Avascular necrosis of the femoral head is caused by impaired blood flow in the vascular system that feeds this area. Such phenomena occur as a result of squeezing or twisting during blockage by a small thrombus of an artery or injury. Next, let's take a closer look at what avascular necrosis of the femoral head is.
Provoking factors
Prolonged vascular spasm and increased blood viscosity, venous congestion and impaired outflow significantly worsen the nutrition of the femoral head. In this regard, internal pressure increases, ischemia develops. This provokes violations of the mechanical qualities of the bone tissue. As a result, voids are formed. Over time, the bone begins to deform, the articular cartilage, collapsing, exfoliates from it.
Features of pathology
Necrosis (avascular) bone is found quite often. Mostly, pathology is detected in men aged 20 to 45 years. Avascular necrosis of the femoral head is also diagnosed in children aged 2 to 12 years.years. At the same time, boys get sick more often. The symptoms that accompany avascular necrosis are, in some cases, quite difficult to differentiate. This makes it somewhat difficult to make an accurate diagnosis. In particular, the symptoms of avascular necrosis are almost indistinguishable from the manifestations of the pathological process in the hip joint.
Progression of condition
Avascular necrosis is developing quite rapidly. Already on the third day, the patient feels unbearable pain, the intensity of which is increasing. When you try to get up, while walking there is pain in the groin area. It also appears on the side and front of the thigh and gives to the knee. For many patients, the pain can be debilitating and constant. It can last at night and subside in the morning. When moving, the load provokes pain in the lower back or buttock. Limitation of mobility, the appearance of lameness should immediately alert a person and become a reason for an early visit to a specialist.
Avascular necrosis of the femoral head: causes
According to many experts, the development of pathology contributes to the long-term use of alcohol in large volumes. Also, the cause of necrosis can be long-term treatment with corticosteroid hormones in high doses. Among the popular factors provoking the condition, injuries should also be noted: fractures, dislocations, bruises. Necrosis (avascular) of the bone can begin due to normal fatigue, stress, emotional overstrain. Cases have been registeredwhen the pathology developed as a result of chronic or acute pancreatitis. Exposure to high doses of radiation can also act as a provoking factor. Pathology may accompany sickle cell anemia, osteomyelitis. In medical practice, there is also such a thing as idiopathic necrosis. It is used in case it is impossible to establish what exactly provoked the pathology.
Diagnosis
Avascular necrosis needs to be identified as early as possible. In this case, there is a high probability of doing without surgery. However, as a rule, pathology is diagnosed rather late. This is due to the fact that with the appearance of pain in the thigh, the patient is sent for an X-ray examination. In the pictures, the first stage of the pathology is not detected. Violation becomes noticeable on x-ray after a few months. Necrosis (avascular) of the bone can be detected at the initial stages using MRI or CT. Do not give an accurate result of a blood test and ultrasound. As diagnostic methods, scanning and measurement of internal bone pressure are used.
Stages of pathology development
How does avascular necrosis of the femoral head progress? The stages of pathology are as follows:
- Violation of vascular function. At this stage, it is necessary to avoid jumping, carrying heavy loads, standing in one place for a long time, running. The patient is advised to rest and rest. Treatment at this stage should be aimed at restoring blood circulation in the femoral head, as well as regeneration in the tissue. The patient is recommended special gymnastics to prevent the development of muscle atrophy. At this stage, the specialist may recommend taking vasodilator drugs. Medicines will help eliminate congestion and restore the structure of the head by normalizing arterial circulation and eliminating spasms. In this case, non-steroidal anti-inflammatory drugs, novocaine blockade, hirudotherapy, and massage are effective. Decompression of the greater trochanter or femoral head is also applied.
- Deformation and destruction of the damaged element. At this stage, walking at a slow pace for 30-50 minutes, exercising on an exercise bike, and swimming in sea water are useful. Of the medicines, drugs that promote the restoration of bone tissue and vasodilators are recommended. Hirudotherapy, massage, decompression are also prescribed.
- Arthrosis of the hip joint. At this stage of the pathology, gymnastics and massage are recommended. Of the drugs, a specialist can prescribe chondroprotectors and vasodilators.
At later stages, lameness and a noticeable shortening of the affected limb are noted. This is especially noticeable when the patient is in a horizontal position. Against the background of pathology, muscle atrophy progresses: tissues begin to dry out and decrease in volume.
Avascular necrosis of the femoral head: treatment with NSAIDs
The recommended drugs in this group includesuch means as "Diclofenac", "Indomethacin", "Ketoprofen", "Piroxicam", "Butadion", "Meloxicam", "Nimulid", "Celebrex" and derivatives from them. These medications help reduce pain. It should be noted that NSAIDs do not treat necrosis (avascular) of bone. However, these medicines can bring quite a tangible benefit to the patient. Assigned in a timely manner, the drugs prevent reflex muscle spasm that appears in response to unbearable pain. Relaxation of the fibers helps to restore blood circulation in the affected area. However, taking NSAIDs can be dangerous for the patient. The fact is that after the use of medications, a person ceases to feel pain and loads the affected area in the same way as a he althy one. This, in turn, contributes to the rapid destruction of the head of the bone. In this regard, the patient must remember that, despite the absence of pain, the damaged area should be protected from stress.
Vasodilators
This category includes drugs such as Trental (Pentosifylline, Agapurine) and Teonicol (xanthinol nicotinate). They are quite effective in avascular necrosis. These medicines help to eliminate stagnation in blood circulation. When they are taken, the restoration of the tissues of the head of the bone is accelerated. This becomes possible due to the stabilization of arterial blood flow and the elimination of spasm insmall blood vessels. Among the additional advantages of vasodilators should be called their almost absolute harmlessness. When following the recommendations of a doctor and taken in therapeutic doses, they have almost no contraindications and side effects. They are not prescribed for acute infarction, as well as for patients who have recently had a hemorrhagic stroke. When taking vasodilators, patients often experience a feeling of heat, their face turns red. This is quite normal in such cases. It is due to the active expansion of blood vessels. Medicines in this category are taken twice a year in courses lasting 2-3 months.
Means to stimulate tissue repair
This category should include such medicines as "Calcium D3 forte", "Alpha D3 TEVA", "Osteomag", "Oxidevit" and others. These remedies are very useful in pathology. Vitamins of group D improve the absorption of calcium. Due to this, its content is significantly increased. This, in turn, prevents the reverse excretion of calcium from bone tissue into the blood. Due to this, the compound accumulates in the skeletal elements. In particular, its concentration increases in the tissues of the femoral head. Calcitonins are of great help in pathology. These, in particular, include such agents as "Sibacalcin", "Alostin", "Miacalcic" and others. These drugs stimulate bone formation andeliminate pain. Thanks to their use, the outflow of calcium is significantly reduced and the activity of osteoblasts ("building" cells) is stabilized.
More information
Avascular necrosis of the femoral head (ICD-10: M91.1) has another name. It is called Legg-Calve-Perthes disease. The most common pathology in England. This country reports 1 case per 1800 inhabitants.
