Original popular science article: How does the femoral head become necrotic?

Editor: Kang Yan Reviewer: Yang Pengbin

(Guo Zhonghua) Femoral head necrosis is a common disease among young and middle-aged people, with a high disability rate. How does this disease occur? How to prevent and treat it? What good methods does traditional Chinese medicine have? These are topics that people often pay attention to. This article starts with a small case and uses easy-to-understand words to tell readers the common causes of femoral head necrosis, including how trauma, hormones, and alcohol lead to femoral head ischemia and necrosis, which in turn causes clinical symptoms and endangers human health. It reminds three groups of people to detect, treat, and prevent early. In particular, this article starts from the perspective of traditional Chinese medicine and uses manual language to describe the pathogenesis of traditional Chinese medicine and the treatment and prevention methods of traditional Chinese medicine. It is well-structured, well-reasoned, and very attractive to readers. It is literary, scientific, novel, and readable.

"Why did I get femoral head necrosis? Is there any good way to treat it in traditional Chinese medicine?" On June 27, 58-year-old Master Zhang, who lives in Jinfeng District, Yinchuan City, consulted an orthopedic doctor at Ningxia Hospital of Traditional Chinese Medicine and Institute of Traditional Chinese Medicine with a worried face. Master Zhang was in good health and rarely got sick, but in February this year, he had a dull pain in his right hip without any signs. The symptoms worsened when he walked more, and he was diagnosed with femoral head necrosis. The expert told him that according to his age and the degree of femoral head necrosis, it is best to take the method of preserving the head (retaining the original femoral head) for treatment, and try to postpone the age of artificial joint replacement, because the lifespan of artificial joints is only a dozen years, and the later the replacement, the better. Since conservative methods of Western medicine are limited, experts suggest that he might as well use traditional Chinese medicine for treatment.

Femoral head necrosis is a common and intractable disease in orthopedics. Due to a variety of factors, the femoral head blood vessels are blocked and the blood supply is interrupted. The femoral head collapses and deforms due to ischemic necrosis, loses its normal function, and has a high disability rate. It is more common in young and middle-aged people. At present, the number of patients with this disease in my country has exceeded 10 million, and there are 100,000 to 200,000 new cases each year. Traditional Chinese medicine conservative treatment is the main method of treating this disease.

① Favor three types of people

It is reported that although there are many causes of femoral head necrosis, it mostly affects three groups of people.

The first group of people are patients with a history of hip trauma, such as hip dislocation, acetabulum fracture, femoral neck fracture, etc. The fracture also damages the blood vessels supplying the femoral head, causing blood vessel distortion, rupture and compression. Although blood supply can be restored after a period of treatment, the damage is difficult to repair. Because the blood supply cannot keep up, qi stagnation and blood stasis cannot be eliminated, ischemic necrosis occurs.

The second group of people are frequent drinkers. Modern research shows that frequent excessive drinking can damage vascular endothelial cells, promote lipid deposition, and cause local microcirculation disorders. Traditional Chinese medicine believes that alcohol is produced from the essence of grains, is hot and toxic, and long-term alcohol abuse can damage the spleen and stomach, leading to dysfunction of transportation and transformation, endogenous dampness and heat, and phlegm. Phlegm affects blood circulation and causes blood stasis, and blood stasis blocks the qi, which affects the dissipation of phlegm, leading to a vicious cycle of phlegm and blood stasis, and phlegm and blood stasis causing arthralgia and femoral head necrosis.

The third group of people are those who take hormones (such as prednisone and dexamethasone) for a long time. Some patients with special skin diseases, nephrotic syndrome, rheumatoid arthritis, etc. need to take hormones frequently, which can cause fat metabolism disorder in the femoral head, osteoporosis, increased intraosseous pressure, micro-fat plugs in the bone blood vessels, and blockage of small blood vessels, resulting in femoral head necrosis. The development of this disease is a relatively slow process, and necrotic areas gradually appear. Femoral head collapse can be seen in 2 to 3 years after the onset of necrosis. Just like a round wheel eventually becomes a flat wheel, the joints are not flexible during exercise, and pain and lameness are prone to occur.

② How to detect early

The early clinical manifestations of the disease are not obvious. Hip pain is an early symptom. Because the pain is mild and the symptoms are hidden, the patient can still walk normally and even relieve it after rest. Even if the X-ray film is taken to check the contour of the femoral head, it is also normal. It is very easy to misdiagnose as cold, rheumatism, lumbar disc herniation, hip synovitis, muscle strain, and the misdiagnosis rate can be as high as 40.8%. As the disease progresses, the pain becomes obvious. In addition to the hip, sometimes the thigh root will also hurt, and it can also radiate to the inner thigh to the knee joint.

The second symptom is lameness. As the disease progresses, pain causes muscle spasms, inflexible walking, limited joint movement, and limited internal and external rotation earlier than flexion, which can eventually lead to flexion contracture and eventually lameness, seriously reducing the patient's ability to work and live. Therefore, we must be good at catching the early signs of femoral head avascular necrosis, such as unexplained dull pain in the hips on one or both sides, pain when walking a long distance, unexplained pain in the thigh root, and pain on the inner side. We must not be careless. If the symptoms do not improve after reducing activities, we should seek medical attention in time to find out the cause. In the early stage, if the necrosis is mild and the scope is light, and the X-ray does not show bone changes, it is advisable to do an MRI examination, which can "see the slightest detail" and find early changes in edema and ischemic signals, and can also indicate the degree of femoral head necrosis.

③ Traditional Chinese medicine treatment has advantages

It is understood that Chinese medicine believes that this disease belongs to the category of "bone erosion", "bone atrophy" and "bone arthralgia". "Syndrome Causes and Pulse Treatment Volume 3" points out: "Arthralgia means closure, and the meridians are blocked." Clinically, it is generally divided into 4 common syndromes: Qi stagnation and blood stasis syndrome, phlegm and blood stasis blocking collaterals syndrome, meridian arthralgia blocking syndrome, and liver and kidney deficiency syndrome. It can be a single syndrome or two or more complex syndromes. Chinese medicine therapy takes the holistic view as the guiding principle, "preventing before illness and preventing changes after illness", preventing femoral head necrosis in high-risk groups, and early Chinese medicine intervention for confirmed femoral head necrosis. Head-saving treatment has obvious advantages. The most commonly used method is oral Chinese medicine under the guidance of syndrome differentiation and treatment. The treatment methods include blood circulation method, kidney tonifying method, and spleen tonifying method. The most common application is the combination of blood circulation method and kidney tonifying method. Commonly used prescriptions include Huoxue Bushen Decoction, Bushen Jiangu Decoction, and Yishen Jianpi Decoction. Traditional Chinese medicine treatment can be combined with conservative treatments such as electromagnetic therapy, braking traction, and extracorporeal shock waves. Traditional Chinese medicine treatment can also be combined with minimally invasive surgery according to the severity of the lesion, such as arterial perfusion, core decompression, vascular bundle implantation, drilling bone grafting, arthroscopic cleaning, etc. Through comprehensive treatment of traditional Chinese medicine, bone necrosis absorption can be promoted, pain can be relieved, and hip function can be improved. According to statistics, the condition of about 70% to 75% of patients can be reversed or no longer develop, thereby improving the quality of life of patients.

④ Focus on prevention

Once diagnosed with femoral head necrosis, don't be nervous or pessimistic, and don't carry a psychological burden. This disease is not a malignant disease. As long as you go to a regular Chinese medicine hospital for diagnosis and treatment in time, and adopt head-preserving treatment as soon as possible to prevent the disease from progressing, better results can be achieved.

Preventive measures: First, hormone therapy should be used with caution. Rheumatoid arthritis, special skin diseases, chronic nephritis and other diseases should be treated with hormone therapy under the guidance of a doctor, with regular close observation and follow-up, and early oral Chinese medicine intervention when necessary. Second, frequent and large amounts of drinking are harmful and useless, and those who have a drinking habit should quit drinking immediately. Third, do not buy homemade Chinese patent medicines advertised in small advertisements to treat osteoarthritis, as these drugs often contain corticosteroids. Fourth, pay attention to preventing hip trauma, such as femoral neck fractures, hip dislocations, sprains, etc. Fifth, prevent the invasion of wind, cold and dampness to avoid inducing this disease. Sixth, after discovering signs of early femoral head necrosis, you should walk with crutches while treating, try to reduce all weight, prevent femoral head collapse, and go to the hospital orthopedics department for regular reexamination.