Treatment of femoral head necrosis with bone metastasis
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Urumqi General Hospital of Lanzhou Military Region
Clever treatment of femoral head necrosis
1, chief physician Shi, director of the Orthopedic Center of Urumqi General Hospital of Lanzhou Military Region, has successively carried out surgical methods for treating femoral head necrosis, such as repairing bone defect with fascial bone flap, assisting artificial hip joint and autologous hip joint replacement. (Left)
2. Liu Shuhua, deputy chief physician, is a military orthopedic center of Urumqi General Hospital of Lanzhou Military Region. She is good at the diagnosis and treatment of femoral head necrosis, femoral neck fracture and pediatric orthopedic diseases, and has won many military scientific and technological progress awards. (right)
Moderator: Hello, audience friends! This is the live program of CCTV's Road to Health. Today we are going to talk about the problem of femoral head necrosis. There are 30 million patients with femoral head necrosis in the world, and 4 million in China. The two new therapies introduced today are called assisted artificial hip joint and greater trochanter femoral head replacement. First of all, let's look at a Mr. Peng: 46-year-old Mr. Peng has always been the pillar of the family.
Mr. Peng: I was treated in Liaoning Xincheng for three months after my illness. I have been taking medicine since I came back. The effect of taking medicine is not very good, and it costs a lot of money. Walking legs are particularly painful now, and walking for more than ten meters is particularly painful. Being ill for three years has also brought a lot of pain to the family and exhausted the family's money.
Liu Shuhua: The femoral head is simply in the position of our hip joint. Look at a model, the femoral head is like a door shaft, moving freely, and the weight of the femoral head is very heavy. Almost all the weight of the whole body depends on it. Mr. Peng's femoral head eventually died of ischemia.
Stone: There are many reasons for femoral head necrosis. Lao Peng's condition was caused by trauma. As can be seen from the figure, the patient's right femoral head necrosis has collapsed (three years). We look at the development process of femoral head necrosis through an animation. After grinding the acetabulum for a long time, there will be no joint space, and then bone hyperplasia will continue, so there will be fewer crabs. Do you want Deng Lang to knock and wave, and your brother will blow a blow? What's the matter with you? What's wrong with the swimming pool? Another grave? Seeking harmony? How can I help you? What's the point? What's the matter with you? Hey? What's the matter with you? The beak was dark and steep, and Deng fell to the ground. Source erasure forgiveness?
Moderator: How to distinguish the degree of femoral head necrosis?
Stone: We divide femoral head necrosis into seven types by imaging examination. Although the early femoral head necrosis, but the basic shape is still round, and gradually developed into a little collapse and partial collapse. Then the necrosis of the femoral head will become more and more serious in the later stage, and eventually it will completely lose its mobility. Femoral head necrosis can be repaired in the early stage and can only be reconstructed in the later stage. Next, let's look at the principle of assisted artificial hip joint treatment. First, the femoral head was repaired by surgery, and then it took 1-2 years to recover. The patient must rest in bed. In this way, in 1997, we developed a solution to bedridden, which is the assisted hip joint. With this auxiliary equipment, the load-bearing of the femoral head can be well replaced, and the femoral head is actually no longer load-bearing. Then the femoral head can be well repaired and healed, and the stent can be taken out after healing.
Moderator: What is the actual treatment situation?
S: Let's watch a film: This is a 20-year-old boy with femoral head necrosis. The patient suffered from necrosis of the left femoral head for one year. 1999 assisted in combination therapy. After one and a half years, the brace was taken out and recovered well.
Moderator: This method is mainly aimed at patients with early femoral head necrosis, and severe cases need reconstruction. What kind of treatment is this?
S: Our trochanter and femoral head replacement is not using allogenic bone or artificial bone, but using the trochanter of the patient's own femur. The greater trochanter and femoral head are two parts that grow on the same bone. These two parts are the same size and fully meet the exchange conditions. The operation begins with the resection of the necrotic femoral head, then the greater trochanter is removed, and then the femoral head is replaced, and the greater trochanter is replaced with the resected femoral head. The new femoral head is supplied by the original blood vessels, and the necrotic femoral head is no longer loaded. In addition, there is abundant blood supply around it, and it can finally heal well.
Moderator: What is the effect of the operation?
Shi: Let's look at the film of a patient with femoral head necrosis for more than 30 years. This is a 44-year-old woman. Her right femoral head necrosis lasted for 37 years. 1998, she underwent an exchange operation. After five years of operation, her recovery is very good. She can stand and squat, and her functions are basically restored.
Moderator: Let's look at the situation of two patients:
Patient female (necrosis of the right femoral head for one year): She received exchange surgery on 1997. Before the operation, she was unable to walk with crutches, which was very painful. It doesn't hurt now. She can run and jump with crutches.
Patient male (left femoral head necrosis for 33 years): he broke his leg and fractured his femoral neck in 60 years. I have been treated once in Lanzhou and once in Inner Mongolia, and the results are not good. I have to walk with crutches. Later, he was treated in Urumqi Hospital of Lanzhou Military Region, and he could do everything for two months after operation.
Moderator: Are there any indications for the operation?
Stone: scope of application
● avascular necrosis of femoral head
● Hip fracture and dislocation
● Hip tumor or tumor-like lesion
Liu Shuhua: The specific situation of each patient is different, and it is necessary to analyze and judge whether it is suitable for surgery according to the specific situation. In addition to femoral head necrosis, it depends on the patient's whole body.
Moderator: Mr. Wang of Shenyang is 47 years old. How can hip pain be found early in femoral head necrosis?
There are many methods of medical examination. Magnetic resonance and ECT (local blood supply examination) can detect femoral head necrosis at an early stage.
Moderator: Ms. Wang from Fujian, 46 years old. Because of the necrosis of the right femoral head, I had a total hip replacement for 5 years. Now I can't walk because of my hip pain. Can I still receive your treatment now?
Shi: the patient has lost the treatment conditions for this kind of operation, because this method uses the patient's own materials for treatment. Artificial joint surgery is actually a destructive operation, and there is no condition for repair. In this case, the patient can only undergo hip replacement surgery again.
Moderator: Mr. Zhang, a 44-year-old from Nanchang, Jiangxi Province, can he still do artificial hip replacement after this treatment?
Liu Shuhua: Yes.
Moderator: So how long is the recovery time of repair surgery and reconstruction surgery respectively?
Liu Shuhua: The recovery time of repair surgery is about 2-3 months. Reconstruction surgery takes 4-6 months to recover.
expert opinion/advice
● Drinking, it is best not to drink.
● Avoid trauma as much as possible.
● Use hormone drugs such as prednisone and dexamethasone with caution.
References:
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