Treatment of aseptic necrosis of the femoral head 2 and stage 3

Femoral head necrosis is generally staged by FICAT: stage I and II are the early stages of necrosis, and the femoral head remains round. Stage III is the necrosis and collapse stage of the femoral head, and its degree of collapse is the key to the selection of the first method, so it is divided into three types: A, B, and C according to the degree of collapse.

Stage IV, the lesion enters the osteoarthritis stage. This stage is also divided into three types: A, B, and C, except for the narrowing of the joint space (1 2 of the normal joint space), the increase in the density of the whole head, the hyperplasia of the molars and the head, and the appearance of osteophytes, the manifestations of each type are consistent with those of stage III types. Stage V and stage VI are advanced stages of osteoarthritis with severe limitation of mobility.

Staging Surgery (Suitable for Young and Middle-aged People):

Most of the young and middle-aged people are the pillars of the family, the main pillar of the family economy, and they have high expectations for the curative effect, hoping that the recovery will be fast, the long-term effect will be good, and they will be able to participate in the work normally. In view of the contradiction between artificial joints and age, according to the diagnosis and staging type, we designed the corresponding hip preservation surgery method with traditional Chinese medicine, and achieved positive efficacy.

1) For stage II, with a large range of head necrosis and no obvious cyst cavity, new products such as modified medullary core decompression and compression bone graft support are used.

2) Stage IIIA is performed with femoral head lesion removal, sartorial musculoskeletal flap or greater trochanteric bone flap implantation, or compression bone graft support.

3) Stage IIIB Removal of femoral head lesions, implantation of large bone flaps and implantation of multiple vascular bundles, and some can be suppressed bone graft support.

4) Stage IIIC: Femoral head lesion removal, greater trochanteric bone flap implantation and multiple vascular bundle implantation were performed. If the head and neck are broken, appropriate internal fixation should be given.

5) The stage IV joint space is acceptable, the cephalar-mobulary relationship is still stable, and cephaloplasty, bone flap and vascular bundle implantation are used. If the femoral head is slightly displaced, acetabular capping is used. Patients with unstable cephalar relationship and cartilage surface degeneration may consider joint replacement as appropriate.

6) Stage V: Femoral head, acetabular plasty and multiple vascular bundle implantation are used.

Surgery** is best performed in the type of stage II and III necrotic femoral head that does not collapse or does not collapse slightly for a long time (pericollapse stage), and if the joint is properly protected, the joint can survive for a long time without OA (osteoarthritis) in the short term.

Artificial total hip replacement.

It is suitable for patients with femoral head necrosis stage IV or above, aged over 50 years old, or elderly patients with femoral neck fracture and advanced osteoarthritis, and young and middle-aged patients with advanced necrosis can also be considered if necessary, such as severe symptoms, hip preservation**, unsatisfactory efficacy or ankylosing spondylitis, joint deformity, ankylosis or severe symptoms that are unable to take care of themselves.

For more specific points, please refer to.

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The fourth stage of femoral head necrosis belongs to the disability stage. The morphological structure of the femoral head was significantly changed, the trabecular structure was changed, a large area was irregularly collapsed or flattened, and the gap between the acetabulum and the femoral head disappeared. Among the symptoms of the various stages of femoral head necrosis, the fourth stage is clinically characterized by pain, dysfunction, stiffness, inability to walk, dislocation or subluxation, and marked limitation of movement.

Conservative** is indicated for patients with small necrosis of the femoral head without femoral head collapse. **The process requires strict follow-up, weight control, and weight avoidance. In conservatism, physics and shock waves are also recognized as one of the effective methods.

Double crutches and hyperbaric oxygen can be used to improve osteocyte hypoxia.

Femoral head necrosis needs to be staged**. In general, head retention** is carried out in stages, and the pain is obvious, so hip replacement should be considered! So what is the third stage?

The collapse of the femoral head has entered the third stage! At present, hip replacement technology is very mature. In general, even young people cannot wear ceramic joints for life, and they do not need revision surgery due to joint wear and tear.

However, hip replacement is, after all, a technically demanding procedure. It is recommended to go to a big hospital!

If femoral head necrosis is in stage 3, it cannot be conserved**. You need to go to the hospital for a femoral head replacement. After surgery, exercise training, surgical training and other functional exercises can be carried out under the guidance of professional teachers.

Pay attention to maintenance, do not overwork, and reduce the weight of the affected limb. If you don't pay attention to maintenance, it is easy to make the disease again**.

Necrosis of the femoral head is divided into four stages. Stages 3 and 4 are called late stages, so in this case, the joints should be replaced. There is no conservative approach to pedestrian hip arthroplasty.

Antithrombotic drugs should be used routinely postoperatively. At the same time, antibiotics should be used to prevent infection and calcium should be given appropriately. For example, osteopeptide injections can be given intravenously.

Femoral head necrosis is a progressive disease that causes local blood vascularization of the femoral head due to a variety of reasons, resulting in osteocyte ischemia, necrosis, trabecular fracture, and femoral head collapse.

The necrosis of the femoral head enters the collapse phase, which is the third stage, including two types, hip preservation and joint replacement.

Hip preservation**In clinical practice, part of the lesion is removed. Remove the bad bone in the lesion area and collapse area, and perform bone grafting. Including implantation with or without blood vessels, filling the collapse of the femoral head, delaying the necrosis of the femoral head, but mainly delaying the collapse of the femoral head and delaying the time of joint replacement.

If the third stage collapses, the collapse area is particularly large and the necrosis is extensive, and the effect of hip preservation will not be too good. Older age, consider total hip replacement.

By the time of the third stage of femoral head necrosis, the condition is already very serious, and at this time, it is necessary to go to surgery for the replacement of artificial joints.

In the third stage, surgery should be chosen, because this method is very safe and the effect is relatively good.

In the third stage, surgery should be performed**. Because there is no way to heal by taking conservative ** at this time, you must go to a regular hospital for surgery at this time.

**During the period, you must abstain from taking hormones, and at the same time, do not work for a long time, and should gradually engage in work labor. Do not drink a lot of alcohol, and you also need to pay attention to protect the hip joint to avoid damage to the blood vessels of the femoral head caused by hip bumps. These are all things that patients need to pay attention to.

For patients after stage 3 of femoral head necrosis, pain symptoms are generally the mainstay, and some patients may affect normal activities, so they can choose to be active and conservative** first. For example, walking on crutches, reducing weight bearing, reducing one's own body weight, cooperating with hyperbaric oxygen** or drilling decompression surgery**, oral non-steroidal anti-inflammatory and analgesic drugs and blood circulation and blood stasis removal drugs**.

Femoral head necrosis is in the stage 3 clinical diagnosis stage, mainly based on surgical treatment, and it is necessary to formulate a specific plan according to the patient's specific situation, hip arthroplasty can be performed, and the first exercise should be implemented after surgery, and the physical ** stable joint motor function and pain reduction should be integrated.

Stage 3 necrosis of the femoral head is a very serious one, and if you want to be completely aware, you can only take surgery to replace the femoral head. Because of the obvious destruction and deformation of the bone of the femoral head, the purpose of the operation was achieved. Generally, the symptoms of femoral head necrosis are not too serious, you can take conservative**, take some blood-invigorating and pain-relieving drugs, these are only temporary relief of symptoms, can not be achieved**.

Surgical replacement of the femoral head can only be said to be a more feasible way, and it is not completely **, and there are risks and complications associated with surgery.

What are the symptoms of stage 3 necrosis of the femoral head.

X-rays show small cystic changes in the femoral head, and the density of the ring around the cystic area is uneven; trabecular bone structure is disordered, sparse, or blurred; Small collapses can occur, and the collapse area can be 10-30%. Clinically, there are obvious pain and mild limitation of activities.

The morphology of the femoral head is obviously changed, with incomplete margins, insect erosion or flattened shapes, partial trabecular bone structure is lost, bone density is very uneven, the space between the acetabular and femoral head is widened or narrowed, and osteophytes may also be formed.

The symptoms of necrosis of the femoral head are mild and severe, and some people are still in a relatively mild stage, so it is necessary to go to the hospital for examination as soon as possible to reduce the damage of osteonecrosis to the human body. In addition, some people have very serious bone necrosis and do not plan to go to the hospital**, then it is likely to cause a lot of unnecessary trouble, so everyone should improve it a lot.

The third stage of femoral head necrosis can not be cured, femoral head necrosis is a bone damage caused by ischemia, which generally cannot be recovered, the best way to replace the femoral head with femoral head necrosis, generally after replacing the femoral head, you can not exercise vigorously but can live a normal life without any problem, so the femoral head replacement can not be cured, and the only means of cure is to replace the femoral head.

The necrosis of the femoral head has reached the third stage, which is already a relatively serious degree, and there are already changes in the shape of the femoral head and the destruction of subchondral bone, cystic degeneration, and sclerosis. For example, some patients who are unable to tolerate surgery or are unwilling to undergo surgery can be temporarily conservative**, and then achieve joint wear and tear and pain reduction by reducing the use of joints. However, there will be no change in the shape of the joint.

It is completely possible for femoral head necrosis to reach stage III, but the specific plan must be decided by the doctor's thorough evaluation and the patient's will.

The rate of stage 3 femoral head necrosis** is very low.

Because stage 3 necrosis of the femoral head is usually more severe, the local bone may have been severely damaged, and there is still a lot of dead bone. Even if surgery** is performed, such as joint replacement, there is no guarantee that it will be able to return to its original state after surgery, and there may be some mild sequelae. Try to stay in bed as much as possible after surgery, do not move too early, lose weight, and quit smoking and drinking.

After gradual recovery, local functional exercises can be strengthened, or simple activities can be performed by getting out of bed with the help of a cane or crutches. Through active care and care, although it is not possible to return to the patient's pre-illness state, it can also significantly improve the patient's quality of life.

There are stages of necrosis of the femoral head.

In this phase (pre-radiation phase), about 50% of patients have mild hip pain that worsens with weight bearing. Physical examination reveals limited hip motion, with limited motion first occurring with internal rotation and worsening hip pain with strong internal rotation. X-ray display:

May be negative, or scattered osteoporosis or trabecular obscuration may be seen.

The clinical symptoms of stage (necrosis formation, pre-head flattening) are obvious and aggravated compared with stage I. X-ray showed widespread osteoporosis of the femoral head, scattered sclerosis or cystic changes, trabecular bone disorder and interruption, partial necrosis area, and normal joint space.

The clinical symptoms continue to worsen during the transition phase. X-rays show mild flattening of the femoral head, collapse within 2 mm, and mild narrowing of the joint space.

The clinical symptoms are more severe in the collapse stage. The function of the lower limbs is significantly limited, the pain is mostly relieved or disappears, and the muscles of the affected limb are atrophied. X-rays show that the outer contour of the femoral head and trabecular bones are disturbed and interrupted, with semilunar signs, collapse greater than 2 mm, dead bone formation, flattening of the head, and narrowing of the joint space.

The clinical symptoms of the stage (osteoarthritis stage) are similar to those of osteoarthritis, with significant pain and severe limitation of joint range of motion. X-rays show collapse of the femoral head, margin hyperplasia, fusion or absence of the joint space, and hip subluxation. Correct diagnosis and staging are closely related to the method and effect of decision-making.

Early and middle femoral head necrosis can be carried out by conservative methods, I saw in Dahe Daily that Zhengzhou Jihua Orthopedic Hospital has a six-link synchronous regeneration of femoral head in the early and middle stages, if it is in the late stage of femoral head necrosis, it is recommended that people should be able to undergo surgery. Here's a little bit of advice from me, I hope it will be helpful to you.

You can take Tongluo Shenggu Capsule, this medicine is still possible, because this medicine is a Chinese patent medicine, and the elderly don't have to worry about eating it, my mother-in-law just has necrosis of the femoral head and doesn't want to have surgery**, just take this medicine to stabilize, now it doesn't hurt, and the bones don't continue to deteriorate. Your adoption is a support for my work.

In this case, you should first pay attention to rest and keep warm, avoid strenuous activities, minimize weight-bearing, prohibit smoking and alcohol, and can take oral anti-inflammatory and analgesic drugs and blood circulation and analgesic drugs**, combined with hyperbaric oxygen** to enhance the efficacy, if the symptoms are not relieved, the femoral head collapses obviously, hip arthroplasty is required**.

The necrosis of the femoral head begins to collapse from the third stage, and once the femoral head collapses, it is impossible to grow back, which means that there is no such thing as **. Now the best-case scenario is to stop getting worse and stop progressing, and that's the best-case scenario. Now it seems that the best way is to use "blood vessels grafted into the femoral head" to fundamentally solve the necrosis problem caused by "femoral head ischemia".