accounted for a large proportion, which has brought a lot of pain to patients. Part of the cause of femoral head necrosis is due to long-term alcohol abuse. If you continue to drink with sorrow, it will not only increase your sorrow but also cause your illness to become more and more severe.
- Alcohol can bring great changes to the femoral head. First of all, alcohol can cause chronic poisoning. Chronic poisoning can cause hyperlipidemia. Hyperlipidemia can lead to an increase in free acid in the blood, which is FFA. Will stimulate the increase in prostaglandins. An increase in these factors will lead to angiogenesis, and over time, the microcirculation of the femoral head will be blocked, and the femoral head will gradually necrosis after losing blood flow.
Osteonecrosis Treatment
Osteonecrosis TCM Treatment
- Traditional Chinese medicine believes that the human body has five meridians, six limbs, limbs, and hundred bones connected by meridians. The meridian transmits information, transports qi and blood, bone tissue growth, development, repair, and its normal physiological functions. On the one hand, it is related to the "kidney". On the other hand, it is also related to the state of the meridian in the bone. Under normal circumstances, the meridian in the bone is unobstructed and can run qi and blood in the bone, which plays an important role in bone growth, development and repair.
- If due to trauma or other reasons, the veins in the bones are blocked, the bone growth, development, and repair will be affected, and the "luo veins" in the femoral head are not abundant, and "qi and blood" are rare. Ischemia and necrosis, which are consistent with insufficient arterial blood supply and venous congestion confirmed by modern medical research.
- In the treatment of osteonecrosis by traditional Chinese medicine, the method of dredging the bones and collaterals is used as a cure method. The use of some Chinese medicine that can penetrate the bones internally and externally can fundamentally change the blood state of the femoral head. Properly cooperate with Yishen traditional Chinese medicine to treat the femoral head. On the basis of improved blood flow, it stimulates the activity of osteoblasts and osteoclasts, promotes the absorption of dead bones and the growth of new bones, thereby quickly eliminating symptoms such as pain and lameness in patients with femoral head necrosis, improving their functions and promoting their early recovery. .
Principles of External Treatment of Traditional Chinese Medicine for Osteonecrosis
- The principle of traditional Chinese medicine external treatment for osteonecrosis is the balance of meridians and the function of viscera. The balance of meridians and the function of the viscera. When administered on the body surface, through the meridian blood vessels or information transmission, through the medicinal properties of different drugs, the meridians enter the viscera, spread the whole body, and go directly to the disease. Meet the purpose of systemic disease.
- There are four aspects to the treatment principle of Chinese medicine external treatment:
- (1) Local stimulating effect. That is, the use of factors that have a certain stimulating effect can make local blood vessels dilate, promote blood circulation, improve the nutrition of surrounding tissues, and thus play the role of qi and blood circulation, anti-inflammatory and swelling.
- (2) Direct penetration of drugs. The method of external application of the drug can directly penetrate the skin, close to the lesion, increase the intensity of local drugs, play a role in activating blood circulation, removing qi and blood, clearing cooling blood, reducing swelling and pain, promoting angiogenesis, absorbing dead bone, and forming new Bone and other effects.
- (3) the balance of meridians and the function of the viscera. When administered on the body surface, through the meridian blood vessels or information transmission, through the medicinal properties of different drugs, the meridians enter the viscera, spread the whole body, and go directly to the disease. Meet the purpose of systemic disease.
- (4) The absorption effect of the skin. The skin is the body's largest peripheral barrier, with a large area and many pores. In addition to resisting external evils, it also has a metabolic effect of excretion and absorption. This therapy is the unity of the permeability of the drug and the absorption function of the skin into the body, and then through the balance of meridians and viscera, the effect of transfusion, or directly acting on local lesions to play a systemic or local treatment.
Osteonecrosis diet therapy
- While treating osteonecrosis, do not neglect dietary therapy in daily life.
- Traditional Chinese medicine believes that osteonecrosis is mostly caused by heat poisoning, qi stagnation and blood stasis, rotten bone and marrow, and deficiency of essence and blood. It should be treated by clearing heat and stagnation, and nourishing liver and kidney. Dialectical food selection for this disease can be divided into two categories: virtual and solid. The following dietary treatments can be used:
- Beef tendon soup
- 100g of beef tendon, 15g each of angelica, salvia, shiitake mushroom, ham, ginger, green onion, wine, monosodium glutamate, salt, etc. Wash the beef tendon with warm water, boil 500g of water, add 15g of alkali, pour the beef tendon, cover the pot and simmer for two minutes, remove the oil and wash it with hot water; repeatedly, wait for the beef tendon to swell To be processed. The bulged beef tendon is cut into sections, put into a steaming bowl, put angelica and salvia into the gauze bag and place it around, shiitake mushrooms and ham are placed on it. After putting ginger, green onion and seasoning in the basket, steam for 3 hours Left and right, when the beef tendon is cooked, you can come out of the cage, pick out the medicine bag, green onion, and ginger. Serve with a meal. It has the functions of promoting blood circulation and replenishing blood, relieving muscles and replenishing energy, and is suitable for the strain type of ischemic necrosis of the femoral head.
- Barley porridge
- Coix seed 30g papaya 10g japonica 60g white sugar 2 spoons Wash the barley and papaya, pour it into a small pot, add two large bowls of japonica and cold water, soak for a while, and then slowly simmer over low heat until the barley is crispy Add white sugar and simmer for a day. It has the functions of expelling wind and dampness, relieving muscles and relieving pain, and is suitable for those with severe joints and unfavorable movements, such as ischemic necrosis of the femoral head.
- Traditional Chinese medicine believes that osteonecrosis is mostly caused by heat poisoning, qi stagnation and blood stasis, rotten bone and marrow, and deficiency of essence and blood. It should be treated by clearing heat and stagnation, and nourishing liver and kidney. Dialectical food selection for this disease can be divided into two categories: virtual and solid. The following dietary treatments can be used:
- The early symptoms of osteonecrosis are only mild manifestations, that is, knee pain, lameness, but do not ignore these symptoms, osteonecrosis will cause patients with functional dysfunction, and even unable to walk, so you must treat osteonecrosis as soon as possible!
Osteonecrosis surgery
- Artificial joint replacement
- Types and materials of artificial joints:
- Early diagnosis and treatment of femoral head necrosis can prevent or delay artificial joint replacement in more than 70% of patients. However, in China, delayed diagnosis and irregular treatment are more common, which makes many patients with femoral heads already in the advanced stage (stage III, IV). Other methods have been difficult to work, and artificial joint replacement has to be performed. With the improvement of artificial joint materials, the improvement of prosthesis design and the skill of physicians, the effect of artificial joint replacement is rapidly increasing, and excessive concerns are unnecessary. The types of artificial hip joints include: femoral head surface replacement; artificial femoral head replacement; total hip artificial joint replacement. Commonly used artificial joint implant materials are: metal alloys; polymer materials; ceramic materials. According to different fixation methods of artificial total hip joint prostheses, they are divided into: non-cement biological fixation; bone cement fixation.
- (2) What is the service life of the artificial joint?
- For patients about to undergo artificial total hip arthroplasty, the greatest concern is the life of the artificial joint. Although artificial total hip arthroplasty has been widely carried out in China in the past ten years, and orthopedic surgeons have become more mature, there is a lack of follow-up results for more time. According to foreign multi-center, large-sample, long-term research results, the 20-year artificial joint survival rate is 80% and the 30-year survival rate is 64%, that is, about 80% of patients' artificial joints can still be used in 20 years after artificial joint replacement. After 30 years, 64% of patients, and the prostheses they use were designed in the 1970s or 1980s. In the 21st century, the material selection and design of artificial total hip prostheses are more reasonable, and the surgical techniques have been widely improved. It is expected that the prostheses will have a longer service life and a more optimistic effect.
- (3) Application of minimally invasive surgery in artificial joint replacement:
- With the continuous development of artificial total hip arthroplasty, the minimally invasive total hip arthroplasty with small incisions becomes possible. The osteonecrosis and joint preservation and reconstruction center of China-Japan Friendship Hospital has carried out this operation for many years, making the incision length within 10cm, and the operation time has not been extended or even shortened. This technology means more than just a small incision. Its technical focus is to reduce damage to ligaments, muscles, and bone tissue, and to be safe, effective, repeatable and stand the test of time. Its advantages are: small incision is beautiful (intradermal suture can be used); the soft tissue around the joint is less trauma, the amount of bleeding is reduced, the postoperative wound pain is reduced, and the complications are less; Patients can walk on crutches 2 to 3 days after surgery, greatly reducing perioperative complications.
- (4) Application of navigation technology in artificial joint replacement:
- Image guided surgical navigation system is a new technology developed in the past 10 years and has been widely used in clinical practice. China-Japan Friendship Hospital Bone Necrosis and Joint Retention and Reconstruction Center has accumulated more than 700 cases of artificial joint surgery experience. Since March 2003, it has been the first in China to carry out navigation-guided minimally invasive artificial hip and knee replacement surgery. rich experience.
Osteonecrosis after repair
- Ischemic necrosis of the femoral head caused trauma caused by surgery, causing inflammation and congestion and edema around the hip joint. It reached the peak in the next two days, and then entered the absorption stage of inflammation, edema, and hematoma. At this stage, due to the size of the wound, the hematoma remained The presence or absence of fat liquefaction, the presence of infection and age, and the situation of wounds are different, usually about a month or so. Early postoperative period is anti-infection, smooth drainage, eliminate hematoma, promote wound healing, and pay attention to the body's righting.
- After 14 days of suture removal, the focus was to further promote the absorption of local inflammation and edema and prevent and reduce adhesions around the joints. At this time, the combination of internal and external treatment for promoting blood circulation and removing blood stasis was emphasized. External treatment focuses on plasters for external application, physical therapy, massage, bone distraction exercises, sitting and lying exercises (pelvic osteotomy, with the exception of capping), or passive lifting of legs and hips to prevent joint adhesion.
- After one month of treatment, the local tissue was soft, hip flexion function gradually recovered, and pain was reduced. These three criteria are used to evaluate the effectiveness of this period, which is also called the scar formation period. Such as activating blood circulation and removing blood stasis, anti-inflammatory and analgesic, hematoma, and edema absorption, the femoral head is repaired quickly, and scar formation is less, which is conducive to the further recovery of function.
- Under what circumstances can osteonecrosis patients be abandoned?
- During the process of osteonecrosis, there will be dead bone resorption, new bone growth and shaping, and its transformation is the change of bone parenchyma, not the change of symptoms. After a period of treatment in some patients, hip pain is reduced or disappeared, which does not mean that the condition is cured. The true diagnosis is assessed by radiography and ECT. Through these assessments, changes in the femoral head can be seen, from ischemic to stasis, from trabecular bone reconstruction to shaping, only when the femur is seen The cystic area of the bone disappeared, filled with new bone, the trabeculae were arranged in order, and the femoral head could only be abandoned after it reached a certain supporting force.
- These signs do not depend on the patient's own feelings, but are judged by a doctor with extensive clinical experience. Therefore, when a crutch can be thrown, and how to effectively protect the femoral head at each stage requires close cooperation between the patient and the doctor.
Osteonecrosis Home Care
- The adjuvant treatment of femoral head necrosis includes: femoral head traction, hip function exercise, massage, etc.
- Traction is generally about 10% of body weight. 3-4 times a day, the traction time is about 1 hour. In terms of daily life, first of all, we must not allow patients to bear weight, as long as standing, use double crutches, and cannot carry heavy objects. Encourage patients to build confidence and ensure that patients have a good mentality and adequate sleep. Secondly, in terms of diet, foods rich in calcium, protein and vitamins should be the mainstay. Avoid irritating food and alcohol. In addition, we should pay attention to moisture and wind, and keep warm.
- During the treatment, walk less and reduce weight bearing. Avoid cold, wet irritation, ban drinking liquor, and steroids.
Osteonecrosis diagnosis
- 1. Whether there are predisposing factors for the incidence of femoral head necrosis;
- 2. Symptoms and physical examination characteristics of femoral head necrosis;
- 3. Combined with the imaging examination of femoral head necrosis. It is very important to ask a detailed medical history, and the patient should cooperate with the physician to carefully review whether there is a history of hip trauma, history of taking hormones, history of heavy drinking, and other predisposing factors of femoral head necrosis, which will help the doctor to judge.
- Early hip pain, claudication, and hip dysfunction in patients with femoral head necrosis can be insignificant or easily confused with symptoms of other diseases, and they can be easily misdiagnosed as other diseases in the clinic, which requires careful inquiry and identification. X-ray examination is the most commonly used clinical examination method, but the detection of early cases still depends on the application of other advanced examination methods. With the development of science, CT, magnetic resonance (MRI), bone isotope scanning, intravascular venography, intramedullary angiography and intraosseous pressure measurement have been widely carried out in hospitals, and the early diagnosis rate of femoral head necrosis has also been obtained. Up.
- X-ray judgment
- Early stage: The hip joint space is slightly widened, mainly in the middle and lower joints, mainly due to the widening of the articular cartilage and the femoral head outward. The early femoral head is within 2mm of the outward movement, and it can reach 5mm in the late stage. The congestion of the internal soft tissue can be reversed.
- Medium-term: The femoral head cortex can be fractured (stepped) and angled, and parallel bicortical signs (bilateral signs) appear at the base. The step signs and bilateral signs are the early signs of the X-ray to determine the collapse of the femoral head, and then the femoral head is widely dislocated. And disintegration, with dead bones, fissures, sclerosis and light transmission areas visible, femoral head pressure
- X-ray manifestation of femoral head necrosis
- Late stage: The femoral skull structure completely disappears, the femoral head is significantly flattened or tanned, with diffuse or localized sclerosis or cystic changes, narrowing of the joint space, thickening of the femoral head, and joint subluxation. The hyperplasia of the acetabular margin and the base of the femoral head becomes osteophytes, the acetabular articular surface hardens and the capsule changes, the femoral head and acetabulum become flat, and the femoral neck absorbs, making the lower limbs shorter.
- Imaging performance
- X-ray manifestations of femoral head necrosis
- Early stage: The hip joint space is slightly widened, mainly in the middle and lower joints, mainly due to the widening of the articular cartilage and the femoral head outward. The early femoral head is within 2mm of the outward movement, and it can reach 5mm in the late stage. The congestion of the internal soft tissue can be reversed.
- Middle stage: The femoral head cortex can be fractured (stepped) and angled, and a parallel double cortical sign (bilateral sign) appears at the base. The step sign and bilateral sign are early signs of the collapse of the femoral head on X-rays, and the femoral head is widely dislocated subsequently And broken, the dead bones, fissures, sclerosis and light transmission area can be seen inside, the femoral head is compressed and flattened, the contour is irregular, and the joint cavity is initially widened due to the flattened femoral head. Cortical thickening or periosteal hyperplasia appears below the femoral neck, joint space can be irregularly narrowed, acetabular articular surface hyperplasia and sclerosis, Sheaton line is discontinuous, and femoral head fragments can become joint free bodies.
- Late stage: The femoral skull structure completely disappears, the femoral head is significantly flattened or deformed, there is a diffuse or localized sclerosis or cystic area, the joint space is narrowed, the femoral head is thickened, and there may be joint subluxation. The hyperplasia of the acetabular margin and the base of the femoral head becomes osteophytes, the acetabular articular surface hardens and the capsule changes, the femoral head and acetabulum become flat, and the femoral neck absorbs, making the lower limbs shorter.
- CT performance of femoral head necrosis
- There was no obvious abnormality of bone in stage , but there were thickening of synovium, swelling of joint capsule, effusion of joint cavity, and relative widening of joint space.
- Stage femoral head is normal in shape without collapse. Normally, the femoral head center increases the physiological density of bone trabecula due to the load-bearing stress. When the ischemic necrosis of bone is found, the interstellar bone is small. The absorption of the beam was uneven and large-eyed. Due to the reflective hyperplasia, the star-shaped bone pattern was thickened, distorted and dense.
- Stage is called the pre-collapse period. The femoral head becomes flat, and a narrow, translucent band is seen under the articular surface of the anterior upper part of the femoral head, which is the "half moon sign".
- Stage IV femoral head collapse and deformation. There are cystic changes in the femoral head to varying degrees. There is sclerosis or irregularity in the surrounding area. Fracture fragments and joint free bodies can be seen due to the collapse. Secondary degenerative osteoarthropathy, hyperplastic bone spurs, narrow joint space, and subluxation of joints.
- MRI manifestations of femoral head necrosis
- MRI sensitivity is better than bone nuclide scan and CT and X-ray examination. This is because after the femoral head is necrotic, the changes of the bone marrow above the necrotic area continue to change before the bone changes. MRI can reflect the changes of bone marrow cells before the bone collapse and repair. Therefore, MRI should be the main method for early diagnosis of osteonecrosis.
- Patients at stage 0 are asymptomatic, with pathological manifestations of loss of hematopoietic bone marrow, retention of cytoplasm with sinusoidal tubules, interstitial fluid and necrosis of bone marrow fat cells. MRI can be normal, showing a tracer ischemic cold spot locally during bone scan. The cold spots described above can only appear to be weaker during dynamic MRI scans.
- The stage femoral head is not deformed, the joint space is normal, and plain radiographs and CT can not show obvious bone lesions. T1 weighted femoral head weight-bearing area (based on the characteristics of articular cartilage structure and function, the femoral head cartilage surface is divided into three parts, the pressure-bearing area that is different from the upper and outer acetabular cartilage surfaces, and the non-pressure-bearing area inside the pressure-bearing area And non-pressure-bearing areas around the outside) show line-like low signals. The T 2 weighted pathological features are high signal, and there is no repair of bone and bone marrow necrosis. The main changes are bone marrow edema, osteocyte necrosis, and osteoporosis.
- The stage femoral head was not deformed and the joint space was normal. T 1 weighting is a heterogeneous signal with a clear crescent boundary, T 2 weighting shows a medium to slightly higher signal, and the surrounding unevenness is slightly lower. The signal is surrounded by a typical two-line sign, and the location is basically the same as that of CT sclerosis. Pathologically, a large number of irregular cell debris necrosis in the center of the lesion, peripheral fibrosis, new bone formation and granulation tissue proliferation.
- Stage III femoral head deformation, subchondral fracture, collapse, crescent formation. T1 weighting showed a band-like low signal, and T2 weighting showed a medium or high signal, which was the joint effusion into the fissure of the subchondral fracture line. Crescent necrotic bones suffered from stress subchondral fractures, collapsed and separated from articular cartilage. As the fibrous tissue grows into a dense avascular wall, repair is blocked and access to necrotic bone is limited.
- Stage articular cartilage was completely destroyed, the joint space narrowed, the femoral head significantly collapsed and deformed, and non-specific secondary osteoarthritis such as sclerosis, cystic degeneration, and marginal osteophytes appeared.
Osteonecrosis considerations
- After three months of hospitalization and rehabilitation after the operation, the foundation of functional recovery has been laid. At this time, the scar softening period will be entered. The patient must adhere to functional exercise (1.5-year calf traction at night). The function will continue to improve. I feel mild to moderate pain (I can tolerate it), and it is not effective if it is not painful. If any movement is painful, we should strengthen the exercise, that is, the more painful the exercise, the more satisfactory it will be after 2 to 3 years of functional exercise. Function, at this time the ischemic necrosis of the femoral head has reached the basic clinical cure and reached the purpose of treatment.