aseptic necrosis of bone
Introduction
Introduction Aseptic osteonecrosis, also known as ischemic osteonecrosis, is a pathological condition in which the blood supply of bone tissue is deficient and the cells are repaired.
Cause
Cause
Not very clear. Can be divided into three categories:
1 Traumatic osteonecrosis: Some bone tissues in the body have special blood circulation, and ischemic necrosis is easy after trauma. The avascular necrosis of the femoral head is common after femoral neck fracture and posterior dislocation of the hip. The humeral head and lunate bone after dislocation of the shoulder joint are common. It can also occur after fracture or dislocation of the wrist, scaphoid and talus.
2 idiopathic osteonecrosis: more common in the femoral head, femoral condyle, humeral head can also occur. Osteonecrosis can be secondary to corticosteroid use, or barotrauma, Gaucher disease, chronic alcoholism, sickle cell anemia, radiation exposure, chronic pancreatitis, and gout. Therefore, some people speculate that osteonecrosis is associated with high-lipeemia osteoarter embolism, intramedullary hypertension, and nitrogen bubble embolism.
3 osteochondritis: whether it is ischemic osteonecrosis is not conclusive, but these diseases have ischemic osteonecrosis in the pathological process, more common in adolescents, occur in the epiphysis, common disease with femoral head cartilage (Legg -perthe disease), aseptic necrosis of the humeral head (Freiberg disease), aseptic necrosis of the lunate bone (Kienbock's disease), aseptic necrosis of the scaphoid (Kohler's disease), aseptic necrosis of the humeral head (Panner's disease), Vertebral primary osteophyte (Calve disease) and the like.
Examine
an examination
Related inspection
Bone imaging
In stage I and stage II of avascular necrosis of the femoral head, only joint pain is occasional. Stage III occurs intermittent pain in the inguinal region and radiates to the medial thigh. The hip joint activity is mildly restricted and mild muscle atrophy. In stage IV, the pain is aggravated, especially when standing from a sitting position, painful claudication occurs, hip activity is limited, and the abduction and internal rotation are performed. There is severe joint pain in the V phase, and it is necessary to have a slow-moving stroke and the joint activity is obviously limited. In stage VI, the joints are hard and the pain is severe, so they can't hold weight at all. The development period from Phase I to Phase IV is about two years.
Osteophyte chondritis is a case of femoral skull cartilage inflammation, which is more common in children aged 4-8 years. Early joint swelling, pain, lameness, etc., late joint activity is limited. Sometimes there is a hip varus or a subluxation deformity.
X-ray examination: No abnormalities in stage I of avascular necrosis of the femoral head. Spotted sclerosis can be seen in stage II. Stage III shows hardening, cystic changes and new moon signs. Stage IV shows the inverted conical hardening of the femoral head and deformation of the femoral head. V-stage joint space is narrowed, bone hyperplasia, asymmetry of the femoral head, increased density, fragmentation and separation after necrosis. In stage VI, the joint space disappeared, the articular surface was uneven, and the callus increased. Sometimes there is a hip varus.
Diagnosis
Differential diagnosis
Avascular necrosis of the femoral head needs to be differentiated from hip joint tuberculosis and rheumatoid arthritis.
In stage I and stage II of avascular necrosis of the femoral head, only joint pain is occasional. Stage III occurs intermittent pain in the inguinal region and radiates to the medial thigh. The hip joint activity is mildly restricted and mild muscle atrophy. In stage IV, the pain is aggravated, especially when standing from a sitting position, painful claudication occurs, hip activity is limited, and the abduction and internal rotation are performed. There is severe joint pain in the V phase, and it is necessary to have a slow-moving stroke and the joint activity is obviously limited. In stage VI, the joints are hard and the pain is severe, so they can't hold weight at all. The development period from Phase I to Phase IV is about two years.
Osteophyte chondritis is a case of femoral skull cartilage inflammation, which is more common in children aged 4-8 years. Early joint swelling, pain, lameness, etc., late joint activity is limited. Sometimes there is a hip varus or a subluxation deformity.
X-ray examination: No abnormalities in stage I of avascular necrosis of the femoral head. Spotted sclerosis can be seen in stage II. Stage III shows hardening, cystic changes and new moon signs. Stage IV shows the inverted conical hardening of the femoral head and deformation of the femoral head. V-stage joint space is narrowed, bone hyperplasia, asymmetry of the femoral head, increased density, fragmentation and separation after necrosis. In stage VI, the joint space disappeared, the articular surface was uneven, and the callus increased. Sometimes there is a hip varus.
