In a dark alley, there is a middle-aged man walking swayingly, passers-by can smell a strong smell of alcohol when passing by him. Suddenly, the man tripped over a brick on the side of the road and fell to the ground. Unexpectedly, the fall caused him to feel a severe pain under his hip, which made him unable to stand up. A well-meaning person passing by helped him dial an ambulance and contact the man’s family.
The man who fell down is Uncle Zhang, 55 years old this year. Uncle Zhang likes to drink with friends when he has nothing to do. Every time he drinks, he goes home very late. . After examination by the hospital, Uncle Zhang was diagnosed with bilateral femoral head necrosis, requiring surgical treatment.
Why do I need surgery just for a fall? How can such a hard bone as the femur be necrotic?
Why do I get femoral head necrosis?
The femur is the longest tubular bone in the human body. It is connected to the hip joint above and the knee joint below, and the surrounding muscles, blood vessels, tendons and other tissues constitute our thigh. There is a hemispherical structure at the upper end of the femur, which is the femoral head. Walking and activities of the human body require the support of the femoral head, so the femoral head is also more prone to injury.
Between the femoral head and the femur, the neck of the femur connects the two. If the blood flow at the femoral neck is blocked or interrupted, it may lead to structural changes or even collapse of the femoral head, resulting in avascular necrosis. This series of pathological evolution processes is called Femoral head necrosis. Just like the relationship between the neck and the head of the human body, if the blood supply to the neck fails, it will cause ischemia, hypoxia and even necrosis of the brain.
The most common traumatic cause of femoral head necrosis is traumatic hip. If the femoral neck is fractured, or if the hip joint is dislocated due to trauma, the blood supply to the femoral head is disrupted. In addition, hemorrhage may occur in the joint capsule, causing increased pressure in the capsule and accelerating the process of femoral head necrosis.
There are two main causes of nontraumatic femoral head necrosis: alcohol and hormones. Long-term drinking can lead to abnormal fat metabolism in the body, thereby affecting the differentiation ability of bone marrow mesenchymal stem cells, and eventually causing necrosis of the femoral head. According to clinical studies, chronic alcoholism can cause alcoholic femoral head necrosis.
Corticosteroids are commonly used drugs in clinical treatment. Various studies have shown that long-term use of high-dose glucocorticoid can increase the risk of femoral head necrosis. This may be related to factors such as increased intraosseous pressure caused by glucocorticoids, osteoporosis, and impairment of bone tissue repair.
Atraumatic necrosis of the femoral head often occurs in men between the ages of 30 and 50, and long-term smoking and obesity may cause Increased chance of femoral head necrosis.
So, when the body has what symptoms, will it remind us that it may be caused by femoral head necrosis?
If these symptoms occur in the body, it may be femoral head necrosis
pain
Pain is the most common and typical symptom of femoral head necrosis . In the early stage of necrosis, the inflammation caused by the necrotic tissue of the femoral head often causes some mild pain that are not easily detected, and this pain will also increase as the disease progresses. The pain is usually in the groin area, but it can also radiate to the ipsilateral hip or knee.
If necrosis occurs in both femoral heads, it will manifest as left and right intersecting pain, and then gradually develop Some people also experience painful lameness due to difficulty walking, stiffness of the hip joints. If the femoral head collapses, lower limb deformities and pelvic tilt may also occur, and you can only walk on crutches.
The pain caused by necrosis of the femoral head may not be constant, severe pain, but intermittent rest pain (bouts of pain at rest). When the femoral head necrosis is severe, the volume of the femoral head is reduced due to the lesion, and subluxation occurs. At this time, the femoral head can no longer bear the huge pressure brought about by the body’s activities, causing some patients to experience severe pain when walking, or even unable to walk.
Limited mobility
When the femoral head is necrotic, it causes the hip to which the femoral head is attached. Problems with the joints, often manifested as restriction of normal movement. such as walking, squatting, sitting, standing and other activities that require the use of the hip joint, patients often cannot perform normally, which will bring serious inconvenience to the patient’s life.
If there is a large area of collapse or structural variation of the femoral head, and its shape and structure are completely changed, it may cause disability of the patient, not only the inability to walk, but also may cause various complications .
Especially in some children with necrosis of the femoral head, symptoms of claudication may occur, and this lameness may accompany the patient for life. When children have problems walking, they must be checked in time to avoid aggravation of necrosis and affect treatment.
Muscle atrophy
After a bone problem, the tissue around the bone may also appear accordingly question. When ischemia occurs in the femoral head, the muscles surrounding the joint may also be affected, resulting in insufficient blood supply and atrophy. Elderly people may be reluctant to move because of the pain caused by necrosis of the femoral head, and long-term lying in bed can also lead to muscle atrophy.
Osteoporosis occurs when the bone tissue cells in the femoral head decrease, which in turn causes the physical strength of the joint to weaken. As the disease progresses, muscle atrophy and avascular necrosis will occur. Subsequently, it will affect the health of surrounding joints and bones, so some patients with femoral head necrosis will have problems such as knee pain and limited mobility.
Positive “4” test
When femoral head necrosis causes hip and sacroiliac joints After the lesion occurs, the patient may show a positive “4” test.
Lay flat on the bed with one leg straight and the other raised, placing the ankle on the outside of the knee of the straight leg, pressing down on the bent leg , making the legs the “4” shape. At this time, observe whether the patient’s bent leg can touch the bed surface and whether there is pain in the sacroiliac joint. The “4” test was positive if the bed surface could not be touched or the sacroiliac joint was painful. Proved the possibility of necrosis of the femoral head.
Early femoral head necrosis may not have obvious symptoms, but it can be judged by X-ray examination. If the X-ray shows a slight fracture in the femoral head, it may cause a more serious problem. Therefore, you must pay more attention when discovering X-ray problems.
What are the treatment options for femoral head necrosis? How to prevent the occurrence of femoral head necrosis in life?
How to prevent and treat?
As with any disease, prevention is far more important than cure. So let’s talk about how to avoid the risk of femoral head necrosis first.
The first is the protection of bones and joints. With the increase of age, the metabolic capacity of bone tissue gradually weakens, coupled with insufficient calcium intake, it is easy to develop osteoporosis. Especially in the middle-aged and the elderly, severe osteoporosis may also lead to risk factors such as fractures.
Therefore, it is necessary to strengthen the exercise of the joints, and insist on a moderate amount of exercise every day, which can not only prevent osteoporosis, but also improve the body’s immunity. In your daily diet, you should also pay attention to your calcium intake, and eat more calcium-rich foods, such as milk, fish, shrimp, spinach, etc. Also, take care to not overwork and avoid spraining your hips.
The second is Abstain from drinking. We learned above that alcohol is one of the main factors that cause non-traumatic femoral head necrosis. Drinking alcohol is very harmful to the human body, and alcohol is also listed as a carcinogen by the World Health Organization. Although drinking alcohol can suppress nerve function and temporarily reduce pain, alcohol is broken down in the body and exacerbates pain symptoms. To prevent femoral head necrosis, be sure to avoid alcohol.
The last step is to develop the habit of regular physical examination. It is recommended that healthy people aged 20-45 have a physical examination every two years, and middle-aged and elderly people over 45 years old have a physical examination once a year. If you are a patient with chronic diseases, you can have a physical examination every six months. Regular inspections can lead to early detection of problems and early treatment.
The treatment of femoral head necrosis is divided into conservative treatment and surgical treatment. The main purpose of the treatment is to prevent the collapse of the femoral head and maintain the original hip joint as much as possible. The specific treatment plan needs to be determined by the doctor according to the individual situation of the patient.
In conservative treatment, glucocorticoids should be discontinued first. Take protective measures for patients, Avoid impact sports, and promote the self-repair and regeneration of bone tissue through biological responses such as hyperbaric oxygen therapy. Also try taking medicines that promote bone and cartilage growth.
In the case of ineffective conservative treatment, surgical treatment is required. The main surgical methods include hip preservation surgery and artificial hip replacement< /strong>. Hip-preserving surgery is mainly to relieve pain, restore blood supply to the femoral head and the function of the hip joint. You can try to establish a new channel to reduce the pressure in the medullary cavity and promote the formation of new blood vessels to restore the normal blood supply in the femoral head.
Hip replacement surgery may be considered when hip-preserving surgery is ineffective or severe collapse of the femoral head.
Doctors recommend
Patients suffering from femoral head necrosis should pay attention to the protection of the hip joint and exercise moderately within the range allowed by the body or under the guidance of doctors. Obese patients should pay attention to losing weight, so as not to cause a greater burden on the joints for a long time. For patients whose activities have been affected, a cane can be used for daily walking to relieve pressure on the joints. In terms of life, pay attention to quitting smoking, have a balanced diet, and eat more calcium-rich foods, but pay attention to calcium intake to avoid excess.