Non-surgical treatment of avascular necrosis of the femoral head (ANGBK)

Content

  • Symptoms of the disease
  • developmental stage
  • Non-surgical treatment
  • Results of clinical trials
  • Forecast


  • During the last 15 years in China, due todevelopment and introduction of new technologies, Professor Huang Ketsin (KeQin Huang) is treating avascular necrosis of the femoral head, and other joint diseases degenerative nature of the non-surgical method.

    Symptoms of the disease


    Symptoms of the disease

    Non-surgical treatment of avascular necrosis of the femoral head (ANGBK)Quiet hip disease(ANGBK) - heavy degenerative bone disease due to disruption of the structure of bone tissue, the microcirculation and fatty degeneration of the bone marrow. Read more in the article "The treatment of degenerative diseases of the joints."

    Treatment of avascular necrosis developed forthe femoral head is the most vulnerable and most difficult to treat. Treatment aseptic necrosis other locations (vertebral body, the head of the humerus bone Tarrano et al.), Is generally less difficult and the flow duration.

    The treatment is extremely important ANGBK diagnosis and initiation of treatment in the early stages when the main clinical manifestations are only pain in the hip joints radiating to the groinunmotivated pain in the knee joints. When a patient is suffering from necrosis of the femoral head, according to objective and subjective reasons, delaying the start of treatment, this inevitably leads to a complication of the disease, and there is a collapse or hip stiffness in the femoral head.

    developmental stage


    developmental stage

    Analysis of the structural and radiographic changes, as well as a detailed study of existing classifications ANGBK allowed to formulate a working chetyrёhstadiynuyu classification of the pathological process ANGBK:

    Stage I - the microscopic changes in the structuresubchondral bone and osteonecrosis. Affected cancellous bone in the femoral head cartilage unmodified, and a zone of structural change is not more than 10%.

    Stage II - Impression fracture. Femoral head surface has cracks of the "cracked shell." The load area of ​​trabeculae are cracked or irregularly shaped lesions mikrokollapsa. The zone of structural change is not more than 10-30%.

    Stage III - fragmentation. Characterized by irregular contours of the femoral head, mild collapse, the emergence of a few pockets of seals or cystic degeneration. Changes interarticular space (contraction or expansion). The zone of structural change is not more than 30-50%.

    Stage IV - the complete destruction of the head. Head shape is changed, portions of the collapse of irregular shape or collapse the entire head. The structure of trabecular dissolved or sealed, the strip fractures of irregular shape. Internal or external edge of the acetabulum ectopic undergo changes. Interarticular space narrowed or disappeared. There is a dislocation or subluxation. Zone Structural changes of 50-80%.

    Clinical observations allow us to determinethe duration of each stage of the flow. It is for Stage I - 6 months, II stage - 6 months, III stage - 3-6 months, followed by transition to stage IV.

    Non-surgical treatment


    Non-surgical treatment in Russia

    A new method of non-surgical treatment has become ANGBKused since 1997 in the Department of Traditional Medicine of the 2nd Central Military Clinical Hospital named after PV Mandryka. Since 2006, based on the obtained exclusive rights to the non-surgical method of treatment ANGBK Professor Juan Ketsin (KeQin Huang) open specialized medical center for non-surgical treatment ANGBK - as the most complex and difficult diseases of degenerative nature.

    Non-surgical treatment - is a systemic,intensive multi-function, multi-component, isoenergetic, the length of time the impact on the body to restore the bone structure and function of the joint.

    The main components of the non-surgical method of treatment:

    • plain radiography of both hipjoints using pilings on Launshteynu followed by photos are processed in a special computer program that allows to quantify changes in bone structure and its density;
    • dual energy X-ray densitometry of the femoral head;
    • Laboratory assessment of endocrine status, mineral indicators, carbohydrate and fat metabolism, indicators of bone formation and resorption;
    • two-phase scintigraphy of the skeleton and soft tissues to the blood flow assessment, changes to the bone and to exclude the presence of malignant tumors or metastatic disease;
    • diagnosis of diseases of the internal organs and changes to the method of information analysis electrocardiosignals;
    • medical procedure using devicesHC-5, 1-Osteon providing electrical signals to the supply point of the meridian in order to maintain the electrochemical environment of bone and optimization of new bone growth;
    • the use of hardware and softwareCAP-MT8 Multimag with independent multi-channel management intensity continuous and pulsed magnetic field directions of the vectors of magnetic induction and at times pulse action, providing:
    • o timing of the nervous and endocrine systems, increasing the level of non-specific Resistance;
    • o increase in the rate of action potentials along nerve conductors, reducing perineural edema, reducing or eliminating pain impulses from the hearth;
    • o optimization of central and peripheral hemodynamics, improvement of microcirculation, stimulation of collateral circulation and normalizing blood rheology;

  • the use of drugs inside Chentszay increasesresistance and normalizes its functions, ensuring the stabilization of lipid and carbohydrate metabolism, reduces fat deposits in the cartilage and bone tissue, restoring trabecular structure, circulates qi and blood;
  • the use of an individual complex of medical drugs, normalizing metabolism in bone tissue (active vitamin D metabolites, antiresorptive agents, and others.);
  • unloading hip joints, treatment exercise, holistic massage, and balneotherapy, aimed at modeling and restoration of hip function.
  • According to the results of analysis of factors and peculiaritiesthe patient selected treatment and non-surgical treatment is carried out, aimed at the restoration of bone structure, improve the circulation of qi and blood, restoration of hip joint function and improve the quality of life of the patient. In the construction of the treatment program is estimated age, occupation, patient demand for joint function, the type of necrosis of the femoral head, hip fracture stage.

    The main varieties of pathological changes of the femoral head to be a new method of treatment:

    • acute necrosis of the femoral head dissolution type;
    • the occurrence of fragmentation band necrosis of the femoral head with a tendency to disintegration and destruction of the femoral head;
    • joint space narrowing in the hip joint, limiting its functions with a tendency to self-locking;
    • lack of fusion of the bones after surgery for hip fracture combined with femoral head necrosis, absorption of bone collapse;
    • dissolution and absorption of necrosis of the femoral head, the occurrence of hip subluxation and destruction and its structure;
    • osteoporosis bone after installing the prosthesis, endoprosthesis aseptic loosening of components;
    • aseptic necrosis of the femoral head, misalignment of the pelvis, scoliosis;
    • destruction of epiphysis necrosis of the femoral head in children, the destruction of the acetabulum, hip joint deformation of the structure;
    • necrosis of the femoral head, complicated by epifiziolizom children;
    • fracture of the femoral neck in children, complicated by necrosis of the femoral head, or the presence of focus in the metaphysis;
    • osteochondropathy at the epiphyseal ends of long bones, short spongy bones, apophysis, certain articular surfaces;
    • therapeutic for diseases, infectious and vascular origin involving endothelial dysfunction and pain in the hip joints.

    A new method of treatment of femoral head necrosisbone is based on the fundamental theory of traditional Chinese medicine combined with western classical medicine. In it used modern scientific technology, used new developments in osteology, trauma, biomechanics and related disciplines.

    Results of clinical trials


    Results of clinical trials

    In specialized medical centersANGBK non-surgical treatment from September 2006 to October 2008 under the supervision there were 60 people. aged 3 to 70 years with varying degrees of avascular necrosis of the femoral head. At 6 people. (10%) had complete destruction of the femoral head or a pathological fracture of the femoral head (IV ANGBK stage). A 54 people. (90%) had less severe manifestations of the disease (II-III stage of disease).

    The main cause of the disease were ANGBK: osteoporosis / osteopenia type I and II (48%), alcohol (22%), the consequences of receiving hormonal therapy and cytotoxic drugs (17%), the consequences of postponed hip injuries (13%).

    The course of treatment was 3 months (2 proceduresdaily, total: 180 procedures). Methods of treatment provided in the outpatient and home. The total duration of treatment ranged from 1 to 2 years. It depended on the degree of destruction of the femoral head, the individual patient tolerability and therapeutic exercises. Most long-term treatment took 10 courses (30 months), and the shortest - 2 courses (6 months) on average - 15 months. Evaluation of treatment results was performed using ANOVA.

    Every three months, was carried out comprehensiveexamination of the patient, which included plain radiography of both hip joints and laboratory assessment of endocrine status, mineral indicators, carbohydrate and fat metabolism. Every twelve months carried out static and dynamic scintigraphy of the femoral head and the skeleton and X-ray densitometry at L2-L4 program and hip.

    Evaluation of the hip joint functions volume before treatment, as well as its degree of recovery during and after the treatment was carried out by the point system Harris'a.

    The criteria for the effectiveness of treatment They were: increasing the load tolerated by patients; increase the volume of joint movement; the absence of pain; the possibility of self-service; no lameness. Excellent and good results were observed in 78% of patients, satisfactory - in 12%, there was no effect - 10% (2 patients in this group were held total hip replacement). It should be noted that all of the last six groups of patients were stage IV (complete destruction of the femoral head).

    Analysis of the results of treatment of patients in groups withdifferent putative etiological factors of necrosis of the femoral head showed that the treatment effect was in particular due to the causes of the disease. The therapeutic effect in patients with dysplasia and consequences of injury was better than in the treatment of patients whose disease is caused by the use of hormonal drugs and alcohol abuse (p <0,05).

    Positive results of complex therapyWe observed already after 1 month. Treatment: decreased the severity of pain, increased range of motion, improved overall well-being of patients. Given the fact that the treatment is designed for the long term (at least one year), great importance was the attitude of the patient to the recovery process (adherence), compliance with the established regime and the implementation of medical prescriptions and recommendations.

    Forecast


    Forecast

    Thirteen-year practice of the treatment of asepticnecrosis of the new non-invasive method has shown that a full recovery of the femoral head usually does not occur (observed isolated cases of complete recovery of bone structure without head collapse in patients with central necrosis of the femoral head). However, in most cases, it is possible to achieve an acceptable outcome of the disease: prevention of lesions of the contralateral joint; reduction of destructive processes in the femoral head and secondary coxarthrosis; prevent vicious hip flexion setting in position and bring the excessive rotation; achieve the minimum limit range of motion in the hip joint; achieving synchronization of functioning of the thigh muscles.

    Experience in the treatment of patients with aseptic necrosisvarious locations indicates that huge unaccounted mass of secondary necrosis occurs in the treatment of the underlying disease - hematologic, autoimmune, chronic infection, acute viral lesions - with the use of hormonal drugs, cytostatics. In the presence in this group of patients with clinical manifestations of the need to carry out a targeted inspection.

    Conclusions:

    • ANGBK, osteochondropathy, degenerative-dystrophic diseases of joints united by a common pathogenetic syndrome - changes in bone structure;
    • In the treatment of these diseases using conservative, surgical and non-surgical methods of treatment depending on indications and clinical features;
    • The use of non-surgical treatmentmay at any stage of the patient, because the treatment provides increased resistance to diseases, strengthening the body and improving bone structure.

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