Aseptic necrosis of the femoral headThe disease, called aseptic necrosis of the femoral head, occurs quite often. Women suffer from them several times less often than men. It is characteristic that 2/3 of the patients are young people 20-45 years old. It is a rapidly progressing disease.
In the absence of proper treatment threatens with violation of the functions of the joint and, as a result, disability.
That's why it's important not to miss the first symptoms of the disease.
The main causes of the disease
The head of the femur is a closed compartment that is sensitive to circulatory disorders that alter the architectonics of the bone.
Blood supply to the head is through three small arteries. When one of them stops( violates) the supply of blood, necrosis( ischemia, necrosis) occurs in the area of the head that was supplied by the damaged artery.
The essence of asthenic necrosis is a violation of microcirculation and further necrosis of the bone tissue zone in the head of the hip bone. As a result, the integrity of the cartilage covering this area is disturbed and a secondary deforming arthrosis develops.
Vascular causes of
Common causes of discontinuance of artery supply with blood from the head of the hip bone:
- compression or twisting of the artery in trauma,
- its obstruction by small thrombus,
- venous congestion,
- prolonged vasospasm,
- increase in blood viscosity,
- disturbed venous outflow.
Vascular disorders increase intraosseous pressure, resulting in mechanical destruction of bone tissue.
About the mechanical theory of
The "mechanical" theory supplements the vascular theory of causes. According to her, the head of the femur undergoes "fatigue".
Impulses about this are sent to the cerebral cortex.
Back signals lead to spasm of blood vessels or stagnation of blood, disruption of metabolic processes, accumulation of decomposition substances in bone.
As a result, the physico-chemical and structural properties of the bone change, which is gradually destroyed with difficulty in local blood circulation.
Exchange disorders and pathological conditions
Among them leads as the causes of the ailment:
- long-term use of alcoholic beverages;
- long-term use of corticosteroids in high doses;patients with arthritis or bronchial asthma take corticosteroid hormones for a long time( metipred, prednisolone, etc.);
- chronic pancreatitis;
- high doses of radiation irradiation;
- caisson disease;
- sickle cell disease and other diseases,
- trauma( bruised thigh, hip dislocation, hip bone fracture, etc.).
One of the causes of the ailment is a congenital defect in the form of a hip dislocation( hip dysplasia).
Symptomatics and Diagnosis of
Disease stages of aseptic necrosis of the head of the hip joint with distinctive symptoms:
- Initial. Pain serves as a starting clinical manifestation. It grows to the maximum and becomes intolerable in the first two or three days. Usually appears in the groin, less often in the thigh, knee joint, lower back. The joint fully retains its mobility.
- The second is an impression fracture. At the patient constant strong pains in a joint even in rest. During the period from several days to six months, vascular disorders develop. Possible atrophy of the muscles of the thigh. The aching leg seems to decrease in volume. Movement is limited. Lightness is noted in the gait.
- The third is a secondary arthrosis. For 6-8 months, the bone beams are destroyed, the femoral head is deformed. In the joint, severe pain is noted. Movement is limited in three directions. When walking, there is a starting pain, an average limp, a desire for support.
- Fourth .When the disease lasts more than 8 months, there is complete destruction of the head. Constant pains in the joints of the hip and knee, in the lower back. Movement is severely limited. Atrophy of the muscles of the buttocks and thighs is strongly pronounced. The aching leg becomes shorter, according to a more severe variant, it lengthens.
The widely used methods for diagnosis of include:
- MRI .The early stage is detected by magnetic resonance imaging or computed tomography. This method of diagnosis almost 100% reveals the disease, when the X-ray does not "see" it. Therefore, during the first weeks of the disease, diagnosis with MRI is a priority.
- Radiography .Aseptic necrosis on the X-ray is made visible only in 2-3 stages of the disease. When the disease has an "experience" of more than a year, its signs are very clearly manifested in the pictures. At this stage, the tomogram is not needed.
- Radioisotope scanning .This method shows the unequal absorption of the radioactive preparation by pathological and normal bone tissues. The administered dose of the drug serves as a "mark" for the abnormal zone in the bone. The result is a two-dimensional image where the affected areas of the bone are visible.
X-ray patterns of patients with different stages of aseptic necrosis of the femoral head: from a - the initial stage, to d - complete destruction of the bone.
Treatment and pain relief with conservative methods
The main groups of medicines used to treat the disease include:
- Anti-inflammatory non-steroid preparations , for example, diclofenac, indomethacin, piroxicam, butadione, etc. They contribute to reducing pain in the thighand groin. This group of drugs does not cure the disease. But due to anesthetic action, prevention of reflex spasm of muscles occurs with pain. These drugs are especially effective in the first six months of the disease.
- Drug vasodilator , for example, trental, theonikor. They eliminate stagnation in the circulation. As a result, the arterial blood flow is activated and the spasms of small vessels are removed. Decreased vascular night pains in the affected joint. Effective in the first 6-8 months of ailment.
- Bone Restorers .To stimulate the recovery process help with vitamin D( calcium D3 fort, oxide oxidation, napokal D3, etc.).These drugs contribute to the accumulation of calcium in the head of the affected bone of the thigh.
- Calcitonins effectively stimulate bone formation and eliminate bone pain. These include miacalcic, sibacalcin, alostin, and others.
- Chondroprotectors ( chondroitin sulfate and glucosamine) provide cartilaginous tissue and restore the structure of the destroyed cartilage. Treatment gives an effect in the period of the disease from 8 months.
Therapeutic gymnastics and massageOne of the most important treatments for necrosis of the femoral head is the therapeutic gymnastics .Without it, it is impossible to overcome the progressive deterioration of blood circulation in the region of the femoral head and the growing atrophy of the hip muscles.
It is necessary to choose exercises to strengthen the muscles and ligaments of the sore leg. And there should be no pressure on the head of the hip bone without active flexion-extension of the legs.
An example of a static exercise is a small rise of a straight leg in a position on the back of a prone. The leg is supported by weight. There will be fatigue, although the joints do not work. A set of exercises should be carefully thought through with the doctor.
Therapeutic massage is used as an additional method of treatment. But if you do it correctly, without rough pressure, it will bring real benefits. With massage of the femoral muscles and back, blood circulation improves.Pains in the hip joint can talk about the development of arthrosis. How to properly treat coxarthrosis read in our stelye. Chto do, if you have a suspicion of deforming arthrosis of the ankle joint? The measures that need to be taken first look here.
Orthopedic rulesIt is very important to observe the orthopedic regime. Many experts oppose the prolonged use of crutches and bed rest at the onset of the disease.
In their opinion, this threatens:
- progressive muscle hypertrophy,
- by the formation of pain resistant syndrome,
- by violation of motor stereotypes.
For to facilitate the flow and reduce the duration of the disease you need:
- walking up to 20 min.in average tempo,
- walking up the steps,
- exercises on the stationary bike,
- using canes in the first weeks and with long walks,
- fighting overweight.
It is necessary to exclude inertial loads on the joint in the form of lifting weights, jumps, running.
Surgical treatment of
disease Surgery is resorted to when conservative drugs are ineffective.
Decompression of the femoral head
The operational method of decompression consists in drilling a channel into the femoral head region with no blood flow. The drill passes along a large trochanter and neck of the hip bone.
- increase of blood supply of this site due to the growth of new vessels in the formed channel( puncture),
- decrease in intraosseous pressure in the head of the thigh.
By reducing the pressure in 70% of patients reduce pain.
Transplant of autograft from fibula
Unlike decompression, a fragment of the fibula, located on the vascular pedicle, is transplanted into the drilled cavity. Such a transplant from your own body gives an improvement in blood flow and strengthening of the neck of the thigh.
Endoprosthetics of the hip joint
It consists in the complete replacement of the damaged joint of the thigh with an artificial one. A titanium pin( or zirconium) with an artificial head on the edge of the joint is inserted into the formed cavity of the hip bone and fixed.
Simultaneously, the second articulating part of the joint is operated, inserting a concave bed to rotate a new head in it. Correctly done surgery removes pain and restores joint mobility.A timely and well-conducted treatment for the head of the hip joint in most patients gives an improvement over several months of therapy.
In another part of the patients the condition is stabilized, which does not lead them to surgical measures.
Video: What systemic diseases can provoke the development of necrosis of GDK
Hip joints are the largest in the human body, they actively participate in walking movements and play a crucial role in the proper functioning of the musculoskeletal system.
But enrichment with oxygen and nutrients provides only one artery, and in case of blood supply disorders, the cells of the head of the hip joint begin to die - this process is called necrosis of the hip joint. Another term for this disease is the aseptic necrosis of the head of the hip joint or Perthes' disease.
What are the possible reasons?
- long-term use of steroid( hormonal, anti-inflammatory) drugs in large quantities;
- excessive consumption of alcoholic beverages;
- injury, which could lead to a violation of the blood supply area( dislocations, fractures);
- transferred inflammatory processes;
- regular overload, a change in atmospheric pressure( for example, in scuba divers or miners).
These are the most common causes, but, unfortunately, in some cases it is impossible to establish what exactly led to the destruction of the bone tissue of the joint.
There is a version that can be the cause of fatigue and systematic mini injury, like that of athletes. True, this remains only a theory.
Symptoms and Diagnosis
Necrosis of the head of the hip joint is manifested in accordance with the four stages of the development of the disease:
- for the first stage is characterized by small changes in bone tissue( up to 10%), joint mobility is unlimited, the patient complains of periodic hip pain giving in the groin orfoot;
- cracks appear on the area from 10 to 30% of the entire bone area, the pain is greatly increased, the mobility is markedly limited;
- dying occurs on 50% of the joint tissues, mobility is greatly reduced, the patient experiences constant, severe pain;
- there is almost complete restriction of joint mobility, buttocks and thigh muscles quickly atrophy, painful pains do not pass.
On radiographic examination, only manifestations of the disease at 3-4 stages are clearly visible. Therefore, for the detection of necrotic lesions of tissues in the early stages of using MRI.
Treatment of hip joint necrosis
There are two ways of influencing the disease: using surgery and conservative.
It will be fair to note that the conservative treatment of the necrosis of the head of the hip joint does not eliminate the problem completely, but only helps to significantly slow down the process of cell death. And use it rationally only in the first three stages of necrosis.
Conservative method involves the use of various drugs( for the removal of inflammation, pain relief, vasodilation, regeneration of cartilage tissues, etc.), as well as a whole set of procedures that the doctor prescribes in accordance with the stage and course of the disease as a whole.
In this case, the patient is limited in long-term stresses on the joint and replaces them with physiotherapy exercises to maintain muscle strength.
But it is important to remember that only surgical treatment of aseptic necrosis of the hip joint can completely relieve the disease.
It is true that if the disease is started and moved to the fourth stage - the damaged joint is replaced by an artificial one, and the life of the prosthesis is no more than 15 years. After this time, a second operation is necessary.
Aseptic necrosis of the hip joint is a very dangerous disease and the faster the patient turns for qualified care, the greater the chance of a full recovery.
Aseptic necrosis of the head of the femur is manifested at different stages by the following symptoms:
- In the first stage, the pain manifests suddenly, is localized in the groin, in the region of the hip joint, is given back and knee. Then comes a period of slight improvement, when the pain manifests only when the load on the joint. After a short remission, the intensity of pain increases. At this time, a little decrease, atrophic muscles of the thigh, but the lameness is not there, the weight is distributed to both extremities.
- In the second stage, the pain is always felt, the affected hip becomes less healthy in the girth by a few centimeters. Most of the body weight is transferred to a healthy limb.
- The third stage is characterized by severe lameness, significant pain, and atrophy extends to the muscles of the shins. The leg may become shorter.
- The fourth stage is characterized by a completely disturbed gait and a strong atrophy of the entire leg. Avascular necrosis of the femoral head completely destroys the joint, which leads to disability and requires prosthetics.
Necrosis of the hip and knee
The hip joint is the largest spherical articulation of the skeleton, it consists of the joint cavity and the head moving in it. Blood supply occurs with the help of only one femoral artery.
In thrombosis or atrophy of the femoral artery, blood poorly feeds this zone, and bone tissue begins to suffer from the lack of nutrients and oxygen .Regeneration of bone mass stops, and the joint begins to collapse. Avascular necrosis of the bone is accompanied by severe pain in the affected area.
Problems with the knee joint usually begin after injury, as a result of which the blood supply of this zone is stopped or disturbed. The condyles( protrusions on the bones to which the muscles are attached), which make up the knee joint, suffer in the first place.Necrosis of these bones does not allow to bend and unbend lower limbs, as a result of which a person becomes disabled.
Non-steroidal anti-inflammatory drugs help relieve pain and inflammation in the affected areas, but self-medication here does not help - with the slightest suspicion, you need to see a doctor immediately. It is likely that surgery will be prescribed - bone grafting or joint replacement.
Necrosis of the brachial and talus bones, Mushe's disease
First, pains appear in the shoulder joint, it becomes inactive, then the muscles are atrophied, and deforming arthrosis begins. Treatment of aseptic necrosis of the talus is most often in endoprosthetics of the joint of the upper limb.
Treatment for aseptic necrosis
Tactics of treatment consists primarily in restoring blood circulation in the joint and renewing bone regeneration.
Drugs and healing methods prescribed for the treatment of aseptic necrosis of the femoral head:
- Non-steroidal anti-inflammatory drugs - indomethacin, diclofenac, piroxicam, butadione and related agents, which reduce pain in the inguinal zone and in the leg. They relieve muscle spasm.
- Vasodilators - theodical, trental - resume blood circulation, cause the tissues of the head of the bone to regenerate due to good blood supply. Femoral artery is restored, spasmodic manifestations in small blood vessels are removed. These remedies are practically harmless, but you need to be careful when you suspect a heart attack.
- Novocain blockade of the lumbar region.
- Massage in the affected area to improve blood flow.
- Hirudotherapy - treatment with medical leeches.
- Preparations to stimulate bone mass formation - calcium preparations in combination with vitamin D( vitamin improves the absorption of calcium).
- Calcitonins - drugs derived from thyroid hormones, help regenerate bone cells, eliminate pain in the necrotic areas of the bones. Stop the leaching of calcium from the skeleton.
- Chondroprotectors, feeding and restoring cartilage tissue in joints, - glucosamine and chondroitin sulfate.
- Mandatory use of a walking stick or wand to reduce the load on the joint.
- Therapeutic gymnastics.
- Endoprosthetics with titanium and zirconium prostheses.
As a preventive measure for this type of disease, should be recommended for a healthy lifestyle.To avoid thrombosis in the femoral artery, you need to eat right - without excessively cholesterol dishes, fatty, salty and smoked foods.
Also you can not move too little , because that's why there are disorders in the circulation of pelvic bones. Alcohol is harmful to all organs of - and in the causes of this disease it is not in last place.
Adhere to the principles of a healthy life, in time contact a doctor and you do not have to think about how to cure the necrosis of the head of the femur, and you will be able to avoid many problems with your body.
Treatment of aseptic necrosis at different stages »Luxmama.ru
The hip joint consists of the head of the femur and a special depression in the pelvic bones, called the acetabulum. Normally, the head of the femur should be inserted into the acetabulum and, through ligaments, fixed in it. The articular surface of the head has the shape of a hemisphere, and under the acetabulum it should be understood a recess having smooth rounded walls in the shape of a bowl. Due to the presence of such a form of contiguous surfaces, the leg can make large amplitude movements in different directions. If necrosis of the bone of the head of the femur takes place in places where it has the greatest load, aseptic necrosis of the hip joint develops.
Symptoms of aseptic necrosis
Aseptic necrosis is a severe degenerative-dystrophic( associated with impaired blood circulation and metabolic processes) disease. With aseptic necrosis, a gradual destruction of the femoral head occurs, the formation of bone formations( osteophytes) along the edges, a change in the structure of the acetabulum, and the formation of a deforming arthrosis of the hip joint. Movement in the joint is severely limited until complete immobilization. Under necrosis is understood the course of the process of necrosis of tissues, which can be caused by a variety of causes. The term "aseptic" means that in this disease necrosis occurs under sterile conditions, that is, microorganisms do not participate in this process.
The course of aseptic necrosis has certain stages, which depend on what degree of damage the structures of the hip joint. Each stage has almost the same symptoms, but their nature and degree of expression varies.
Symptoms of aseptic necrosis of the hip joint include:
- occurrence of pain;
- development of soft tissue atrophy of the hip;
- reduction of the load on the aching leg, transfer to the healthy leg of most of the body;
- decrease in the amplitude of movements in the joint.
Treatment of aseptic necrosis
It is possible to conduct conservative and surgical treatment of aseptic necrosis of the hip joint. The conservative method of treating necrosis is aimed at preventing or slowing the progression of the disease;reduce or relieve pain;improve the function of the joint. Conservative treatment of aseptic necrosis includes:
- taking non-steroidal anti-inflammatory drugs and corticosteroids to relieve pain, reduce inflammation in the affected joint, and normalize metabolic processes;
- performance of exercise therapy;
- the physiotherapy, in which electrophoresis with novocaine is performed, paraffin, ultrasound, ozocerite, diadynamic currents, balneotherapy, etc are used;
- realization of orthopedic treatment: application of orthopedic lining for the prevention of contractures etc.;
- holding a massage in order to increase the contractile function of the muscles and restore their function.
The surgical treatment of aseptic necrosis of the hip is different depending on the stage of the disease. At the initial stage, the main objectives of the operation are:
- to restore the circulation of blood in the tissues of the hip joint;
- to eliminate venous congestion.
Treatment in the second stage of
If the disease was detected in the second stage, then:
- it is necessary to change the position of the femoral head in relation to the acetabulum so that the most damaged portion of the head is removed from the load;
- needs to improve blood supply to the joint and reduce intraosseous blood pressure;
- it is necessary to increase the mechanical strength of the damaged sections of the head.
In the treatment of aseptic necrosis in later stages, the damaged joint is replaced with a prosthesis to restore the function of the lower limb.