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Introduction of non-surgical treatment for hormonal ischemic necrosis of femoral head

BY Iris Wheatley 2020-04-10

The appearance of hormonal ischemic necrosis of the femoral head has caused great harm to patients. At present, clinical treatment of this disease mainly uses surgical treatment and non-surgical treatment, and non-surgical treatment is suitable for young patients because of its better The potential self-repairing ability of the femoral head can often be reconstructed as it grows. For the adult patients, the disease belongs to stage Ⅰ-Ⅱ, and the smaller range can also be used.

   First, avoid weight-bearing: For single hip joint lesions, the side of the lesion should strictly avoid weight-bearing, can support crutches, and walk with a booster; if both hips are affected at the same time, you should stay in bed or wheelchair; such as hip pain Severe, bed rest and lower limb traction often relieve symptoms. The shortcomings of its treatment are: long treatment time, the patient is difficult to persist.

  Second, lipid-lowering treatment: the theory of fat embolism of hormonal ischemic necrosis of femoral head has been known for a long time. Large doses of hormones can promote the decomposition of adipose tissue, the decomposition or release of free fatty acids in the blood to form hyperlipidemia, fat emboli and blood-neutral lipid-like emboli combined vascular embolism. In addition, the bone marrow adipocytes are hypertrophic and accumulated, resulting in increased intramedullary pressure and compression of the microvascular structure in the bone, resulting in circulatory disorders.

  Animal experiments suggest that lipid-lowering drugs may correct hormone-induced lipid metabolism disorders and correct some physiological changes of early femoral head necrosis. Some scholars believe that lovastatin can not only reduce cholesterol levels, but also can resist the differentiation of bone marrow precursor cells into fat cells induced by hormones, thereby preventing bone necrosis.

   3. Interventional therapy: The principle of interventional therapy for hormone-induced necrosis of the femoral head is to directly inject high-dose thrombolytics, anti-inflammatory drugs and bone growth promoting drugs into the blood supply artery of the affected femoral head to ensure The concentration of drugs in the nutritional blood vessels of the lesions can be expanded to dissolve blood vessels, dissolve fat emboli, and dredge the microvessels near the hip joint, thereby improving local blood supply, delaying the development of osteonecrosis, and promoting bone repair and new bone regeneration. Interventional therapy for hormone-induced ischemic necrosis of the femoral head can significantly improve clinical symptoms, with little damage to the patient and good efficacy.

   Fourth, correct the disorder of coagulation mechanism: Based on the theory of lipid thrombosis, Jones put forward the theory of intravascular coagulation, and believes that the occurrence of osteonecrosis may be caused by a series of interrelated body environment caused by multiple causes. The changes eventually trigger intravascular coagulation, which leads to bone ischemic necrosis. Intravascular coagulation may be the last common pathway for non-traumatic osteonecrosis. He observed the presence of fat emboli and fibrin thrombi in the microcirculation of the femoral head subchondral region of typical patients with osteonecrosis. He further proposed a new concept of "triple syndrome" of fat embolism, intravascular coagulation and osteonecrosis.

   Fibrin Polypeptide (FDA), D-dimer (D-dimer) and Antithrombin Ⅲ (AT-Ⅲ) are indicators for the diagnosis of local or systemic intravascular coagulation sensitivity and can be used for exploration The presence of local or systemic coagulation in patients with high-risk osteonecrosis. Congenital thrombosis tendency and low fibrinolysis ability are one of the susceptible factors of hormonal femoral head necrosis. Tadami applied hormones to rabbits for 8 weeks alone, which proved that the platelet aggregation rate increased and could improve PGE1. He believes that hormones increase the platelet aggregation and cause the prethrombotic state, which can be inhibited by PGE1, thereby protecting endothelial cells and improving blood flow, thus preventing the occurrence of osteonecrosis. Chinese scholars have used Stanozolol and benzacetone coumarin sodium to treat hormonal femoral head necrosis, and achieved satisfactory results.

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