Necrosis of the avascular bone. Avascular necrosis of the femoral head

Avascular necrosis of the head of the femur is caused by blood flow disorders in the vascular system feeding this site. Such phenomena occur as a result of compression or twisting during occlusion with a small artery thrombus or trauma. Next, let us consider in more detail what avascular necrosis of the head of the femur is.

The provoking factors

Prolonged vascular spasm and increased blood viscosity, venous stasis and impairment of outflow significantly impair the nutrition of the head of the hip bone. In connection with this, internal pressure increases, ischemia develops. This provokes a violation of the mechanical properties of bone tissue. As a result, voids are formed. Over time, the bone begins to deform, articular cartilage, destroying, exfoliates from it.

Features of pathology

Necrosis (avascular) of the bone is found quite often. Predominantly, pathology is detected in men aged 20 to 45 years. Avascular necrosis of the femoral head in children aged 2 to 12 years is also diagnosed. In this case, the boys fall ill more often. Symptoms that accompany avascular necrosis, in some cases, it is difficult to differentiate. This somewhat complicates the formulation of an accurate diagnosis. In particular, the symptoms of avascular necrosis are almost impossible to distinguish from manifestations of the pathological process in the hip joint.

Progression of the state

Avascular necrosis develops quite rapidly. Already on the third day the patient feels unbearable pain, the intensity of which increases. When trying to get up, while walking, there is soreness in the groin area. She also appears on the lateral and anterior part of the thigh and gives to the knee. In many patients, the pain can be exhausting and permanent. It can last at night and abate by the morning hours. When the load is moving, soreness in the lower back or buttock is provoked. Limitation of mobility, the appearance of lameness should immediately alert the person and become the reason for an early appeal to a specialist.

Avascular necrosis of the head of the femur: causes

According to many experts, the development of pathology is facilitated by the continued intake of alcohol in large quantities. Also, long-term treatment with corticosteroid hormones in high doses can cause necrosis. Among the popular factors provoking the condition, it should also be noted injuries: fractures, dislocations, bruises. Necrosis (avascular) of the bone can begin because of the usual fatigue, stress, emotional overstrain. There are cases when pathology developed due to chronic or acute pancreatitis. As a provoking factor, radiation irradiation in large doses can also act. Pathology can 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 triggered the pathology.

Diagnostics

Avascular necrosis should be identified as early as possible. In this case, there is a high probability of avoiding surgical intervention. However, as a rule, the 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. The disorder becomes noticeable on x-rays after several months. Identify the necrosis (avascular) of the bone in the initial stages can be 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 development of pathology

How is avascular necrosis of the femoral head progressing? The stages of pathology are as follows:

• Violation of vascular function. At this stage it is necessary to avoid jumping, carrying heavy loads, long standing in one place, running. Patient recommended rest and relaxation. Treatment at this stage should be aimed at restoring blood circulation in the head of the femur, as well as regeneration in the tissue. The patient is recommended special gymnastics to prevent the development of muscle atrophy. At this stage, a specialist can recommend the use of vasodilator drugs. Medications will help eliminate stagnant phenomena and restore the structure of the head due to normalization of arterial blood circulation and elimination of spasms. Effective in this case, non-steroidal anti-inflammatory drugs, novocain blockade, hirudotherapy, massage. Decompression of the large trochanter or head of the hip bone is also used.
• Deformation and destruction of the damaged element. At this stage, it is useful to walk slowly at 30-50 minutes, exercise on a stationary bike, and swimming in sea water. From drugs recommended drugs that promote bone restoration and vasodilators. Hirudotherapy, massage, decompression are also prescribed.
• Osteoarthritis 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 dates, lameness and marked shortening of the affected limb. In particular, this is noticeable when the patient is in a horizontal position. Against the background of pathology, muscle atrophy progresses: tissues begin to shrink and decrease in volume.

Avascular necrosis of the femoral head: treatment with NSAIDs

Such drugs as Diclofenac, Indomethacin, Ketoprofen, Piroxicam, Butadion, Meloksikam, Nimulide, Celebrex and their derivatives are among the recommended drugs of this group. These medications help to reduce soreness. It should be noted that NSAIDs do not treat necrosis (avascular) of the bone. However, these medicines can bring a significant benefit to the patient. Appointed in a timely manner, the drugs prevent a reflex muscle spasm that appears in response to intolerable pain. Relaxation of the fibers contributes to the restoration of blood circulation in the affected area. However, taking NSAIDs can be dangerous for the patient. The fact is that after using medicines a person ceases to feel pain and loads the affected area in the same way as a healthy 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 such drugs as "Trental" ("Pentosifillin", "Agapurin") and "Theonikol" (nicotinate xantinol). They are quite effective in avascular necrosis. These drugs contribute to the elimination of stagnation in the circulation. When they are taken, the restoration of the head tissue of the bone is accelerated. This is made possible by the stabilization of the arterial blood flow and the elimination of spasm in small blood vessels. Among the additional benefits of vasodilator drugs should be called their almost absolute harmlessness. When following the recommendations of a doctor and taking in therapeutic doses, they have almost no contraindications and side effects. They are not prescribed for acute myocardial infarction, as well as for patients who have recently undergone 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 precisely to the active expansion of the vessels. Reception of medicines of this category is carried out twice a year by courses lasting 2-3 months.

Means for stimulating tissue repair

This category includes such drugs as "Calcium D3 Fort", "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 connection accumulates in the skeleton elements. In particular, its concentration increases in the tissues of the head of the hip bone. Significant help with pathology brings calcitonins. They include, in particular, such means as Sibakaltsin, Alostin, Miakaltsik and others. These drugs stimulate bone formation and eliminate soreness. Due to their use, the outflow of calcium is significantly reduced and the activity of osteoblasts ("building" cells) is stabilized.

additional information

Avascular necrosis of the head of the femur (ICD-10: M91.1) has another name. It is referred to as Legg-Calve-Perthes disease. The most common pathology in England. In this country, 1 case per 1800 inhabitants is registered.