What Is the Femoral Head?

The femoral head (caput femoris) is round, accounting for about two-thirds of a sphere, which is completely covered by articular cartilage. There is a small nest at the top of the head, called the femoral head depression, which is the attachment of the femoral head ligament. Femoral head can get a small blood supply.

Chinese name: Femoral head

Foreign name: caput femoris

Femoral head function

The femur is the most important bone of the human body, and the femoral head is more important. People's upright walking, activities, and labor all rely on the support of the femoral head. So the femoral head is also the most vulnerable area.

Femoral head auxiliary structure

1. Femoral head ligament: It is located in the joint and connects the femoral head depression with the acetabular transverse ligament. It is covered by the synovium and contains the blood vessels of the nourishing femoral head. When the thigh is half flexed and adducted, the ligaments are tense, and the ligaments are loose during abduction.

2. The femoral tibial joint is a ball-and-socket joint, and the femoropopliteal joint is a tackle joint. The two together constitute a tackle-socket joint. From the aspect of the articular surface, the joint head is much larger than the joint socket, which can cause the instability of the knee joint. At the same time, the knee joint is located between the two largest levers in the body-the femur and the tibia. During running and jumping, they must be affected by forces in different directions, which is prone to joint damage.

Blood supply to the femoral head and neck

The main blood vessels supplying the femoral head include the medial circumflex femoral artery, lateral circumflex femoral artery, obturator artery, superior gluteal artery, inferior gluteal artery, and iliopsoas. In 1980, Crock et al. Through the study of the arterial supply of the human femoral head and neck believed that the arterial supply of the femoral head and neck believed that: (1) the femoral carotid basal artery ring, which is located at the posterior inner femoral artery branch and anterior of the femoral neck basal joint capsule Of the external circumflex femoral artery. (2) The branch from the basal artery ring and other bone distances penetrates the hip joint capsule along the intertrochanteric line, and reaches the femur along the deep side of the femoral neck synovial reflex at the posterior side of the femoral neck, below the annular fiber, and along the femoral neck synovial membrane. The articular cartilage margin at the cervical junction, the metaphyseal artery and the epiphyseal artery at the upper end of the femur all originate from these branches. (3) Round ligament artery. Zhou Dongfeng et al. Studied the blood supply of the hip joint capsule of 10 male corpses, and considered that from the distribution of the arteries on the joint capsule, the importance of these arteries on the joint capsule blood supply was: Arteries, lateral femoral arteries, superior gluteal arteries, inferior gluteal arteries, obturator arteries, and sacroiliac arteries. The articular capsule vascular network and femoral neck basal artery ring formed by the convergence of these arteries are considered to be the main arterial sources of the hip joint.

Femoral head related diseases and treatment

Avascular necrosis of the femoral head (ANFH) is a common disease in orthopedics with a high disability rate. Interventional treatment of ANFH, that is, intubation of the femoral artery under X-ray television, direct administration from the deep femoral artery to the medial circumflex femoral artery or lateral femoral circumflex artery.

Non-surgical treatment of femoral head

1. Protective weights and avoid impact and confrontational movements. For early and middle-term patients, it can reduce pain. It is recommended to use double crutches instead of using a wheelchair.

2. Drug treatment, including Chinese and Western medicine. (1) Western medicine: anticoagulation, fibrinolysis, and dilation of blood vessels can be used for early necrosis, such as low-molecular-weight heparin and alprostadil. Application of drugs that inhibit osteoclasts and increase osteogenesis, such as phosphate preparations, medopa and the like. Depending on the condition of necrosis, the drug can be used alone or in conjunction with hip-sparing surgery. (2) Traditional Chinese medicine treatment: The prevention and treatment of femoral head necrosis with traditional Chinese medicine emphasizes early diagnosis and early treatment and overall adjustment, and the medicine is used by the waiting party according to the traditional Chinese medicine certificate. The basic prevention and treatment method is to promote blood circulation and remove blood stasis, supplemented by Tongluo analgesic, kidney and bone strengthening, spleen and dampness, etc., specific prevention and treatment methods are selected according to the clinical manifestations of patients. Herbal preparations such as Epimedium and Pigeon Leaf have been used clinically. Chinese medicine can be used for femoral head necrosis that is asymptomatic or symptomatic but does not involve the lateral column of the femoral head. Chinese medicine can also be used in conjunction with hip-sparing surgery to help improve hip-sparing efficacy.

3. Physical therapy: including extracorporeal shock waves, electromagnetic fields, hyperbaric oxygen, etc.

Femoral head hip surgery

Hip-preserving surgery includes core decompression or autologous bone marrow mononuclear cell implantation; lesion removal, bone transplantation with or without blood flow.

Three major types of osteotomy:

1. Pulmonary heart decompression. Effective for reducing pain, it is recommended to use a fine drill (3.5mm), and drill multiple holes in the femoral head. 2. Autologous bone marrow mononuclear cell implantation. It is still in the experimental stage and should be used with caution. 3. Necrotic lesions cleared, bone graft with or without blood flow. The approach of lesion removal includes the transtrochanteric femoral head, the anterior path through the femoral head, the window at the junction of the neck, and the transfemoral head cartilage flap (trap-door). Each has its advantages and disadvantages and can be selected for application. Bone grafting should be performed while decompression. 4. Free blood vessel fibula transplantation has exact effect and high technical requirements. 5. Bone graft with blood vessels. Including iliac bone graft with deep circumflex and superficial arteriovenous veins, greater trochanteric bone with lateral branch of circumflex femoral branch, and greater trochanteric bone with middle gluteal muscle branch. 6. Muscle pedicle bone transplantation. Transplantation with femoral muscle is a common method. 7. Allograft or autologous fibula transplantation, artificial bone products support bone graft. 8. Suppression of bone grafting. Autogenous bone, allogeneic bone with or without artificial bone and BMP2. 9. Osteotomy. More commonly used are femoral trochanteric femoral head and neck rotation osteotomy and transfemoral trochanteric osteotomy. 10. The selection of tantalum rods should be cautious, and simple interventional therapy via blood vessels is not recommended.

Femoral head artificial joint replacement

Some ONFH patients eventually undergo artificial joint replacement. With the improvement of artificial joint design, materials and technology, the popularization and improvement of technology, the scope of hip-sparing surgery is shrinking, and the scope of artificial joint replacement is gradually expanding.

The types of artificial joints available for ONFH patients are:

1. Surface replacement. The scope of application is limited, and those with large necrosis volume are not applicable. The complications of gold-bearing load-bearing surface reduce the amount of application. 2. Femoral head replacement. There is no indication for pain and acetabular wear after surgery. 3. Total hip replacement with short-stem femoral prosthesis. Under development. 4. Total hip replacement. This is the most classic, most mature, artificial joint surgery with a certain long-lasting effect. It is suitable for most patients with stage IV and ONFH. For middle and young patients, it is recommended to use a wear-resistant bearing surface Ethylene), biological bone ingrown prosthesis.