Treatment of aseptic necrosis of the femoral head (AngBK) presents great difficulties. When the patient suffers from the head of the femoral bone, on objective and subjective reasons, delays the beginning of treatment, it inevitably leads to a complication of the disease, and a collapse occurs in the head of the femoral bone or the hip rigidity occurs. About modern approaches to the treatment of this formidable disease, read in the article.
Content
Over the past 15 years in China, thanks to the development and implementation of new technologies, Professor Juan Cacy (Keqin Huang) is treated with aseptic necrosis of the femur head and other diseases of the joints of the degenerative-dystrophic nature by the non-operational method.
Symptoms of Disease
Aseptic necrosis of the head of the femur (Angbk) — Heavy degenerative-dystrophic disease of the bone due to violation of the structure of bone tissue, microcirculation and bone marrow dystrophy. Read more in the article «Treatment of degenerative dystrophic diseases of the joints».
Treatment of aseptic necrosis is designed for the head of the femur, as the most vulnerable and most difficult to treat. Treatment of aseptic necrosis of other localizations (body of the vertebral, brachial bone head, plate bone, etc.), as a rule, is less difficult for the flow and duration.
In the treatment of Angbk, the diagnosis and start of treatment in the early stages are extremely important when the main clinical manifestations are pain in hip joints With irradiation in the inguinal area and unmotivated pain in the knee joints. When the patient suffering from the necrosis of the femoral head, on objective and subjective reasons, delays the beginning of treatment, it inevitably leads to a complication of the disease, and collapse occurs in the head of the femoral bone or the hip rigidity occurs.
Development Stages
Analysis of structural and radiographic changes, as well as a detailed study of existing classifications AngBK, made it possible to formulate a working four-stage Classification of the pathological process Angbk:
Stage I Stage — Microscopic changes in the structure of the bone and the stacking osteozecosis. The spongy fighter of the head of the femur with unchanged cartilage is affected, and the zone of structural changes is no more than 10%.
Stage II — Impression fracture. The surface of the femoral head has a type crack «Cracked shell». In the load zone of Trabez have cracks of irregular shape or foci of microcollaps. The zone of structural changes is no more than 10–thirty%.
III Stage — Fragmentation. It is characterized by the irregularity of the contours of the head of the femur, light degree of collapse, the occurrence of several foci of sealing or cystic rebirth. The intermediate space changes (narrowing or expansion). The zone of structural changes is no more than 30–fifty%.
IV Stage — Full destruction of the head. The shape of the head is changed, the sections of the collapse of the wrong shape or the collapse of the entire head. The structure of the trabeculae was dissolved or sealed, the strip of cracks of the wrong shape. Internal or outer edges of the grateful depression undergo ectopic changes. Intermediate space narrowed or disappeared. There are dislocation or submissions. Structural zone is 50–80%.
Clinical observations allow you to determine the duration of the flow of each stage. It is for stage I — 6 months, stage II — 6 months, III stages — 3–6 months with the subsequent transition to IV stage.
Excessive treatment
The new method of non-operative treatment Angbk began to be applied since 1997 in the framework of the department of traditional medicine of the 2nd Central Military Clinical Hospital named. IN. Mandryka. Since 2006, on the basis of the received exclusive right to treatment AngBK, a specialized medical center for non-operationary treatment Angbk opened by the non-operative method of Professor Huang — as the most complex and difficult degenerative dystrophic disease.
Excessive treatment — This is a systematic, intense multifunctional, multicomponent, iso-energy, exposed to the body to the body before restoring the bone structure and functions of the joint.
The main components of the non-operative treatment method:
- Overview radiography of both hip joints using laying on the Louncen with subsequent processing of images in a special computer program that allows you to quantify changes in the structure of the bone structure and its density;
- X-ray two-energy densitometry of the femoral head;
- laboratory assessment of endocrine status, indicators of mineral, carbohydrate and fat exchanges, costh formation and resorption indicators;
- two-phase scintigraphy of soft tissues and skeleton for assessing blood flow, changes in bone tissue and to eliminate the presence of malignant formations or metastasis;
- diagnosis of diseases and changes in the internal organs by the method of information analysis of electrocardios;
- Therapeutic procedure using HC-5 devices, osteon-1, providing the supply of electrical signals to the meridian points to maintain the electrochemical environment in the bone and optimization of the growth of the new bone;
- Using the Cap-MT8-Multimag software complex with an independent multichannel control of the intensities of a constant and impulse magnetic field, the directions of magnetic induction vectors and the pulse exposure times, providing:
- o synchronization of the work of nervous and endocrine systems, increasing the level of non-specific resistance;
- o Increasing the speed of the potentials of the action on nervous conductors, reducing the perineural edema, weakening or stopping the impulse from the pain of the hearth;
- o optimization of central and peripheral hemodynamics, improvement of microcirculation, stimulation of collateral blood circulation and normalization of blood properties;
According to the results of the analysis of the factors and characteristics of the patient, the treatment method is selected and a non-operational treatment is carried out, aimed at restoring the bone structure, improving the circulation of qi and blood, restoring the function of the hip joint and improving the quality of life of the patient. In the construction of the treatment program, age, profession, requirements of the patient for the joint function, type of necrosis of the femoral bone head, stage of destruction of the hip joint.
The main varieties of pathological changes in the head of the femoral bone to be treated with a new method:
- acute necrosis of the head of the femur of the dissolution type;
- the occurrence of the fragmentation band with necrosis of the femoral head with the tendency to disintegration and the destruction of the femoral head;
- narrowing of the articular slit in the hip joint, limiting its functions with a trend towards self-blocking;
- lack of a bone battle after surgery for the fracture of the femoral cervix in combination with the necrosis of the head of the femur, the bone absorption, collapse;
- dissolution and absorption in necrosis of the head of the femoral bone, the occurrence of the sublock of the hip joint and the destruction and its structure;
- Osteoporosis of the bone after installing the endoprosthesis, the aseptic instability of the components of the endoprosthesis;
- Aseptic necrosis heads of femur, skew pelvis, scoliosis;
- the destruction of the epiphyse under the necrosis of the head of the femur in children, the destruction of the godded depression, the deformation of the structure of the hip joint;
- necrosis of the head of the femur, complicated by epiphysiolysis in children;
- The fracture of the femoral cervix in children complicated by necrosis of the femoral head, or the presence of a focus in metaphyism;
- with osteochondropathy epiphyseal ends of tubular bones, short spongy bones, apophysis, individual joint surfaces;
- For diseases of therapeutic, infectious and vascular genesis, accompanied by endothelial dysfunction and pain in hip joints.
A new method of treating the necrosis of the femoral head is based on the use of the fundamental theory of traditional Chinese medicine in combination with Western classical medicine. It applies modern scientific technologies, new achievements in osteology, traumatology, biomechanics and related disciplines have been used.
The results of clinical studies
The results of clinical studies
In the Specialized Medical Center for non-Operative treatment Angbk since September 2006 to October 2008, 60 people were under observation. aged 3 to 70 years with different degrees of aseptic necrosis of the head of the femoral bone. 6 people. (10%) There was a complete destruction of the head of the femoral bone or the pathological fracture of the femoral head (IV stage AngBK). 54 people. (90%) less pronounced disease manifestations (II–III Disease Stage).
The main cause of the Angbk disease was: osteoporosis / osteopyation I and II type (48%), alcohol abuse (22%), the consequences of the reception of hormonal drugs and cytostatics (17%), the consequences of the injuries of the hip joint (13%).
The course of treatment was 3 months (2 procedures daily, total: 180 procedures). The technique provided for treatment both under the conditions of polyclinics and at home. The total duration of treatment amounted to 1 to 2 years. It depended on the degree of destruction of the head of the femoral bone, the individual characteristics of the patient and the tolerance of therapeutic exercises. The longest treatment took 10 courses (30 months), and the shortest — 2 courses (6 months), on average — 15 months. Evaluation of the results of treatment was carried out using dispersion analysis.
Every three months, a comprehensive examination of the patient was carried out, which included an overview radiography of both hip joints and a laboratory assessment of endocrine status, indicators of mineral, carbohydrate and fat exchanges. Every twelve months were held static and dynamic scintigraphy of the head of the femur and skeleton and X-ray densitometry under the L2-L4 program and the hip neck.
Estimation of the volume of the functions of the hip joint before treatment, as well as the degree of its recovery during and after the treatment carried out on the ballroom Harris system’but.
Criteria for the effectiveness of treatment were: an increase in the load carrying patients; an increase in the volume of the joint movement; lack of pain; the possibility of self-service; No chromoth. Excellent and good results were celebrated in 78% of patients, satisfactory — 12%, no effect noted — In 10% (2 patients from this group conducted total endoprosthetics of the hip joint). It should be noted that all 6 patients from the last group had IV stage (complete destruction of the head of the femoral bone).
Analysis of the results of the treatment of patients by groups with different estimated etiological factors of the occurrence of necrosis of the femoral bone head showed that the effect of treatment was in a certain connection with the causes of the disease. Therapeutic effect in patients with dysplasia and the consequences of injuries was better than in the treatment of patients who were caused by the use of hormonal drugs and alcohol abuse (P<0.05).
Positive results of complex therapy were celebrated after 1 month. Treatment: The severity of pain syndrome has decreased, increased the volume of movements, improved general well-being of patients. Considering the fact that treatment is designed for a long time (at least one year), the patient's attitude towards the recovery process (treatment commitment), compliance with the established regime and the implementation of medical appointments and recommendations.
Forecast
The thirteen-year-old practice treatment of aseptic necrosis has shown that the complete restoration of the femoral head, as a rule, does not occur (there were single cases of complete restoration of the bone structure without a collapse of the head in patients with the central necrosis of the femoral bone head). However, in most cases, it is possible to achieve a completely acceptable outcome of the disease: preventing the damage to the contralateral joint; reduction of destructive processes in the hip head and secondary coxarrosis; preventing vicious hip installations in the bending position, bringing and redundant rotation; achieve minimal restriction of the volume of movements in the hip joint; achieve the synchronization of the functioning of the thigh muscles.
The experience of treating patients with aseptic necrosis of various localizations shows that a huge unrecorded mass of secondary necrosis occurs in the treatment of the main disease — hematologic, autoimmune, chronic infection, acute viral lesions — with the use of hormonal drugs, cytostatics. If there are patients with clinical manifestations in this group, it is necessary to conduct a targeted survey.
Conclusions:
- Angbk, osteochondropathy, degenerative-dystrophic diseases of the joints unites a single pathogenetic syndrome — changing the structure of bone tissue;
- In the treatment of these diseases, conservative, surgical and non-operational treatment methods are used depending on the testimony and characteristics of the clinical picture;
- The use of the non-operational treatment method is possible at any stages of patient maintaining, since treatment provides an increase in disease resilience, strengthening the body and improving the structure of bone tissue.
