What Are the Different Osteonecrosis Treatments?

Femoral head necrosis is a pathological evolution process that initially occurs in the weight-bearing area of the femoral head. The trabecular structure of the necrotic bone is damaged under stress, that is, microfracture, and the subsequent repair process for damaged bone tissue. The cause of osteonecrosis is not eliminated, the repair is incomplete, and the injury-repair process continues, leading to changes in the structure of the femoral head, collapse, deformation of the femoral head, arthritis, and dysfunction. Femoral head necrosis, of course, can cause pain, joint movements and weight-bearing walking dysfunction, but people should not be affected by the horrible meaning of the word "necrosis and death". Necrosis of the femoral head, after all, is limited and involves individual joints, which can be reduced, subsided and self-healing Even if it is serious, it can be remedied by artificial hip replacement in the end, and the walking ability can still be restored.

Basic Information

nickname

Avascular necrosis of the femoral head

English name

femur head necrosis

Visiting department

orthopedics

Common causes

Caused by femoral head autopathy, trauma, hormones, etc.

Common symptoms

Hip, proximal thigh, knee pain, restricted hip movement

Causes of Femoral Head Necrosis

There are two causes of femoral head necrosis: one is the poor healing of femoral neck fractures, the load-bearing trabeculae in the femoral head turn to the load-bearing area to reduce the bearing stress, and stress damage occurs, so necrosis always occurs in patients with fracture healing After walking with a load. The other is the autologous lesions of bone tissue, such as the most common chronic alcoholism or osteonecrosis caused by the use of glucocorticoids. At the same time, the regeneration and repair capacity of bone tissue is impaired. It also includes the development of long-term femoral head germinal centers in children-femoral skull condyle necrosis, also known as children's femoral head necrosis and flat hips.

Clinical manifestations of femoral head necrosis

The symptoms and signs of femoral head necrosis are various. The time of the onset of the pain and the degree of the attack are different, but they are based on pathological evolution. And various clinical manifestations are not unique to femoral head necrosis. Many hip joint diseases can occur. In other words, it is difficult to make a diagnosis of femoral head necrosis through subjective symptoms and clinical examination of patients. For example, many lesions of the hip and sacroiliac joints can be expressed as positive "4" test (that is, knee flexion and flexion and abduction of the hip joint, placed in a "4" shape on the contralateral straight lower extremity, with one hand pressed against the On the lateral condyle, the other hand is placed on the inner side of the knee while pressing down, causing hip and hip pain.) Therefore, it is not a specific sign for diagnosis of femoral head necrosis.

The most common symptom is pain. The pain is in the hip joint, near the thigh, and can radiate to the knee. Pain can be caused by necrotic tissue-repaired inflammatory lesions or high pressure in inflammatory lesions, which can manifest as persistent pain, resting pain. Osteochondral collapse causes traumatic arthritis, or chronic trauma pain at the site of attachment of muscle ligaments around the hip joint. Restricted hip movements, especially restricted rotational movements, or painful and shortened lameness.

Femoral head necrosis examination

Early X-ray films could not be found positively. With the progress, trabecular bone disorder and interruption appeared in the weight-bearing area. Later, the femoral head subchondral bone became cystic and included sclerosis. As the disease progressed and the obstacle was repaired, a linear translucent area appeared in the lesion area, surrounded by hardened bones, showing a crescent sign. Collapse, deformation, subluxation, and narrowing of the joint space in the later stage. X-ray can determine the scope of the lesion and exclude other lesions of the bone. It has the advantages of simplicity, convenience, economy, and wide application, and is still used as the basic examination method for femoral head necrosis.

Also in the early stages of necrosis of the femoral head, CT films can appear normal. CT scan is better than MRI in judging the changes of bone structure in the femoral head, and it is of great significance to determine the prediction of the collapse of the femoral head after necrosis diagnosis. Therefore, CT examination is also a commonly used method. Early stage: The trabeculae of the femoral head bearing surface are disordered, partially absorbed, mixed with thickening and fusion, cystic absorption, and partially hardened. CT can show that the crescent sign is a three-layer structure: the dead bone is in the center, and it is surrounded by a translucent bone resorption band, and the outermost is new bone sclerosis. In the later stage, the femoral head appears to collapse and deform, and the center has a large low density Area, shell fractures appear under the articular cartilage, the acetabular labrum is prominent, and there may be joint deformation.

MRI can detect osteonecrosis early, and make diagnosis before X-ray and CT films find abnormalities. Various signal changes of MRI of femoral head necrosis reflect the metabolic level of diseased tissues at different levels. The pathological features of the T ₂ weighted image with high signal are the repair response caused by bone and bone marrow necrosis, which are mainly characterized by acute inflammatory pathological changes such as bone marrow edema, local congestion, and exudation. T ₁ weighted images are mostly low signals. T ₂ weighted images show mixed signals. High signals indicate inflammation and congestion, edema, and low-signal lesions are mostly fibrosis and sclerotic bone. T _{1 is} weighted as a heterogeneous signal with a clear crescent boundary. If the T ₂ weighted image shows a moderately high signal, and the surrounding unevenness is slightly low, the signal is a typical two-line sign, and the position is basically consistent with that of the CT bone sclerosis.

Radionuclide bone scan (ECT) is also a detection method that can achieve early diagnosis.

Diagnosis of femoral head necrosis

The diagnosis of femoral head necrosis is based on imaging. The imaging manifestations of femoral head necrosis are related to the severity of the disease and the pathological process. The pathological changes determine the diversity of imaging. There are many clinical stages based on imaging, pathological progress, and clinical manifestations, but such stages cannot be viewed separately.

Femoral head necrosis treatment

Etiological treatment is the key to stopping the progression of the disease and making it possible to enter a track of benign outcomes. For example, alcohol and hormonal poisoning, measures to quit drinking and stop the use of glucocorticoids. Promote bone regeneration and repair of diseased tissues through biological response, make the repair as complete and effective as possible, restore the bearing capacity, and prevent the femoral head from deforming and collapsing. Therefore, the second key treatment is to reduce weight bearing, walking, reduce the load in the femoral head weight-bearing area, and avoid micro-fracture and collapse of the weakened bone tissue. It is advocated that patients walk in small steps, avoid jumping, and should be supported by walking during the progress of necrotic lesions. Encourage patients to take lightening exercises, such as cycling and swimming. It is advisable to stay in bed during acute progression to avoid weight bearing.

Try drugs that promote bone and cartilage nutrition and growth.

For patients who are frequently collapsing or deformed, and have long-term pain dysfunction, artificial hip replacement can be performed. The surgical technique is mature, the effect is positive, and the success rate is high.

Prognosis of femoral head necrosis

Femoral head necrosis affects the hip joint, and the degree of dysfunction depends on whether the cause can be terminated and the result of pathological changes and repair. Elimination of the cause is a prerequisite for stopping the progression of femoral head necrosis and reversal. Generally speaking, the femoral head does not collapse or deform slightly, and the lesion is repaired to regain its load-bearing capacity. Femoral head necrosis can be cured and hip joint function maintained. Artificial hip replacement is considered only if long-term repeated pain affects weight-bearing walking.

Femoral head necrosis prevention

Avoid alcoholism and avoid using glucocorticoids whenever possible. Strive to achieve anatomical reduction during internal fixation of femoral neck fractures.