Necrosis of the femoral head in children
Introduction
Introduction to femoral head necrosis in children Femoral head necrosis in children, also known as femoral head cartilage or flattened hip, or Legg-Calve'-Perthes syndrome, occurs mostly in children aged 2-12 years. The disease begins with a child called knee pain - hip pain, inconvenient walking or lameness, the hip can not flex and stretch, adduction. At this time, parents often mistakenly believe that sprains, without paying attention, delay the course of the disease, causing the femoral head to squash - "flat hip", resulting in lifelong disability. Therefore, early diagnosis of early diagnosis of this disease is very important. basic knowledge Sickness ratio: 0.0001% Susceptible people: children Mode of infection: non-infectious Complications: Osteoarthritis
Cause
Causes of femoral head necrosis in children
Hip trauma (40%):
In recent years, it has been found in clinical studies that the incidence of femoral head necrosis in children is increasing. Hip trauma is a common disease in children. For example, hip dislocation, femoral head contusion, and epiphyseal spondylolisthesis are mainly caused by vascular injury around the femoral head of children. After the blood vessel is damaged, the femoral head loses blood supply. Avascular necrosis of the femoral head.
Iatrogenic injury (20%):
When women are producing, due to difficulties in production or dystocia, when doctors use their hands or other equipment to help produce, they can also cause strain or sprain of the hip joint, causing damage to local blood vessels, affecting blood supply to the femoral head, and inducing necrosis of the femoral head. occur.
Environmental factors (30%):
The environmental factors for children's growth include perinatal and post-natal living conditions. For example, children with breech presentation are four times more likely to have morbidity than normal children. Children born at the time of parental age and family financial difficulties are prone to femoral head necrosis.
Prevention
Prevention of femoral head necrosis in children
First, parents must let children strengthen their awareness of the protection of the hip joints and avoid the impact of trauma.
Second, when children are walking, they must pay attention to their feet and avoid falling, especially in the winter snow and ice, walking should pay attention to anti-skid and fall.
Third, when doing sports, be sure to do a good job in protecting the hips, first warm up, and exercise when the limbs are flexible.
Fourth, the prevention of femoral head necrosis in children is that parents must not allow children to drink alcohol, and parents should avoid letting children do heavy work, so as not to overweight.
5. When the child's femoral neck fracture, timely treatment is required. The use of strong internal fixation method, but also the use of vascular pedicled bone graft bone graft, promote the healing of the femoral neck, increase blood transport to the head, prevent the occurrence of osteonecrosis, regular follow-up after surgery, appropriate use of traditional Chinese medicine to promote blood supply And calcium to prevent the occurrence of ischemic femoral head.
Sixth, in the treatment of some diseases, must not use hormone drugs, if you must use, also according to the doctor's request to avoid this disease.
Complication
Femoral head necrosis complications in children Complications Osteoarthritis
Because of the complicated pathological process of femoral head necrosis, if the early and ineffective treatment can not be obtained, the femoral head will collapse, the joint space will be narrowed, and finally the osteoarthritis will be caused, which will cause the patient's hip joint dysfunction and cause disability. While suffering from physical ailments, patients suffer from psychological trauma and add a heavy burden to families, units and society.
Symptom
Femoral head necrosis in children Common symptoms Hip dislocation hip varus
In children with femoral head necrosis, there is usually no pain in the early stage, and it can be diagnosed as femoral head necrosis when lameness is found. Hip trauma in children is a common and frequently-occurring disease. When children are playing, if they do not pay attention, they will cause dislocation of the hip, contusion of the femoral head and spondylolisthesis. These traumas are mainly caused by vascular damage around the femoral head of the child. After the blood vessel is damaged, the femoral condyle partially loses blood supply, causing ischemic osteonecrosis of the femoral skull. From the Chinese Journal of Bone and Joint Research in the Chinese Journal of Bone and Joint, we learned that the onset of avascular necrosis of the femoral head in children is characterized by the absence of pain in most cases, the activity of the hip joint, and the concealment of the disease, so early children Femoral head necrosis is not easy to detect and is only discovered when a child is limp. Children with femoral condyle necrosis are very easy to treat, and most patients with femoral head can be restored without leaving sequelae.
1, children with femoral head necrosis will occur in the early stage - hip pain, inconvenient walking or lameness, the hip of the femoral head necrosis can not flex, stretch. At this time, parents often mistakenly believe that they are sprained, unnoticed, delaying the condition, causing the femoral head to squash - "flat hip", resulting in lifelong disability.
2. Symptoms of femoral head necrosis in children generally have no pain symptoms at an early stage, and can be diagnosed as femoral head necrosis when lameness is found. When children are playing, if they don't pay attention, they will cause dislocation of the hip, spondylolisthesis, and contusion of the femoral head. These injuries are mainly the biggest cause of femoral head necrosis in children.
3, the incidence of avascular necrosis of the femoral head in children is characterized by no pain in the early stage, hip dysfunction, and hidden features of the disease, so the symptoms of early femoral head necrosis are not easy to find, and children are found when the child is limp. Bone skull necrosis.
Examine
Examination of femoral head necrosis in children
When the X-ray of the bone plate is taken, the deformation, collapse and displacement of the femoral head can be seen, and the acetabulum itself has no abnormality at the beginning.
1 patient friend, when you feel hip pain, do not use drugs, observe for a few days, then go to the hospital for consultation.
2 When you feel the pain is aggravated, you can deepen the pain area and do a 4 sign test. If it is positive, it proves to be a lesion.
3 Self-test hip function tests, such as hip abduction, bone harvest, flexion, etc., with or without femoral tendon and pain.
4 early can be used for ECT or magnetic resonance examination, generally early ischaemia can be diagnosed.
5 radiological examination in the middle and late stages can be clearly diagnosed.
Diagnosis
Diagnosis and diagnosis of femoral head necrosis in children
Children's femoral head necrosis requires parental coordination and attention. Observe whether there is persistent knee pain, lameness and hip joint activity, and whether there is trauma or other medical history between 3 and 12 years old (especially 4-8 years old). If you have any, you should go to the hospital immediately for inspection.
According to medical history, clinical symptoms, signs and pelvic orthotopic X-ray films, MRI, CT, etc., early and accurate diagnosis and prevention of femoral head collapse is the key to the treatment of femoral head necrosis. However, due to the small number of medical scientists and technicians specializing in the study of femoral head necrosis, there are fewer monographs in this area. Therefore, the etiology, pathology, diagnosis and treatment of the disease have not been fully defined and paid attention to, resulting in the majority of patients with clinical osteonecrosis (more than 60% reported) as rheumatoid, rheumatoid, ankylosing spondylitis, Misdiagnosis and mistreatment of diseases such as bone and joint tuberculosis, bone hyperplasia, sciatica, and intervertebral disc prolapse. In this way, not only does the patient delay the optimal treatment opportunity, but also causes a great waste of their energy and financial resources.
