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Support small incision decompression and bone graft in the treatment of early femoral head necrosis

Hip been improved, no significant changes in 28 hips, 1 hip collapse slightly increase the effective rate was 97.2 2.1 discuss the clinical collapse of femoral head necrosis femoral head mechanism of the mechanical properties of drop collapse occurred basic reasons. In addition to myeloid cells decreased femoral head necrosis, vascular reduced fat marrow cell proliferation outside. Mainly reduced bone mass, osteoporosis and showed cystic change, empty lacunae of bone cells, bone necrosis or minor fracture. Necrosis of the femoral head at the same time, the natural reaction is also under repair, vascular fibrous tissue that new bone area from the living areas extend to sequester, but not in trabecular bone re-established, the weight-bearing area of the bone off the small Liang Fasheng cracked, broken, or absorbed in the structure of articular cartilage mechanical properties of bone under the area decreased significantly, while the collapse of femoral head deformation]. Femoral head necrosis and ischemic changes were recognized as relevant, but the lesion in the femoral head necrosis, in addition to biological mechanisms, biomechanical factors should not be ignored. Femoral head necrosis of bone destruction occurred in the physiological load area. Repair of femoral head necrosis in the period, if exposed to weight-bearing stress of the femoral head, the necrotic bone and new bone can be generated between the stress concentration, resulting in a slight fracture of trabecular bone, not only affects the mechanical properties of bone structure, but also blocked the repair tissue extension of the fracture of subchondral bone necrosis of the weight-bearing area and the corresponding parts. Structural damage to trabecular bone subjected to greater stress, and with the subchondral bone fracture and collapse. 2.2 decompression and bone graft surgery within the support mechanism to prevent or delay the collapse of the surgical treatment of femoral head necrosis of many, both core decompression, but also with the muscle pedicle, vascular pedicle and bone graft with vascular anastomosis, the surgical procedures on to improve the femoral head blood supply have a positive effect,[link widoczny dla zalogowanych], while the vascularized periosteal graft is more to promote the role of bone. However, these surgical procedures did not fully take into account biomechanical factors. The literature l-3 that core decompression alone can not prevent or correct the femoral head collapse, it will accelerate the collapse of the femoral head. This is due to necrosis of the femoral head blood supply of the repair process with the reconstruction, osteoclasts and bone resorption is often greater than the rate of new bone formation, core decompression surgery can make the already weak support for subchondral bone mechanical strength for further weakened, especially in steroid-induced femoral head necrosis, and its obvious osteoporosis, core decompression surgery cause stress concentration, causing collapse of femoral head. In addition, intertrochanteric varus, valgus osteotomy or other surgical rotation, these surgical attempt to change the weight-bearing area to reduce the stress level of necrosis, but clinical observation that this type of surgery not enough to prevent extensive necrosis shares bone collapse _]. For the early collapse of the femoral head necrosis in patients less than 2mm, we use a small incision decompression and bone graft surgery within the support, its advantage is to reduce the femoral head core decompression in high pressure and improve blood circulation of the femoral head; drilling and bone necrosis of the femoral head in promoting revascularization, but also play a mechanical role, and cannulated screws in femoral neck and femoral head necrosis in medial and lateral, the screw thread and live across the necrotic area bone between the collapse. Support small incision decompression and bone graft surgery within the necrotic bone removed both also reduce intraosseous pressure, the removal of sequestra in favor repair of femoral head; After decompression, the bone marrow cavity closure is opened, the internal pressure due to ischemia caused by bone The pressure then eased to stimulate the regeneration of capillaries and the formation of trabecular bone, bone to improve venous return, increased blood supply,[link widoczny dla zalogowanych], the femoral head also began the process of regeneration of bone within the cycle be restored, thereby enhancing the strength of the femoral head; plant effective repair of bone defects of bone and promote bone healing and regeneration; both screws provide an effective mechanical support to prevent or delay the collapse of the femoral head may delay hip replacement in patients with young age. Therefore, support for small incision surgery for early decompression of bone necrosis of femoral head has a therapeutic effect, can prevent or delay the collapse of the femoral head, with a simple surgery, trauma,[link widoczny dla zalogowanych], less pain, quicker recovery,[link widoczny dla zalogowanych], less impact on work and life, and so on . Consistent with the development of minimally invasive surgery trend.
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