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Mindmap-Galerie femoral head necrosis
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femoral head necrosis
Mind map of femoral head necrosis, the blood supply of the femoral head is interrupted or damaged → the structure of the femoral head changes, the femoral head collapses → joint pain and joint dysfunction.
Bearbeitet um 2023-10-30 10:40:22
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femoral head necrosis
definition
Interruption or damage of the blood supply to the femoral head → structural changes in the femoral head, collapse of the femoral head → joint pain and joint dysfunction
blood supply
obturator artery
foveolar artery
profunda femoral artery
medial femoral circumflex artery mvp
lateral epiphyseal artery
superior metaphyseal artery
inferior metaphyseal artery
lateral femoral circumflex artery
ascending branch of nutrient artery
Cause
traumatic
Femoral neck fracture [especially subcapital type]
Traumatic dislocation of hip joint
Femoral head fracture
non-traumatic
GC
ethanol poisoning
decompression sickness
Hyperlipidemia
More common in middle-aged men
pathology
naked eye observation
Early days
Congestion, edema and thickening of synovial membrane of hip joint
Femoral head cartilage intact
later stage
Articular cartilage sinks → it feels like a ping pong ball floating when touched
Cartilage cracking and peeling, bone exposure
Femoral head deformation
Microscope★
A articular cartilage
B necrotic bone tissue
Bone cells disappear in the lacunae
C granulation tissue
D reactive new bone
ENormal tissue
clinical manifestations
There may be no clinical symptoms in the early stage
50-80% of patients are bilaterally affected
Joint pain! ! !
Pain occurs intermittently and worsens, and bilateral lesions may present alternating pain
physical signs
Typical: Deep tenderness in the groin area
"4-letter test" positive
Limited hip mobility
Diagnosis★★
X-ray
has an irreplaceable role
It takes at least 2 months to see changes in femoral head density
Frontal position, frog position, lateral position
Installment★
I: subchondral dissolution stage
"Crescent sign" [1-2mm arc-shaped transparent zone in subchondral bone]
II: Femoral head repair period
Subchondral bone density ↑, with punctate or patchy areas of reduced density visible around it
The femoral head is in complete shape and the joint space is normal.
III: Femoral head collapse stage
The subchondral bone in the weight-bearing area is flattened and collapsed, the femoral head is deformed, Shenton's line is basically continuous, and the joint space is normal.
IV: femoral head displacement stage
The femoral head is flat, displaced outward and upward, and Shenton's line is discontinuous
MRI
T2 phase “double line sign”
Lateral low signal zone: hyperplasia and sclerosis of bone
Medial high signal zone: granulation tissue
radionuclide scan
Can be diagnosed 3-6 months in advance
Histological examination
Traumatic but reliable
Clinical stage
0
Pathology【】
1
MRI and pathology【】
2
Radiographic examination [ ] but no crescent sign [collapse]
3
Dome flattening or crescent sign can be seen on X-ray and CT
4
X-ray shows flattening of the femoral head and narrowing of the joint space
treat
non-surgical
Strictly avoid weight bearing
Discourage the use of wheelchairs
Operation
vascularized bone graft
No or slight collapse of the femoral head
joint replacement
Osteotomy
Common transtrochanteric rotation osteotomy
core decompression
Conducive to the growth of blood vessels