Aseptic necrosis of the femoral head x-ray. Aseptic necrosis of the head of the hip joint: symptoms, diagnosis and treatment

Aseptic necrosis, Legg-Calve-Perthes disease (avascular necrosis of the femoral head) is a serious disease hip joint. The disease occurs due to changes, violations of the structure of bone tissue, as well as due to the manifestation of fatty degeneration bone marrow, disorders of blood microcirculation. In this case, that part of the femoral head, which is deprived of blood supply, dies.

Since this disease is extremely common at the present time, we, together with the editors of the site www.site, decided to devote our conversation today to this disease and talk on the topic: aseptic necrosis of the femoral head, treatment to consider.

Why does aseptic necrosis (AN) occur?

The causes of necrosis are different and genetically determined. Very often, the disease develops due to injury or thrombosis of the artery, resulting in a violation of the blood supply to the femoral head. The most common cause is a hip fracture or hip dislocation.

After 2-3 months. after injury, AN begins to develop. Although the first symptoms of the disease appear much later, approximately 1 to 2 years after the injury.

Also, aseptic necrosis of the femoral head can be provoked by long-term use of certain drugs, such as glucocorticoid hormones. They are usually used in the treatment bronchial asthma, rheumatism.

Often the disease occurs against the background of regular, excessive alcohol consumption. The fact is that alcohol is the culprit of damage to blood vessels. This can cause ischemia of the femoral head, and subsequently can cause the development of its necrosis.

Workers of certain professions associated with exposure to high pressure, such as divers, miners, etc., are also susceptible to diseases.

Symptoms of aseptic necrosis of the femoral head

Pain is the first symptom of AN. It is deployed in the area of the hip joint when the weight of the body is transferred to the leg damaged by the disease. The pain radiates to the inguinal, gluteal region, along the front surface of the thigh.

With the development of the disease, its progression, lameness may appear, there is a violation of the work, mobility of the joint. Subsequently, the pain persists at rest, disrupting a good sleep, causing insomnia.

Treatment of the disease

In the presence of pain, other symptoms of AN, you should consult a doctor. The doctor will conduct a special physical examination, find out the presence of other chronic diseases, ask you about medicines that you accept. For a more accurate confirmation of the diagnosis, it may be necessary to conduct an additional laboratory and instrumental examination.

In the treatment of the disease, the main attention is paid to the process of restoring normal blood circulation in the area of the head of the femoral bone and bone tissue. When prescribing treatment, the duration of the disease, its severity, general state sick.

1st period A: The course of this period is from several days, it is 6 months. from the moment of occurrence severe pain in the thigh area. At this stage, vascular disorders occur. Treatment of the disease at this stage is to observe rest. You should walk less, if possible, use a cane. You can not overload a sore leg, you need to rest more often, lie more.

2nd period of illness- from 6 to 8 months. from the onset of severe pain. During this period, destruction, necrosis of bone tissue occurs, and deformation of the femoral head occurs. During this period, therapeutic exercises are prescribed, as well as taking vasodilating drugs. It is also useful to use special massage and hirudotherapy procedures.

3rd period of illness: more than 8 months from the onset of severe pain. This period of the disease is characterized by a smooth transition of AN into coxarthorosis. Treatment is similar to the treatment of coxarthrosis. Apply therapeutic exercises, massage.

Also, at all stages of the course of the disease, apply medicines for the treatment of AN:

Vasodilators, chondroprotectors - glucosamine, chondroitin sulfate.

Non-steroidal anti-inflammatory drugs - diclofenac, ketoprofen, indomethacin, butadione, meloxicam, celebrex, as well as their analogues. They are used to reduce pain.

Vasodilator drugs - trental, teonikol. They are recommended for the treatment of aseptic necrosis.

Preparations for stimulating the restoration of bone tissue - alpha D3 TEVA, calcium D3 forte, oksidevit, osteomag, etc.

With conservative treatment, pain is eliminated, inflammatory process, the process of destruction of bone tissue is suspended. In the event that treatment has not been effective, degenerative damage to the joint or collapse of the femoral head may require surgery. The operation is aimed at increasing the blood supply to the femoral head and is performed by decompression of the femoral head or hip arthroplasty.

In any case, it is necessary to treat aseptic necrosis of the femoral head under the supervision of a doctor, who will prescribe the necessary method of treatment. Be healthy!

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The hip bone is one of the most complex in the body. It consists of a head and a glenoid cavity, representing a complex mechanism. With its help, the body keeps balance, it is possible to sit and move around.

The subchondral area of the bone tissue, where there is no necrosis, is well innervated and provided with blood flow. For this reason, it is often prone to inflammation and, in the future, destruction. The most commonly affected is the hip joint. A well-known orthopedist said: do not use painkillers in the treatment of joint diseases - this will lead to disability.

Treatment of aseptic necrosis of the head of the hip bone is based on the rules:

reduce pain;
relieve inflammation in the femur;
resumption of motor function of the joint;
maintaining the achieved result by rationalizing the lifestyle.

Treatment of aseptic necrosis of the hip joint will be of high quality and effective if detected earlier. The patient is able to detect the first signs of malaise on their own. They notice restrictions in the movements of the joint, pain, swelling. Treatment of the femoral bone is divided into conservative and surgical.

Conservative treatment of aseptic lesions of the femoral head is long in time, can last several years. The first step is to help the patient feel better. Use of painkillers in various forms release (ointments, tablets, injections, powders, patches). Doctors recommend nimesulide, diclofenac, ibuprofen and combinations with others active ingredients. Treatment of necrosis of the head of the joint drugs begin immediately.

The next step is to improve blood circulation in the affected area of the bone. Use vasodilators (no-shpa, vitamin PP alone or in combination called "nikospan"). For additional nutrition of bone and cartilage tissue, chondroprotectors (glucosamine and chondroitin) are recommended. It is worth noting that these drugs adversely affect the gastric mucosa, it is recommended to take only after meals. Important are the drugs that are used for the regeneration of the femur (various combinations of calcium with vitamin D3). Together with the above active role calcitonins (miacalcic) play in the treatment of aseptic necrosis. Means help new bone tissue grow faster, reduce the manifestations of pain, make the treatment of necrosis of the head of the joint of the disease not so long.

It will be necessary to remove or limit the mechanical movement of the hip joint as much as possible. Methods are used to achieve:

hip immobilization;
bed rest;
hoods and orthopedic devices;
splints and plaster bandages.

Which method to choose, how long the immobilization will last, is decided by the attending physician. On average, the process lasts from 6 to 18 months.

Physical therapy and rehabilitation are considered important. It will be useful to lose weight, excess weight puts a load on a joint already damaged by aseptic necrosis.

Often, doctors prescribe electrophoresis with novocaine or lidocaine on the affected area of the thigh, providing an additional analgesic effect on the legs and spine. The country has an abundance of sanatoriums and clinics that specialize in the rehabilitation of such patients. Here you can take a course of physiotherapy exercises, mud wraps and massages. Exercise will help stretch the ligaments, providing an opportunity to work out damaged joints and avoid stiffness. Exercises and massage are performed under the supervision of a specialist.

Exercises can be performed at home. They are prescribed sparing and careful. It is better to start with a simple leg lift, holding on weight for a while. Important recognized: swimming in the pool, leisurely walks, weight loss and the use of canes instead of crutches. To prevent re-injury, after discharge home, it is required to ensure the safety of the patient. First of all, remove carpets and runners from the floor so that the patient does not slip.

It is important to note that a conservative method in the treatment of necrosis of the head of the hip joint does not help to avoid the disease by 100%. It is possible to slow down the process of development of the disease and the death of organ cells. Use the method rationally only in the first three stages diseases.

Surgical intervention in the treatment of aseptic necrosis of the hip joint

Often, surgery on a necrosis-affected femur is used in conjunction with conservative treatment. The decision depends on the stage of the course of the disease and the neglect of the disease. The average rate of assigning operations is 15%.

Transplantation of a specific area of the femur. During the operation, a piece of healthy bone (mainly from the fibula) is taken from the patient and transplanted into the affected area. As a result, the blood supply to the head of the joint improves. The chance of survival is high.
Endoprosthetics of the head of the hip joint. It is used in the later stages, when other methods are ineffective. The diseased joint is completely removed from the thigh, replaced by a prosthesis. The operation removes the pain, the patient can walk normally. Rehabilitation takes a long time, the patient requires outside help.
Decompression of the femoral head (tunnelization). With a special device, the surgeon drills a hole in the head of the hip joint. During the operation, the pressure inside decreases, blood flow improves as a result of the formation of new vessels. The effectiveness of the operation is 70%.
Arthrodesis. Creation of artificial fusion of some thigh bones to reduce pain. The operation is performed when the patient is prohibited from hip arthroplasty. The procedure is extremely inefficient. As a result, the patient develops a curvature of the spine in the lumbar region.
Arthroplasty. The operation is considered a kind of plastic surgery. It is aimed at preventing the development of ankylosis (immobility of the joint) or at restoring an already immobile one. During the intervention, manipulations are performed:

Removal of bone or fibrous callus.
Restoration of the anatomical shape of the affected joint.
Prevention of reunion of the hip bone.

More often, the operation is performed under spinal anesthesia, reducing the number of complications when the patient comes out of anesthesia. After the manipulation, it is possible to apply a plaster fixing bandage of the thigh for a short period. It is permissible to start rehabilitation 14 days after the operation.

Osteotomy. Surgical intervention carried out to eliminate the deformity using an artificial fracture. Fix the broken bone with screws or special plates. Gypsum is almost not applied. As a result of the operation, complications are possible in the form of suppuration, displacement of debris, and malunion. To prevent, it is prescribed to carefully follow the rules of asepsis in the operating room and at home.

Folk methods in the treatment of the disease

People in the past centuries used extensively folk ways treatment of various diseases, including the development of the initial stages of aseptic necrosis of the hip joint. When choosing a method, weigh the pros and cons well, no one can return the lost time.

Compresses:

Beat the egg white vigorously with 1 tablespoon of millet flour. The mixture is applied to the diseased joint, covered with polyethylene and wrapped with a warm blanket. The compress can be left overnight. In the morning, wash your skin with warm water.
The lightest is cabbage compress. Spread a little honey on a cabbage leaf, apply to a sore spot, secure with a compress cloth, and wrap it. You will sleep peacefully at night. Substances that are in the cabbage leaf will help relieve swelling from the head of the joint.
Make yogurt from homemade milk (store-bought yogurt is not suitable). Pour a few tablespoons of curdled milk into a cup, add the same amount of pre-ground eggshell. Mix intensively, apply to the affected areas of the joint as a compress. Leave overnight. Treatment is carried out 5 nights in a row.

Rubbing:

Almost every person at home has a flowerpot with Kalanchoe. Pick a small amount of young leaves of the plant, finely chop. Pour the resulting slurry with the same volume of ethyl alcohol. Insist in a dark and cool place for 7 days. The effect of rubbing is amazing.
Take 10 tablets of acetylsalicylic acid, crush, pour 10 ml of camphor alcohol and iodine. Stir and add 300 ml of ethyl alcohol. Insist for 14 days in a dark place. Use the mixture to rub the diseased hip joint.

Nettle bath. This procedure is effective in the early stages of joint disease. Pick fresh nettles with a total weight of 4 kilograms. Dip in a bucket of water and boil for 30 minutes. Strain the broth into the bathroom, add ordinary water to the required volume. The water temperature should not exceed 40 degrees. Get in the bathroom. The procedure lasts no more than 20-25 minutes.

Internal reception:

Take a large head of garlic and 2-3 large lemons. Grind them in a meat grinder, pour 250-300 ml of chilled boiled water. Let it brew for 10-12 hours (preferably overnight). In the morning, start taking 1 teaspoon before meals.
Freeze 1 liter of water and let it melt. Cut into melted water big lemon whole, add chopped garlic and 2 teaspoons of honey. Insist 14 days in the closet. ready mix strain and drink 30-50 ml in the morning on an empty stomach.
Buy nettle leaves, elder flowers, willow bark, and parsley root. Take the components in equal parts, cut and mix. Pour two tablespoons of the mixture into a separate bowl, pour 500 ml of boiling water over low heat for 5 minutes. Wait until it cools down, strain. The amount of decoction is required to drink during the day. Every day it is necessary to prepare a new portion of the remedy.

Consequences of aseptic necrosis of the head of the hip joint

Aseptic necrosis of the head of the hip joint is a serious and dangerous disease. Treatment is painful and lengthy. A neglected disease worsens the life of the patient, in most cases leads to disability. A recumbent lifestyle is predicted, the inability to serve oneself independently and, at best, limitation of movement in the hip joint.

At the slightest symptoms of the disease, you should consult a doctor at the nearest medical institution. Timely started treatment reveals a quite optimistic prognosis, the younger the patient, the easier it is to achieve a full recovery. At times, it is impossible to diagnose the disease in the early stages, because patients do not pay attention to discomfort and consider it temporary.

As far as I know, this disease is the second group of disability. The disease is described in detail here.
www.rusmedserv.com

In order to be recognized as a disabled person, you need documentary confirmation from the specialists of the medical institution who make this decision and issue a certificate, as well as recommend an individual rehabilitation program for the patient.
This certificate is issued after medical and social expertise conducted by a special commission in an institution at the place of residence or at the place of attachment of the patient. The basis for its conduct is a written application of the patient or his legal representative, along with which it is necessary to submit medical documents confirming the violation of his health.
A referral for a medical and social examination is issued by a healthcare institution or a body social protection population. It must indicate data on the patient's state of health, the degree of dysfunction of organs and systems, the state of the compensatory capabilities of his body and the results of the performed rehabilitation measures.
If you were refused in such a direction, then you can independently apply to the Bureau of Medical and Social Expertise with documents confirming the violation of body functions and the associated limitation of life.
www.dislife.ru

Comments

Anastasia, the "organ of social protection of the population" never issues a referral to the ITU! What are the sources of this information? Please provide a link. "Healthcare institution" - can be both CITO and a clinic, commercial medical institutions, a clinic and even a children's dairy kitchen!!! Please, Anastasia, edit your answer with specific information!

Vadim Petrovich, Anastasia is right. An organization that provides medical and preventive care after carrying out the necessary diagnostic, therapeutic and rehabilitation measures, if there is data confirming a persistent impairment of body functions due to diseases, consequences of injuries or defects, sends a citizen to a medical and social examination. The body providing pensions, as well as the body of social protection of the population, has the right to send to the ITU a citizen who has signs of disability, if he has medical documents confirming a persistent violation of body functions. Government Decree Russian Federation dated February 20, 2006 N 95 "On the procedure and conditions for recognizing a person as disabled" www rg ru Ch. III. The procedure for sending a citizen to a medical and social examination

Www rg ru - Order of the Ministry of Health and social development of the Russian Federation (Ministry of Health and Social Development of Russia) dated December 23, 2009 N 1013n Moscow "On approval of the classifications and criteria used in the implementation of medical and social examination of citizens by federal government agencies medical and social expertise"
Published March 26, 2010
"3. The main types of violations of the functions of the human body include:
violations of static-dynamic functions (motor functions of the head, trunk, limbs, statics, coordination of movements)" - the order is quite large, I hope new data will appear in your blog (website)!

The most complete answers to questions on the topic: "necrosis of the hip joint disability."

Please allow me a disability. My diagnosis: aseptic necrosis of the head of the right femur, left-sided deforming coxarthrosis grade 2-3, pain cider on the right. Widespread osteochondrosis of the n-ka, muscular-tonic cider, dorsopathy, spondiolisthesis, stenosis spinal canal, protrusion of L4-L5, L5-S1 discs. I am getting ready for total arthroplasty of the right hip joint. I also have an arteriovenous malformation in the lumbar region of the p-ka, dyscirculatory encephalopathy 2 tbsp. diffuse osteoporosis.

Registration of Legal Entities Charter Hip Joint

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Aseptic necrosis of the femoral head (ANGBK) - severe chronic illness, caused by insufficiency of local blood circulation, which leads to the destruction of bone tissue in the femoral head.

Statistics Of all bone and muscle diseases, aseptic necrosis of the femoral head accounts for 1.2 to 4.7%. According to different authors, mainly men from 30-50 years old are ill (about 7-8 times more often than women).

Moreover, in 50-60% of cases, both legs are affected: the process that began on one side, a year later, in 90% of cases, occurs on the other.

Interesting facts and history

The first reports of a disease similar to aseptic necrosis of the femoral head appeared in the 20-30s of the last century.
For a long time, this ailment was compared with Perthes disease (destruction of the femoral head in children), suggesting the use of the same term. However, it was noted that in children the disease is milder, the bone tissue is often restored while maintaining the shape of the femoral head, and the site of the lesion does not have a clear location.
Only in 1966 in Paris, at the international congress of orthopedists, aseptic necrosis of the femoral head (ANGBK) was brought into a separate disease.
ANFH is the most common reason for hip replacements. Moreover, the results are much worse than with a similar operation for arthrosis of the hip joint (a disease associated with deformity and limitation of joint mobility).
ANGBK is more common in people of young and working age, leading to the development of disability and a decrease in the quality of life.
Conservative treatment of the disease (with the help of drugs) is ineffective.
Often, 2-3 years after the onset of the disease, surgical treatment is performed.

Anatomy of the femur and hip joint Femur- the longest and largest steam room tubular bone lower extremities(legs).

On the part of the femur, which is closer to the body, there is a femoral head - a spherical protrusion. The neck departs from the head - a narrowed area that connects the head with the body of the femur. At the place where the neck passes into the body of the tubercle, there is a bend and two bony protrusions - a large and a small trochanter.

On the head of the femur there is an articular surface that serves to connect with the acetabulum (fossa on the pelvic bone), and together they form the hip joint. The femoral head and acetabulum are covered with cartilage.

The hip joint itself is hidden under soft tissues (joint capsule), which produce joint fluid that nourishes cartilage and provides gliding of joint surfaces.

Structure and layers of bone tissue

There are several types of cells in the bone: osteoblasts and osteocytes form bone tissue, and osteoclasts break it down. Normally, the process of bone formation prevails over its destruction. However, with age and under the influence various reasons osteoclast activity increases and osteoblast activity decreases. Therefore, the bone tissue is destroyed, not having time to be updated.

Structural unit of bone - osteon, consisting of bone plates (from 5 to 20) of a cylindrical shape, located symmetrically around the central bone canal. Vessels and nerves pass through the canal itself.

Between the osteons there are gaps that are filled with internal interosseous insertion plates - this is how the cellular structure of the bone is formed.

Crossbars (trabeculae or beams) of bone substance are formed from osteons. They are located in accordance with the direction in which the bone experiences the greatest load (during walking, movements) and stretching by the attached muscles. Thanks to this structure, the density and elasticity of the bones are ensured.

Moreover, if the crossbars lie tightly, then they form

compact matter(middle layer), if - loose, then form

spongy substance(inner layer) bones. The outside of the bone is covered

periosteum(outer layer), permeated with nerves and vessels that go deep into the bone along the perforating channels of the osteons.

The mechanism of development of aseptic necrosis

Not fully studied, so this question remains open.

There are currently two main theories:

Traumatic theory- when the integrity of the bone is violated due to trauma (fracture, dislocation).
Vascular theory: under the influence of various factors, the vessels supplying the femoral head with blood, on long time narrowed or clogged with a small thrombus. As a result, there is a violation of local blood circulation (ischemia). In addition, the viscosity of the blood increases, so its flow slows down.

Due to ischemia, the death of osteoblasts and osteocytes increases, and the activity of osteoclasts increases. Therefore, the processes of bone formation are reduced, and dissolution is enhanced. As a result, the bone tissue is weakened and its strength decreases. And then, with a load on it, microfractures of trabeculae (beams) occur, which first compress the veins - blood stagnation occurs in small veins with the formation of blood clots, then in small arteries.

All these changes intensify the phenomena of ischemia in the femoral head and increase the pressure inside the bone. As a result, bone tissue dies (necrosis develops) at the site of the greatest load on the femoral head.

However, some scientists put forward another theory of the development of ANGBK -

mechanical. It is believed that under the influence different reasons there is a "overwork" of the bone. Therefore, impulses go from the femoral head bone to the brain, causing feedback signals that lead to compensatory vasoconstriction (an attempt to return to its original state). As a result, metabolism is disturbed, blood stagnates and decay products accumulate in the bones.

In practice, there is no clear distinction between theories. Moreover, they often complement each other, acting simultaneously.

On a note!

As a rule, the first foci of necrosis in the bone appear 3-5 days after ischemia. However, when favorable conditions blood supply is restored, and the destroyed bone tissue is replaced by new tissue. Whereas with further overload of the femoral head, the course of the process worsens, leading to the development and severe course of the disease.

Causes of aseptic necrosis Almost any factor that violates the integrity or blood circulation in the head of the femur can cause necrosis (death) of the bone beams.

Trauma (dislocation, fracture) or surgery

Leads to mechanical damage (rupture) or blockage of the lumen of blood vessels with a blood clot (formation of blood clots). As a result, blood flow to the head of the femur is disrupted. Moreover, the disease begins to develop a few months after the injury, and its first signs appear after 1.5-2 years.

Long-term use of corticosteroids (hormonal drugs) for treatment rheumatic diseases(psoriatic or

rheumatoid arthritis

), bronchial

and others.

Considered the most common cause ANGBK. What's happening? Hormones constrict blood vessels for a long time, disrupting local blood circulation in the head of the hip bone.

In addition, long-term use of corticosteroids gradually destroys bone (osteopenia), leading to the development of osteoporosis (decrease in bone density). As a result, under load, the bone bars experience "overwork" and break (chronic microtrauma), blocking the flow arterial blood to the head of the femur.

Systematic alcohol abuse

The metabolism of fats and proteins in the body is disturbed, and cholesterol is deposited in the walls of the arteries - it develops

atherosclerosis

As a result, the walls of the arteries thicken and lose their elasticity, and the blood supply to the femoral head is disrupted.

Drinking alcohol in large doses at the same time

There is an acute decrease in the blood supply to the head of the hip bone.

Taking painkillers and non-steroidal anti-inflammatory drugs A side effect is the destruction of the bone crossbars and the development of osteoporosis. Therefore, at the slightest disturbance of blood circulation or an increase in the load on the femoral head, ANGBK develops.

Autoimmune diseases: systemic lupus erythematosus or scleroderma, hemorrhagic vasculitis and others.

Immune complexes are deposited in the vascular wall, causing immune inflammation. As a result, the elasticity of the walls of blood vessels and local blood circulation are disturbed. When combined with the use of glucocorticoids for the treatment of these diseases develop severe forms ANGBK.

decompression sickness

Occurs due to a rapid decrease in the pressure of the inhaled gas mixture (for divers, miners). Therefore, gases in the form of bubbles penetrate the bloodstream and clog small vessels (embolism), disrupting local blood circulation.

Problems in the lumbosacral spine

In case of violation of innervation (for example, intervertebral hernia), a spasm of blood vessels occurs that nourish the bone tissue.

Aseptic necrosis develops in other diseases: chronic or acute pancreatitis, ionizing radiation, sickle cell anemia (hereditary disease). Unfortunately, the mechanism of ANFH formation in these diseases is not fully understood.

However, in 30% of cases of ANFH, the cause of the development of the disease remains unidentified. And often several factors act together, leading to a rapid and severe course of the disease.

Types and stages of aseptic necrosis of the femur

The most widespread division of ANGBK into stages, based on the changes that occur during illness in the hip joint. However, this division is conditional. Since the transition from one stage to another has no clear boundaries.

Stages of aseptic necrosis of the femoral head

I stage(lasts about 6 months) - initial manifestations. The spongy substance (bone beams) of the bone tissue in the femoral head dies, but its shape does not change.

Symptoms. The leading symptom of the onset of the disease is pain. And she manifests herself in different ways.

At the beginning of the disease, pain most often occurs only after physical exertion or during bad weather, but disappears at rest. Gradually, the pain becomes constant.

Sometimes after a period of exacerbation, it disappears, but reappears when exposed to a provoking factor.

However, sometimes the pain appears suddenly. Moreover, it is so strong that some patients can name the day and even the hour of its occurrence. For several days, patients can neither walk nor sit because of pain. Then the pain subsides, appearing or intensifying after physical exertion.

In aseptic necrosis of the head of the hip joint, the success of interventions that prevent or prevent the collapse of the head of the femur and maintain the function of the hip joint will be a significant advance in the treatment of this disease.

Core decompression with technique modification continues to be one of the safest and most commonly used procedures with evidence of success in the precollapse phase of the femoral head. The additional use of bone morphogenic protein and bone marrow stem cells may provide an opportunity to improve the results of nuclear decompression.

At present, the use of large vascularized cortical grafts, another surgical procedure with a high success rate, is still not common due to technical difficulties in surgery. Similarly, osteotomies are also not common as arthroplasty becomes more acceptable, so it is used without any intermediate major surgery.

In this article, you will learn how to treat aseptic necrosis of the head of the hip joint, its causes, characteristic symptoms and preventive measures. As well as the features of the course and treatment of the disease in children and pregnant women.

Aseptic necrosis of the head of the hip joint - a characteristic of the disease

Aseptic necrosis of the femoral head (AFNF) or idiopathic necrosis is serious illness of the hip joint, which is accompanied by necrosis of the bone tissue of the femoral head, caused by impaired blood supply and metabolic processes in the head of the hip bone.

In the normal state, the head of the femur is fixed by ligaments in the natural depression of the pelvic bone. This depression is called the acetabulum, and it is a round cavity with smooth walls.

With necrosis, the femoral head is gradually deformed and destroyed. Due to the lack of nutrients and oxygen, the recovery processes stop, leading to gradual wear of the cartilage in the zone of maximum loads and necrosis of the femoral head.

Necrosis is the process of tissue necrosis, which can be caused by a variety of reasons. The term "aseptic" means that necrosis in this disease occurs under sterile conditions, that is, without the participation of microorganisms.

Statistics say that necrosis is common. It is known that men suffer from it more often than women. A distinctive feature of aseptic necrosis is that it most often affects young people from 20 to 45 years old.

In many cases, aseptic (avascular) necrosis affects one limb (approximately 60%), in smaller cases (40%) both legs are affected.

The femur is the longest and largest paired tubular bone of the lower extremities (legs). On the part of the femur, which is closer to the body, there is a femoral head - a spherical protrusion. The neck departs from the head - a narrowed area that connects the head with the body of the femur. At the place where the neck passes into the body of the tubercle, there is a bend and two bony protrusions - a large and a small trochanter.

The hip joint itself is hidden under soft tissues (articular capsule), which produce joint fluid that nourishes the cartilage tissue and ensures the sliding of the joint surfaces.

There are several types of cells in the bone: osteoblasts and osteocytes form bone tissue, and osteoclasts break it down. Normally, the process of bone formation prevails over its destruction. However, with age and under the influence of various causes, osteoclast activity increases, while osteoblast activity decreases. Therefore, the bone tissue is destroyed, not having time to be updated.

The structural unit of the bone is the osteon, consisting of bone plates (from 5 to 20) of a cylindrical shape, arranged symmetrically around the central bone canal. Vessels and nerves pass through the canal itself.

Between the osteons there are gaps that are filled with internal interosseous insertion plates - this is how the cellular structure of the bone is formed.

Moreover, if the crossbars lie tightly, then they form a compact substance (middle layer), if they are loose, then they form a spongy substance (inner layer) of the bone. Outside, the bone is covered with a periosteum (outer layer), permeated with nerves and vessels that go deep into the bone along the perforating channels of the osteons.

The mechanism of development of aseptic necrosis

Not fully studied, so this question remains open. There are currently two main theories:

Traumatic theory - when the integrity of the bone is violated due to injury (fracture, dislocation).
Vascular theory: under the influence of various factors, the vessels supplying the femoral head with blood narrow for a long time or become clogged with a small thrombus. As a result, there is a violation of local blood circulation (ischemia). In addition, the viscosity of the blood increases, so its flow slows down.

And then, with a load on it, microfractures of trabeculae (beams) occur, which first compress the veins - blood stagnation occurs in small veins with the formation of blood clots, then in small arteries.

However, some scientists put forward another theory of the development of ANGBK - mechanical. It is believed that under the influence of various causes there is a "overwork" of the bone.

Therefore, impulses go from the femoral head bone to the brain, causing feedback signals that lead to compensatory vasoconstriction (an attempt to return to its original state). As a result, metabolism is disturbed, blood stagnates and decay products accumulate in the bones.

In practice, there is no clear distinction between theories. Moreover, they often complement each other, acting simultaneously.

As a rule, the first foci of necrosis in the bone appear 3-5 days after ischemia. However, under favorable conditions, the blood supply is restored, and the destroyed bone tissue is replaced by new tissue. Whereas with further overload of the femoral head, the course of the process worsens, leading to the development and severe course of the disease.

The reasons

Injuries.
Any factor that violates the integrity of the bone tissue or the blood supply to the joint can cause massive death of bone cells. How does this happen? If, as a result of an injury, a blood vessel is damaged or blocked by blood clots, then the supply of nutrients to the femoral head is sharply reduced. And after a few months, degenerative processes begin in the joint, which will begin to manifest themselves a year or two after the injury.
Long-term use of hormonal drugs.
Treatment with corticosteroids has side effects, including narrowing of blood vessels and impaired blood supply.
In addition, prolonged treatment with hormonal drugs leads to the development of osteoporosis (bone tissue becomes loose, “loose”).
Under load, such bone tissue receives permanent microtrauma, thereby blocking the blood flow to the head of the bone.
Non-steroidal anti-inflammatory drugs.
They are among side effects development of osteoporosis, therefore, as well as hormonal preparations can cause necrosis of the femoral head.
Autoimmune diseases can also provoke the development of necrosis.
With immune inflammation, the elasticity of the walls of blood vessels decreases, which causes disturbances in the blood supply. And with hormone therapy, the “effect” is aggravated - a severe form of aseptic necrosis develops.
Caisson or decompression sickness.
The disease of divers occurs when the pressure of the inhaled mixture decreases. In this case, gas bubbles penetrate the bloodstream, clogging small blood vessels and blocking blood flow.
Systematic alcohol abuse can also be an impetus for the development of the disease.
Alcohol weakens the walls of blood vessels, as a result they lose their elasticity, which causes circulatory disorders.
Diseases of the lower spine.
For example, if there is intervertebral hernia often there is a spasm of the vessels that feed the bone tissue, which can also induce the development of necrosis of the human femoral head.

It should be noted that it is very difficult to establish the exact cause of the development of the disease, often several factors are “involved” in this. According to statistics, in 30% of cases the etiology of the disease remains unidentified.

In the diagnosis of aseptic necrosis of the femoral head, the symptoms depend on the duration of the disease.

Types, stages and symptoms

Stage I (lasts about 6 months) - initial manifestations. The spongy substance (bone beams) of the bone tissue in the femoral head dies, but its shape does not change.

Symptoms. The leading symptom of the onset of the disease is pain. And she manifests herself in different ways. At the beginning of the disease, pain most often occurs only after physical exertion or during bad weather, but disappears at rest. Gradually, the pain becomes constant. Sometimes after a period of exacerbation, it disappears, but reappears when exposed to a provoking factor.

Usually, at the beginning of the disease, pain occurs in the region of the hip joint, spreading (radiating) to the inguinal or lumbar region, knee joint, buttock. However, pain may primarily appear in the lower back and/or knee joint, misleading the doctor and leading away from the correct diagnosis. There is no restriction of movement in the affected joint at this stage.

Stage II (6 months) - impression (compressed) fracture: under load on a certain area of the femoral head, the bone beams break, then wedged into each other and crushed.

Symptoms. The pain is constant and severe, does not disappear even at rest. Moreover, after physical activity it increases significantly. At this stage, muscle atrophy (thinning of muscle fibers) appears on the thigh and buttock on the affected side. There are restrictions on circular movements. Moreover, the pain intensifies when trying to perform circular motions in the diseased leg, take it aside or bring it to a healthy leg.

Stage III (from 1.5 to 2.5 years) - resorption

The healthy tissues surrounding the necrosis zone slowly dissolve the dead bone fragments. At the same time, connective tissue grows deep into the head of the femur (plays a supporting role in all organs) and islets of cartilaginous tissue. As a result, conditions are created in the femoral head for the growth of new vessels. However, at the same time, the growth of the femoral neck is disturbed, so it is shortened.

Symptoms. The pain is constant, aggravated even after a slight load, but at rest it decreases somewhat. The mobility of the joint is sharply limited: it is difficult for the patient to walk, pull the leg to the chest or put on socks. There is a pronounced lameness when walking, and muscle atrophy from the thigh passes to the lower leg (below the knee).

Patients move with difficulty, relying on a cane. In addition, the leg on the affected side is shortened. Whereas in some patients (10%) it lengthens - a bad sign for the prognosis of the disease.

Stage IV (from 6 months or more) - outcome (secondary deforming arthrosis occurs).

The sprouted connective tissue and cartilage islands turn into bone tissue, due to which the spongy substance of the femoral head is restored. However, at the same time, secondary changes are formed: the beam (cellular) structure of the bone is rebuilt (deformed), and it also adapts (gets used to it) to new conditions and loads. In addition, the acetabulum is also deformed and flattened. Therefore, its normal anatomical contact with the femoral head is disrupted.

Symptoms. In the area of the affected hip joint or lumbar of the spine there are constant pains that do not disappear even at rest. The muscles of the thigh and lower leg are atrophied (the volume decreases to 5-8 cm). Circular movements in the affected leg are absent, and back and forth are sharply limited. Gait is significantly disturbed: patients cannot move independently, or only with a support (cane).

The duration of each stage of ANFH is individual, since much depends on the impact of provoking factors, timely treatment, and the presence of concomitant diseases. However, not always with aseptic necrosis, the entire femoral head is simultaneously affected. Therefore, there is a classification based on the location of the focus of necrosis.

There are four main forms (types) of ANGBK:

Peripheral (9-10% of cases) form: the outer section of the femoral head, which is located directly under the articular cartilage, is affected.
Central (2% of cases) form: a zone of necrosis is formed in the center of the femoral head.
Segmental (46-48% of cases) form: a small area of bone necrosis in the form of a cone occurs in the upper or upper outer part of the femoral head.
Complete defeat of the entire femoral head (observed in 40-42% of patients).

Diagnostics

When complaining of pain in the hip joint, the patient is prescribed an x-ray of both joints. But if on later dates this disease will be quite enough - the x-ray will show the area of necrosis, its shape and size, then in the early stages no changes will be visible on the x-ray. And very often the mistake of doctors is the termination of the examination of the patient and, as a result, an incorrect diagnosis and ineffective treatment.

Therefore, if the radiography did not reveal any changes, an additional examination will be required - MRI of the joints. Magnetic resonance imaging is able to detect incipient aseptic necrosis of the femoral head, while treatment will be prescribed on time, which will help "slow down" the development of the disease.

Treatment of the disease

conservative, that is medical method There is no complete cure for this disease! Even timely treatment can only slow down the development of the disease.

But not a single doctor will undertake to predict the development of osteonecrosis of the femoral head - sometimes several years pass from the moment the diagnosis is established to the destruction of the head, and sometimes this process proceeds at lightning speed. The tactics of treating necrosis of the head of the hip joint directly depends on the duration of the disease.

If at the first stage therapy is aimed primarily at restoring blood circulation in the joint, restoring bone tissue, and relieving pain, then at the last stages the only way out is hip arthroplasty.

Conservative therapy includes a set of measures:

orthopedic mode;
drug treatment;
blockades;
intra-articular injections;
physiotherapy exercises;
physiotherapy;
hirudotherapy.

The orthopedic regimen presupposes a decrease in the load on the diseased limb; jumping, running, and lifting weights should be avoided. To unload the joint, both special orthopedic devices and plaster splints, bandages are used. The type of unloading, as well as the duration of fixation of the joint, is determined by the attending physician.

It should be noted that the unloading of the joint does not imply its complete rest. Walking at an easy pace, exercising on an exercise bike, swimming reduce pain and prevent muscle atrophy. An important aspect is the body weight of the patient, in case of excess weight, it is necessary to achieve its reduction.

Physiotherapy appointed from the moment of diagnosis. The set of exercises is strictly individual and depends on the degree of damage to the head of the hip joint. The goal of exercise therapy is to restore the range of motion of the affected hip joint.

The main drugs used in the treatment of aseptic necrosis of the head of the hip joint:

Vascular drugs: vasodilators (No-shpa, A nicotinic acid), as well as antiplatelet agents - drugs that reduce blood viscosity and thrombosis (Kurantil, Trental).
Phosphorus-calcium metabolism regulators: etidronic acid preparations (Fosamaks, Ksidifon).
Bone regeneration stimulants: vitreous in combination with vitamin D.
Chondroprotectors: Rumalon, Arthra, Chondrolon.

For intra-articular injection therapy, the drug Perftoran is used - a blood-substituting drug with the function of oxygen transfer. The agent normalizes gas exchange in the affected tissues, removes accumulated toxins, has an anti-inflammatory effect and improves blood microcirculation. Also, for intra-articular injections, chondroprotectors are used in combination with oxygen.

Elimination of pain syndrome is an important task in the treatment of the disease. The most effective method is novocaine blockade of the lumboiliac muscle, which allows you to reduce pain to a minimum.

In the treatment of aseptic necrosis, the use of physiotherapy procedures is of no small importance. The most used are:

UHF - and UFO-therapy;
electro - and phonophoresis with preparations of iodine, phosphorus, sodium chloride;
paraffin wraps;
balneotherapy;
massage.

Treatment with leeches for aseptic necrosis effective method improve blood circulation and prevent its stagnation. Leech saliva contains enzymes that thin the blood, dissolve blood clots, and speed up metabolic processes.

Surgery involves one of the following operations:

Decompression of the femoral head (tunnelization);
Autograft transplant;
osteotomy;
Arthroplasty;
Endoprosthetics of the femoral head.

Decompression or tunneling. The procedure consists in piercing the femur with a thick needle in the area of the so-called greater trochanter of the thigh.

The aim of the procedure is to increase blood supply by growing new blood vessels in the "tunnel" of the puncture, as well as to reduce intraosseous pressure within the joint. Reducing pressure in the area of the affected joint helps to reduce pain.

Treatment with folk remedies

Aseptic necrosis of the hip joint can be cured not only by conservative and surgical methods. The treatment of the disease will also come to the aid of patients folk remedies, which is especially effective for early stage diseases. We will offer several recipes that will help restore the blood supply to the head of the hip bone.

Therapy with pine buds
Ambulance for the hip joint - an infusion of pine buds. To prepare the remedy, you need to mix freshly picked pine buds and sugar in a glass container. Kidneys and sugar are laid out in layers up to about half of the dish, after which it is covered with a lid and put in a warm place for seven days.
After the syrup is formed in the container, it must be rubbed into the diseased joint, and also taken orally - three tablespoons twice a day for two months.
Tincture of cinquefoil for joints
You can relieve pain in the head of the hip bone and activate the blood supply with the help of a cinquefoil. 50 g of the dry component is poured into a bottle of vodka, tightly closed and hidden for a month in a dark place. After a month, the liquid is decanted and taken orally thirty drops daily. To improve the effect of treatment, cinquefoil tincture can be rubbed into a diseased joint.
Applications with cabbage
Cabbage leaves are a powerful fighter against pathologies of the musculoskeletal system, therefore they are also used to treat aseptic necrosis of the head of the hip bone. For treatment, you need to take a small head of cabbage, remove a few large leaves and grease them with honey. The oiled side of the sheet is applied to the affected area, after which the application is wrapped around the body with plastic wrap and wrapped in a warm cloth.
The procedure is best done every day and leave the sheet on the joint for as long as possible. The course of treatment in this way is one month.
Peppermint ointment against aseptic necrosis
Highly good effect gives mint ointment. It is very simple to make it - fifty grams of mint, eucalyptus and old aloe leaves are finely chopped, mixed, poured with water and boiled until the mixture resembles a homogeneous mass. To treat the resulting mixture, you need to lubricate the hip joint before going to bed. The procedures are carried out until discomfort won't go at all.
Bath with turpentine
Another way to influence the necrosis of the head of the hip joint is to take a bath with turpentine. To improve the effect, finely chopped Jerusalem artichoke tubers, pine branches, a package of sea salt and half a teaspoon of gum turpentine are added to the bath. Sea salt should be well dissolved, and then lie down in the bath for about ten minutes. Then it is necessary to apply an iodine mesh to the affected area, and honey on top.
To activate blood circulation in the area of the head of the femur, at least twelve procedures will be required.
ficus tincture
To prepare the product, you need to take the three largest, fleshy ficus leaves and pour them with a bottle of vodka. Leaves on vodka are insisted in a dark place for a week, and after that the liquid is drained and rubbed into the affected area at night, before going to bed.
Treatment with animal fat
Animal fat has long been used to activate the work of blood vessels. In equal amounts, it is recommended to take ordinary lard and nutria fat. Both components are melted and cooled to make a combined ointment.
To obtain a positive result, it is necessary to rub the ointment into the joint at night for at least a month.

It is quite difficult to cure aseptic necrosis of the head of the hip joint, however, when treated with all possible means, including folk remedies, the disease can be stopped at an early stage.

Features of treatment in children

Aseptic necrosis of the head of the hip joint in children has many names, such as: Perthes disease, Legg-Calve-Perthes syndrome, osteochondropathy of the femoral head, and many others, but this, unfortunately, does not change the essence.

The disease affects a child's body between the ages of 2 and 14 years. Boys are more susceptible to aseptic necrosis of the femoral head than girls, but in babies the disease is more severe.

Perthes disease manifests itself in childhood, affecting the hip joint and periarticular tissues, leading to shortening of the limb and disability of its wearer.

The main causes of such a serious illness at such a young age are considered to be several factors:

Heredity;
Violation of blood circulation (ischemia);
Various anemias;
Chemotherapy;
Rickets and dysplasia;
Infectious diseases.

Violation of blood circulation is the main factor that triggers the process of destruction of the joint. First, due to lack useful substances, the cartilaginous layer suffers: already at the first stage of aseptic necrosis, it begins to collapse, involving the periarticular tissues in this degenerative process.

Further, bone tissue and the acetabulum suffer. There is an indentation of the head of the bone into the joint and, as a result, shortening of the limb begins with its complete immobilization.

Watching children, parents will not be able to miss a drastic change in the behavior of the child. Until recently, an active and nimble baby, more and more plays calm games, begins to limp, etc.

In order not to miss the initial stage of the development of the disease, you need to know its symptoms:

The most important and companion of osteochondropathy of the femoral head is pain. The older the child, the more accurately he will describe his feelings. At the very beginning of the development of the disease, pain can occur after active games, and with the development of pathology, even at rest.
Gait disturbance. A child with aseptic necrosis begins to limp due to pain, and this is hard to lose sight of.
Crunch and limited movement of the joint. When the disease enters the stage of destruction of bone and cartilage tissues, the hip joint ceases to function normally, up to its complete immobilization.
Shortening of the affected leg. In the later stages of necrosis, the diseased limb will become noticeably shorter than the healthy one.
Atrophy of the periarticular muscles. The process of atrophy and reduction in the mass of the gluteal muscles, muscles of the lower leg and thigh is due to the fact that the child automatically tries to unload the sore leg due to pain. As a result, the muscles lose their tone and, as it were, shrink.
Swelling and pain when feeling the diseased joint.

If you notice at least 1 of the above symptoms in a child, you should immediately seek qualified help. Treatment of aseptic necrosis of the head of the hip joint in children is not an easy task. But do not lose heart, because nothing is impossible for modern medicine.

The primary task for the doctor will be to restore blood circulation in the area of the affected joint, and for this there are many various methods:

The use of chondroprotectors, only after 12 years;
Restoration of calcium metabolism, to preserve the structure of bone tissue;
Drugs to improve blood circulation;
Means for accelerating and improving the quality of metabolic processes;
Vitamins and diet;
Complete unloading of the diseased limb, but with gentle loads during therapeutic exercises to avoid muscle atrophy;
Physical procedures that stimulate metabolism;
Surgical methods used only as a last resort when treatment fails positive results. The destroyed joint and bone tissues are replaced with a prosthesis. Endoprosthetics in a growing body is a temporary matter, so the patient and his relatives must be mentally prepared for a second operation in the future.

Treatment of Perthes disease is much more effective in its initial stages, as is the case with other diseases of the musculoskeletal system. Be attentive to your health and the health of your children, because any disease is easier to prevent than to cure.

Aseptic necrosis of the head of the hip joint in pregnant women

The period of pregnancy for any woman is the most important. Indeed, during these short nine months, the expectant mother will have to endure, and then give birth to a healthy baby. However, not all women easily endure this difficult time.

Many face serious problems: someone has late toxicosis, someone has an acute lack of vitamins, and someone has hip joints during pregnancy. We will talk about the last problem in more detail in this article, as well as what to do if the pain does not go away even after childbirth.

During pregnancy, a woman's spine experiences a tremendous load, which is expressed by lower back pain, especially in late pregnancy. Pain where the pelvic bone is located, torments almost every second woman.

They hurt both at the very beginning of pregnancy, and in the middle and towards the end of the last trimester. On the one hand, the pain in the hip joint seems insignificant, and the woman hopes for her disappearance after childbirth. However, when aches or divergence of bones does not allow you to sleep at night and pain in the pelvic bone prevents you from getting out of bed normally, the expectant mother begins to sound the alarm.

The hip joint during the bearing of a child experiences a tremendous load, and if it hurts, a mass develops. possible complications, since a woman during pregnancy gradually tries to minimize the load on the pelvic bone.

The main causes of bone pain during pregnancy are:

Congenital pathologies, in which the hip joint is located at the wrong angle, which makes it difficult to work.
Dislocations, when the contact between the cavity and the head of the femur is broken.
Dislocations of the hip joint arising from the underdevelopment of the cavity. In this case, the head of the femur can freely extend beyond the boundaries of the cavity itself.
Aseptic necrosis, in which there is necrosis of the tissue of the head of the joint.
Various inflammations that occur with injuries, arthritis, bursitis, etc. This type of pain is usually accompanied by fever.
Hormonal changes associated with the production of a special hormone - relaxin. The hormone causes the bones to separate and increases the possibility of the baby's head passing during childbirth. In this regard, the likelihood of injury to the hip joint also increases.
Significant overload of the pelvic bones associated with the growth of the uterus, an increase in the abdomen and the resulting additional pressure on the spine and pelvic bones.
A severe lack of calcium, resulting from the fact that the growing skeleton of a child consumes a significant amount of this trace element. As a result of this, the skeleton of the expectant mother may become thinner, joints and teeth may be destroyed.
Exacerbation of old injuries that make themselves felt during pregnancy.
Reflected pain that occurs in late pregnancy.

In some cases, pain may persist after childbirth. This is due to the fact that during childbirth, the pelvic bones diverge, their deformation occurs, which causes discomfort in the acetabulum. At the same time, the hip joint begins to work incorrectly, it hurts and interferes in every possible way with enjoying motherhood.

Therefore, many doctors recommend continuing to take calcium after childbirth and drink an additional complex of vitamins so that the pelvic bone becomes strong again. Gymnastics for pregnant women is a very important component in preventing back pain during pregnancy.

What to do if the hip joint hurts? With constant and severe pain before childbirth, it is better to immediately contact an experienced specialist who will prescribe the appropriate treatment or preventive actions.

As a treatment, if the hip joint is very sore, the following is usually recommended:

In addition to eating foods with calcium, you should take special vitamin complexes. The norm of calcium for an adult is 1 g per day. For pregnant women, this rate sometimes increases by 2-3 times. That is why proper and balanced nutrition is so important.
With weak abdominal muscles, doctors recommend wearing a special bandage that removes the main load from the spine. When exactly to start wearing, only a doctor can tell. Some women are prescribed it from 16-20 weeks, and some only after 25-30.
With frequent pain, it is advisable to rest more often. After lunch or a snack, you can lie down for 5-10 minutes, allowing all the muscles to completely relax.
Avoid high heels, because it is because of their wearing that a woman can stumble and get seriously injured.

When the pelvic bones hurt during pregnancy, there is often no time and energy left to correct the pathology, so it is best to do the following before planning a child:

Constantly monitor your posture. This is done to avoid shifting the center of gravity.
Do not lift any weights that can harm your joints.
Do all things slowly and measuredly, because any load and any push can provoke pain and problems with the hip joints.
Sign up for yoga or special gymnastics for pregnant women. During gymnastics, specialists will teach you how to relax, breathe properly and bring your body into harmony. Yoga, on the other hand, will help strengthen the joints, stretch and prepare the muscles with ligaments for the birth process.
After any physical activity It is advisable to lie down and relax a tense body.
The pool also provides beneficial effect for the entire body as a whole. It relieves pressure on the spine, massages and strengthens the entire body. During swimming, the load on the spine is practically not felt, and a woman can relax and enjoy the process.

In childbirth, a natural divergence of the pelvis occurs, and immediately after childbirth, the existing pain may not disappear. However, if the pain in the hip joint has not disappeared after a month after the birth, it is advisable to immediately consult a doctor. Only a qualified specialist can determine the cause of pain, prescribe necessary examination or complex treatment.