traumatic femoral head necrosis
Introduction
Introduction to traumatic femoral head necrosis Traumatic femoral head necrosis refers to the necrosis of human bone tissue. Traumatic femoral head necrosis is one of the conditions. Also known as aseptic ischemic necrosis of bone tissue, also known as aseptic necrosis. Femoral head necrosis is caused by hip trauma, long-term application of hormonal drugs, alcoholism and other causes of femoral head necrosis blood supply disorders, femoral skull tissue can not get normal nutrition, bone cells, bone marrow hematopoietic cells in the femoral head tissue, Fat cells are formed by necrosis. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: osteoarthritis
Cause
Traumatic femoral head necrosis
Glucocorticoid (45%)
Glucocorticoid is one of the most commonly used steroid hormones in the clinic, which can lead to osteoporosis, aseptic osteonecrosis, and serious diseases that directly endanger the lives of patients.
Trauma (25%)
Due to hip trauma, femoral head or neck fracture, hip dislocation, or neither fracture, or dislocation of the vascular injury, can cause local ischemia of the femoral head, and further develop necrosis.
Decompression sickness (15%)
Under the high pressure, the nitrogen and nitrogen dissolved in the blood and tissues will increase. When the environmental pressure is reduced, the dissolved excess nitrogen needs to be gradually discharged through the lungs. If the pressure is too fast, the nitrogen will not be discharged, that is, it will be released in the body. Come out, form bubbles, generate gas embolism, gas embolism in the blood vessels, blood flow is blocked, local blood supply to the femoral head is worse, ischemic necrosis.
Other factors (10%)
Alcoholism, hypertension, diabetes, arteriosclerosis, obesity, gout, radiation therapy, and burns can also cause femoral head necrosis.
Prevention
Traumatic femoral head necrosis prevention
Precaution
1, after trauma, pay attention to the body to add enough nutrients, more vitamins, protein and minerals, diet should also pay attention to light, eat more easily digestible food and fresh vegetables and fruits.
2, pay attention to timely rehabilitation exercise, help the body to recover faster, the femoral head necrosis will be faster for patients to recover.
3. If trauma is caused by other various reasons, be sure to receive local atraumatic therapy within 6 to 15 days after the injury.
4, to avoid the situation of the weight of the injured limb, knowing that the complete cure of the body to return to normal can restore excessive physical labor.
Complication
Traumatic femoral head necrosis complications Complications osteoarthritis
The femoral head collapses, the joint space narrows, and finally leads to osteoarthritis, which causes the patient's hip joint dysfunction and causes disability.
Symptom
Traumatic femoral head necrosis symptoms Common symptoms Osteoporosis inguinal pain gait abnormalities difficulty hip joint gluteal muscle atrophy knee joint pain biceps injury
I. Symptoms
(1) Pain: After the wound has been cured, it is as short as three months and as long as 1-2 years, and there is pain in the hip, that is, intermittent pain in the groin and hip. The pain increased a lot during the activity and improved after the break. Pain is sore, or dull, or acupuncture. As the disease progresses, the pain can turn into a continuous one and pain at rest. This pain is also released to the knee joint, waist, etc., osteoporosis, is characterized by femoral head necrosis pain.
(2) Activity dysfunction, in addition to the typical hip pain, is limited mobility and obstacles, such as thigh abduction, adduction, extension, flexion, internal and external rotation, etc. are limited, can not leg and cross-legged, under It is also difficult to wait.
Two signs
(1) Gait abnormalities: mainly manifested as progressive shortening. The cause of limp is due to hip pain, collapse of the femoral head, pelvic tilt, or subluxation of the hip. Early femoral head necrosis can be intermittent claudication, that is, no cicada after rest, and claudication occurs after walking. After the middle and late stages, it is persistent, and osteonecrosis.
(2) Muscle disease: After the occurrence of femoral head necrosis, muscle atrophy also begins to occur with the appearance of other symptoms and signs. That is, the volume and tension of the muscles are gradually decreasing, mainly manifested as hip muscles, thigh muscles, and calf muscles.
(3) tenderness: sometimes deep tenderness around the musculoskeletal head, especially in the adductor muscles, there is significant tenderness to treat avascular necrosis of the femoral head. In addition, longitudinal sputum pain, active pain, etc. also exist to varying degrees.
(4) Special signs: combined with the etiology and morbidity, symptoms and other signs, and then do some special physical examination, and can see positive signs, such as "4" sign (+), Thomas (Thomas) sign (+) , Allis's sign (+), Trendelen's sign (+), etc.
Examine
Traumatic femoral head necrosis
X-ray performance: The posterior anterior, lateral or tomographic slices of the hip should be photographed. It is necessary to photograph the two hips to control the density. Significant signs of early lesions are often found on lateral and tomographic slices.
Combined with CT, MRI, bone scan and bone biopsy. X-ray can only see the blood circulation around the femoral head is reduced, osteoporosis, a small amount of cystic changes. CT diagnosis of femoral head necrosis, it found that the time of femoral head necrosis compared with MRI, early CT slices in the femoral head necrosis can be symptoms. The CT scan is superior to MRI in judging the change of bone in the femoral head. It is important to prevent the collapse of the femoral head necrosis after diagnosis.
Diagnosis
Diagnosis and diagnosis of traumatic femoral head necrosis
The diagnosis of traumatic femoral head necrosis is not difficult, but the clinical history of traumatic trauma and femoral head necrosis are mostly diagnosed as unilateral morbidity and treatment.
1. Defining the history of trauma
Patients should be clear whether they have had a history of trauma. Experts on femoral head necrosis in Chongqing Yuqing Hospital pointed out that femoral neck fracture, hip dislocation, hip contusion and some other fractures can cause femoral head necrosis. So if you have suffered such trauma, you must pay attention to the occurrence of femoral head necrosis.
2. Identify the injured part
If the femoral head necrosis caused by trauma, most of the unilateral femoral head necrosis, and the injured side, bilateral necrosis rarely occurs, unless bilateral injury may occur bilateral bilateral necrosis.
3. Defining the treatment process
Whether the patient who has been traumatized has undergone some treatments such as traction, repeated reduction, surgery, etc., and the effect after treatment is as follows: whether the reduction is satisfactory, whether there is no reduction, malunion, and the internal fixation is still in the body. Patients should explain the doctor in a detailed and correct manner so that the doctor can get the correct diagnosis.
The characteristics of traumatic femoral head necrosis after femoral neck fracture are as follows: 1 After the internal fixation of the fracture, the pain changes from light to light or disappears. After the pain occurs again, after the internal fixation is removed, the weight is not taken care of, and the femoral head collapses. Minhang 3 was found after the internal fixation after resetting, or before and after the internal fixation, when the x-ray film was taken, the symptoms were not very prominent.
