Aseptic Necrosis Of Femoral Head Research Articles

Special aspects of total hip arthroplasty in patients with proximal femur pseudarthrosis

IntroductionThe rate of proximal femur fractures (PFF) in the structure of musculoskeletal system injuries among all fractures of long bones ranges from 3.9 to 18%. According to Russian Ministry of Health 2020 data, the incidence of femoral fractures in Russia was up to 61 cases per 100,000 population (90,000 per year); and femoral neck fractures incidence was 4 times higher among people over 75 years of age. The choice of surgical technique and the fixator used depend on many factors, such as fracture location and its nature, the age of the patient, comorbidities, and the quality of bone tissue. Internal osteosynthesis, is the current treatment method of choice for extra-articular proximal femur fracture, but every treatment method has its limitations. a significant number of complications caused by technical errors, vicious union or nonunion with the subsequent development of false joints, the development of femoral head aseptic necrosis, which leads to coxarthrosis and persistent pain syndrome. To solve the above-described problems, it is necessary to use a conversion surgery - total hip replacement. Objectiveslong-term analysis of the results of total hip replacement in patients with proximal femur pseudarthrosis. MethodsThe study was based on clinical and laboratory data analysis and on the results of total hip arthroplasty (THA) in 45 patients aged 56–84 years (mean age 68.3), including 32 (71.1%) women and 13 (26.1%) men. 12 patients initially received conservative treatment, and 33 patients received initial surgical treatment using various metal osteosynthesis procedures. The time from osteosynthesis or from the moment of injury to admission to the hospital for hip arthroplasty ranged from 12 to 30 months. All patients, before conversion arthroplasty and after discharge, were repeatedly invited to the clinical diagnostic department for a clinical examination and for assessment using rating scales. 3, 6 and 12 months after the surgery, pain syndrome and patient quality of life were assessed using the following questionnaire scales: Harris Hip Score, MOS SF-36, VAS. The maximum follow-up period ranged from 12 to 60 months. ResultsBased on the results obtained, patients of all 4 groups after conversion arthroplasty noted a significant quality of life improvement, a decrease in pain severity and functional results improvement. This was probably due to the presence of a severe limitation of range of movements in the joint, intense pain, absence of support ability of the extremity, as well as low operative efficacy expectations.In 1 (2%) patient, acute PJI was diagnosed in the early postoperative period, followed by sepsis and death.In 4 patients (9%) the result was considered unsatisfactory. At 1 year of follow-up after surgery, they complained of pain and claudication in the operated joint.3 (6%) patients underwent reduction of dislocation. ConclusionsStrict adherence to the recommended treatment algorithm for patients with proximal femur pseudarthrosis made it possible to achieve good treatment results in 90% of surgically treated patients. An important step in the treatment of this patients is a careful preoperative planning with thorough assessment of bone tissue quality and muscles condition in the proximal femur area, allowing to choose the optimal endoprosthesis components.

Effect of Genetically Engineered Drugs on Aseptic Femoral Head Necrosis in Rats

Effect of Genetically Engineered Drugs on Aseptic Femoral Head Necrosis in Rats

REHABILITATION OF PATIENTS AFTER SURGERY WITH POST-COVID ASEPTIC NECROSIS OF THE FEMORAL HEAD

We carried out rehabilitation of patients after surgery with post-COVID aseptic necrosis of the femoral head according to the method developed by us in 49 patients. The patients were divided into 2 groups: the main group of 25 and the control group of 24 patients. The main group underwent rehabilitation developed by us, the control group by the traditional method. The results of rehabilitation were checked by the Coordination-speed test, the test parameters before the operation to the main group of the operated leg and after the operation, the difference in the number of movements in 10 seconds was estimated. when performing the test with an operated and non-operated leg, at the same time, the hip abduction index increased to the greatest extent after the operation. The data of the coordination test showed that the control group before the operation on the operated leg (retraction, step forward, backward) was within 9.0 m. These indicators after the operation on the 3rd- 5th day became 8.5 m, on the 14th day they were noted within 9.4 m . The data of the coordination test were noted before the operation to the main group on the operated leg (retraction, step forward, backward) was within 9.4 m. These indicators after the operation on the 3rd- 5th day became 9.8 m, on the 14th day they were noted within 12.4 m. The data obtained shows that the result in all parameters is better in the main group than in the control group, and the difference in the dynamics of indicators is clearly visible. Conducting better postoperative rehabilitation shows the performance of the gluteal muscles, as it is most important in terms of prevention of dislocations of endoprostheses. Thus, the method of stage-by-stage rehabilitation developed by us, post-COVID femoral head aseptic necrosis, contributes to improving the results of treatment. A differentiated approach to the rehabilitation of patients with post-COVID femoral head aseptic necrosis has reduced the duration of rehabilitation and disability.

Risk factors for the femoral head aseptic necrosis development in patients with systemic lupus erythematosus

Objective: to identify risk factors for the development of the femoral head aseptic necrosis (FHAN) and osteoarthritis (OA) of the hip joint (HJ) in patients with systemic lupus erythematosus (SLE) according to a retrospective analysis.Material and methods.The retrospective study included data from the case histories of 103 patients with SLE who underwent total hip arthroplasty (HA) (unilateral in 82 patients, bilateral in 21). The total follow-up period ranged from 2 years to 21 years. Among the patients included in thestudy, the majority were women (86.4%), the ratio of women and men was 7:1. At the time of surgery, the average age of women was 36.3±13.25 years, men – 36.2±9.57 years, duration of the disease – 168.0±132.5 months. SLE activity was assessed using the SLEDAI-2K scale. All patients were taking glucocorticoids (GC). The average duration of GC treatment was 89.0±87.2 months. 71.8% of patients received immunosuppressive therapy: hydroxychloroquine – 55.3%, azathioprine – 10.7%, methotrexate – 5.8%. The functional status of hip joint was determined using the Harris scale; by the time of surgery, the average score was 45.6±13.1 points. Pain intensity was assessed using a visual analogue scale and reached an average of 70.1±16.0 mm.Results and discussion. In 58.5% of patients with SLE, the indication for HA was FHAN (Group 1) and in 41.6% – OA of HJ (Group 2). At the time of HA, the duration of the disease was longer and the age was higher in group 2 than in group 1 (p<0.05). An analysis of individual clinical manifestations of SLE that preceded the development of HJ pathology revealed that arthritis and the presence of an antinuclear factor, ANF, were associated with the development of FHAN (p=0.022 and p=0.04, respectively). At the onset of the disease, patients of the 1st group, compared with patients of the 2nd group, more often had lesions of the skin, kidneys and serositis (22.9 and 20.5%; 14.5 and 11.7%; 68.7 and 64.7 %, respectively), but they were less likely to have mucous membranes and the central nervous system (CNS) involvement (14.5 and 23.5%; 10.4 and 17.6%, respectively). However, these differences did not reach statistical significance. Almost all of these disease manifestations, with the exception of the mucous membranes and the CNS lesions, were more often observed in patients with the development of FHAN, which indicates a higher activity of the disease at the onset of SLE. At the time of HA, we did not find any relationship between SLE activity and FHAN formation and hip OA. Patients of the 1st and 2nd groups in the same number of cases had mild (56.2 and 58.8%, respectively) and moderate (35.4 and 32.4%, respectively) activity according to SLEDAI-2K. No activity (SLEDAI-2K – 0 points) was also observed in patients of both groups with the same frequency (8.3 and 8.8% of cases, respectively). Associations of cumulative and daily doses of GC with the development of FHAN and OA of HJ were not revealed. In the 1st group, the average daily dose of GC was slightly higher, and the cumulative dose was less than in the 2nd group (8.59±4.75 and 7.79±5.39 mg; 20.0±11.9 and 23.8±19.2 g, respectively), but these differences were not significant (p>0.05).Conclusion. In SLE patients, the incidence of FHAN and HJ OA was comparable. At the time of HA, SLE patients with HJ OA were older and had a longer duration of the disease than patients with FHAN. The risk factors for FHAN were arthritis and ANF positivity at the onset of SLE.

Expression Dynamics of Bone Homeostasis Genes in the Development of Aseptic Femoral Head Necrosis in Rats

Expression Dynamics of Bone Homeostasis Genes in the Development of Aseptic Femoral Head Necrosis in Rats

Acetabulum fractures. Analysis of treatment results

Treatment of patients with acetabulum fractures (AF) remains a big challenge for orthopaedists and traumatologists. Suchfractures are known for their complications that lead to disability. Objective. To analyze the results of treatment of patientswith AF and complications that arise depending on the of the injury mechanism and the method of treatment, to evaluate the effectiveness available methods of preventing the development of these complications. Methods. A retrospective study wasdone on the basis of 89 AF patients analysis (age 17‒75 years, 22 women and 67 men) with different terms after the fracture.The majority of patients got primary care in other clinics. Diagnostic measures: clinical examination; X-ray examinationof the pelvis, that under conditions of acute injuries were supplemented with CT scan; ultrasound of abdominal cavity,chest X-ray, brain MRI, electroneuromyography of the lower limbs. Results. Most AF occurred as a result of traffic accidents.The most common types are A1 and B1 according to the classification of AO/ASIF. The system of skeletal traction has beenapplied often at the stage of primary treatment. During surgical treatment the Kocher-Langenbeck approach and osteosynthesis was mainly used to stabilize the posterior wall and acetabulum column. The typical complications of AF are coxarthrosis, femoral head aseptic necrosis despite the chosen treatment tactics. Their clinical manifestation with the hip impaired function occurred within a year after the trauma. Defined complications led to the need for total hip replacement in 67 (75.3 %) cases out of 89. In 8 patients, total hip replacement was performed in the acute period of injury and it was possible to restore the joint function with better early functional results compared to the rest of the patients. Conclusions. Primary total hip replacement in the case of AF is an effective treatment measure that gives the posibility restore the function of the hip joint in the shortest time and prevent the development of typical complications.

Modeling of femoral head aseptic necrosis in Wistar rats

Aim. To develop an animal model of femoral head aseptic necrosis for studying Legg–Calvé–Perthes disease.Materials and Methods. To induce the development of aseptic necrosis, we used Wistar rats (n = 8) which suffered from combined hypoperfusion of the femoral head and increased intra-articular pressure in the hip joint. Having employed isoflurane anesthesia, we performed an incision (≈ 3 cm length) on the outer surface of the thigh in the projection of the hip joint and then excised periosteum in the proximal third of the femur. A dense vicryl ligature was applied around the femoral neck to reduce blood perfusion of the femoral head. Further, 1.5 mL 2% rheopolyglucinum solution (10% isotonic dextran, 30-40 kDa molecular weight) was injected into the hip joint cavity to increase intra-articular pressure. Rats were sacrificed upon 8-week follow-up with subsequent X-ray and histological examination.Results. Our animal model of femoral head aseptic necrosis includes two main components of Legg–Calvé–Perthes disease: an increase in the intra-articular pressure and insufficient blood perfusion of the femoral head. In all (8/8) cases, aseptic necrosis of the femoral head was achieved. Eight weeks post intervention, the condition of the proximal femur 8 was similar to impression fracture.Conclusion. Our model of femoral head aseptic necrosis fully reflects the pathogenesis of LeggCalve-Perthes disease and can be therefore used in experimental studies.

Direct femoral head approach without surgical dislocation for femoral head chondroblastoma: a report of two cases

BackgroundChondroblastomas are rare, benign, locally aggressive lesions that appear in the epiphysis. Surgery for femoral head chondroblastoma (FHCB) is difficult. Conventional treatment with curettage via a drilled tunnel along the femoral neck can damage the growth plate and is associated with high local recurrence rates. The trapdoor procedure, which directly facilitates lesion access from the femoral head articular surface, can reduce local recurrence and avoid growth plate damage, although it requires surgical dislocation. Little is known about the long-term results of this direct articular surface approach, and there are no case reports on trapdoor procedures without dislocation.Case presentationWe report two cases (patients aged 12 and 15 years) of FHCB presented with coxalgia treated using the trapdoor procedure without surgical dislocation. Both surgeries were performed with patients in the semi-lateral position. The hip joint was exposed via an anterior approach, and a capsulotomy was performed at the superior rim of the acetabulum, followed by the external rotation of the hip joint. With a fine osteotome, a rectangular flap (trapdoor) was opened on the cartilage surface in the lateral non-weight-bearing area, and curettage of the lesion followed by bone and/or bone substitute grafting was performed. Subsequently, the trapdoor was replaced in its original position. There has been no local recurrence or femoral head aseptic necrosis after more than 6 and 12 years for patients 1 and 2, respectively. Both patients had musculoskeletal tumor society scores of 100% at follow-up and are enjoying a normal active life.ConclusionsThis direct femoral head approach without dislocation may be a simple treatment alternative for FHCB.

Method of dynamic modeling of the femoral head

The mechanism of action of therapeutic exercises can be considered as a universal form of exercise. Therapeutic physical exercises can provide both a direct load on the contact and articular surfaces (walking and exercises with crutches), and muscle load (concentric muscle contractions, motor system). The high sensitivity of the bone to mechanical signals is the basis for non-drug interventions, including physical therapy.
 The article presents the authors method of physical therapy for patients with femoral head aseptic necrosis. The gymnastics was based on a set of exercises for dynamic modelling of the femoral head, developed by Huang Keqin, a doctor of the Beijing Specialized Clinic for the Treatment of Femoral Head Necrosis, and modern concepts of bonne tissue biomechanics and physiology. The set includes 3 types of exercises. The first type is based on the principle of autogravity burden. The second type consists of the exercises with an accelerated rhythm of small amplitude. Type 3 is based on the muscles post-isometric relaxation principle.
 In this article the recommendations are given regarding the exercises use depending on disease stage.

Aseptic necrosis of the femoral head as a complication of its traumatic dislocation

The work is based on the analysis of examination and treatment results in traumatic hip dislocation (52 patients). The development of aseptic femoral head necrosis was detected in 11 patients at follow-up from 2 to 5 years. Algorithm of complex examination and treatment in traumatic hip dislocation has been elaborated for early and long-term periods after trauma. The group of high risk for aseptic femoral head necrosis development includes the patients with concomitant trauma, with posterior, obturatory and central dislocation. Rehabilitation is requiered to all patients with traumatic hip dislocation in the period from 2 to 5 years taking into account the peculiarities of hip injury. If the signs of posttraumatic aseptic femoral head necrosis are detected at early stages, then conservative treatment is indicated. In advanced process the operative treatment is indicated. Localization of necrosis area within femoral head, necrosis extension and articular surface congruence are of importance for the choice of adequate operative treatment. Roentgenologic signs of irreversibility of articular tissues destruction are the indication for total hip replacement.

Osteonecrosis of the humeral head in a human immunodeficiency virus-infected patient under tenofovir disoproxil fumarate\u2013emtricitabine\u2013lopinavir/ritonavir for 10 years: a case report

BackgroundHuman immunodeficiency virus-infected patients are 100 times more likely to develop aseptic osteonecrosis compared with the general population. While 90% of cases concern the femoral head, the involvement of humeral bone remains rare.Case presentationWe report a case of aseptic osteonecrosis of the left humeral head complicating antiretroviral therapy in a female, 46-year-old, Bissau-Guinean human immunodeficiency virus-infected patient received in a context of progressive pain in the left shoulder followed by limitation of articular movements. Standard x-ray of the shoulder allowed us to make the diagnosis by showing a typical image of osteonecrosis. The treatment was medical combined with physiotherapy.ConclusionsAseptic osteonecrosis should be systematically looked for in human immunodeficiency virus patients on antiretroviral treatment. In addition to femoral head aseptic necrosis, the involvement of the humeral bone should also be considered.

Діагностичні методи і класифікації асептичного некрозу головки стегнової кістки

Асептичний некроз головки стегнової кітки (АНГСК) — часте захворювання кульшового суглоба. АНГСК є не специфічним процесом, а, швидше, фіналом низки розладів, які призводять до зменшення кровотоку в головці стегнової кістки, що спричинює некроз клітин. У більшості випадків проводиться діагностика на пізніх стадіях розладу, коли хірургічне лікування, що може зберегти головку стегнової кістки й запобігти деструкції кульшового суглоба, уже не показане. Це, як правило, впливає на пацієнтів середнього віку, які більш активні. Тому багато хірургів намагаються відкласти їм виконання тотального ендопротезування кульшового суглоба. Без загальновизнаних системи класифікації та методу збору даних аналіз та порівняння пацієнтів є проблематичними та призводять до труднощів з оцінкою прогресування та визначенням стадії захворювання. Описані та використовуються декілька систем класифікації АНГСК. Нині до найбільш часто використовуваних класифікацій належать системи Ficat, Steinberg, класифікації Асоціації дослідження кровоциркуляції кістки (ARCO) та Японського дослідницького комітету (JIC). Кілька інших систем класифікації, такі як Kerboul et al., використовуються рідше. Кожна класифікація оцінює дещо інший критерій АНГСК. У той час як система Ficat використовує звичайні рентгенограми для визначення стадії та прогресування захворювання, Steinberg комбінував рентгенограми та магнітно-резонансну томографію (МРТ) для оцінки розмірів ураження. Система ARCO покращила класифікацію Ficat, включивши рентгенограми, комп’ютерну томографію, МРТ та сцинтиграфію для визначення розміру та розташування некротичної ділянки. Класифікація JIC, прийнята міністерством охорони здоров’я, праці та добробуту Японії, використовує Т1-зважений режим МРТ для класифікації остеонекрозу на основі локалізації некротичного ураження. Системи класифікації надають ортопеду можливість диференціювати це клінічно складне захворювання відповідно до тяжкості, прогнозу та показань для різних варіантів лікування. Успішність лікування АНГСК безпосередньо пов’язана зі стадією ураження. Чим раніше буде встановлений діагноз, тим більший шанс вплинути на механізми розвитку даної патології. Клінічні симптоми зазвичай передують рентгенологічним змінам, тому підозра щодо розвитку АНГСК і призначення відповідних діагностичних методик є важливим моментом у своєчасному встановленні правильного діагнозу. У цьому огляді ми хотіли показати найбільш часто використовувані системи класифікації АНГСК та важливі фактори, що слід врахувати в кожній.

[Comparison of total hip arthroplasty with conventional instrument OCM approach and posterolateral approach in supine position].

To compare the clinical efficacy of total hip arthroplasty with conventional instrument OCM approach and posterolateral approach in supine position. From February 2017 to January 2019, 67 patients underwent hip arthroplasty due to hip diseases, including 21 patients in the minimally invasive group, 12 males and 9 females;there were 10 cases of femoral neck fracture, 5 cases of aseptic necrosis of femoral head and 6 cases of hip osteoarthritis. In the traditional group, 46 cases were treated by traditional posterolateral approach, including 28 males and 18 females;there were 24 cases of femoral neck fracture, 12 cases of aseptic necrosis of femoral head and 10 cases of hip osteoarthritis. All patientsused biological ceramic artificial joint prosthesis. The operation time, intraoperative bleeding, incision length, preoperative and postoperative creatine kinase (CK-NAC), underground activity time, hospital stay, abduction angle and anteversion angle of prosthesis were observed and compared between two groups. Harris scores before operation and 12 months after operation were compared between two groups. All cases were followed up for 14 to 26(18.4±3.6) months. There was no significant difference in intraoperative bleeding, postoperative anteversion and abduction angle between two groups (P>0.05). There were significant differences in operation time, incision length, postoperative creatine kinase, underground time and hospital stay between two groups (P<0.05). There was no significant difference in Harris function score between two groups before operation and 12 months after operation(P>0.05). The two approaches of total hip arthroplasty can obtain satisfactory results.OCM approach has less damage and rapid postoperative recovery. It is a reliable surgical approach and can be popularized and used.

Bilateral neck fracture in bimodular femoral stem after primary total hip arthroplasty: a case report

BackgroundBi-modular stems were introduced in primary total hip arthroplasty (THA) to enable better control of the femoral offset, leg length, and hip stability. Despite numerous reports on modular femoral neck fractures, some designs are still marketed worldwide. While the risk factors for the sudden failure are multifactorial and mostly known, the timing of this new THA complication is not predictable by any means.Case presentationIn this report, the literature regarding one of the most popular bi-modular stems with specific neck-stem coupling (oval Morse taper) is reviewed and illustrated with a case of bilateral modular neck fracture in a patient with idiopathic aseptic necrosis of femoral heads treated with primary bi-modular THA. Because of bilateral modular femoral neck fracture, which occurred 3 years on the left side and 20 years after implantation on the right side, the patient required a total of 6 revisions and 208 days of hospitalized care.ConclusionTo our knowledge, this is the first report of bilateral modular neck fracture in a single patient. Even though the same surgeon performed both operations and used the same neck length and orientation, fractures occurred with a 17-year time difference after implantation. This shows that we cannot predict with certainty when a fracture might occur. Orthopaedic surgeons should use bi-modular stem designs for primary THA very cautiously.

[Pressure side and tension side comminution of femoral neck cortex are independent risk factors for aseptic necrosis after femoral neck fracture surgery].

To investigate the related factors of aseptic necrosis of femoral head after closed reduction and internal fixation of femoral neck fracture. From January 2009 to January 2016, 236 patients with femoral neck fracture were treated with closed reduction and internal fixation with 3 hollow lag screws, including 111 males and 125 females, aged from 19 to 89 (50.17±12.88) years. According to the follow-up results, the correlation of aseptic necrosis of femoral head was analyzed. Univariate analysis of age, gender, injured side, body weight, injury mechanism, preoperative waiting time, Garden classification and whether there was comminution of femoral neck cortex was conducted to obtain the independent variables with significant difference. Then binary logistic regression analysis was conducted to explore the independent risk factors of avascular necrosis of femoral head. The average follow-up period of 236 cases was 4.58 years. There were significant differences in the range of injury (24.69% vs. 5.16%, χ2=19.405, P=0.000), operation waiting time>48 hours (20.00% vs. 6.38%, χ2=10.065, P=0.002), Garden type Ⅲ/Ⅳ (18.52% vs. 2.97%, χ2=13.357, P=0.000), femoral neck cortex comminution (66.67% vs. 4.88%, χ2=39.968, P=0.000). Multivariate logistic regression analysis showed that:injury mechanism [high energy injury, Exp (B)=4.397, 95%CI=(1.672-11.562), P=0.003], preoperative waiting time >48 h [Exp (B)= 3.060, 95%CI=(1.176-7.966), P=0.022], comminution of femoral neck cortex [comminution of femoral neck pressure side cortex, Exp (B)=3.944, 95%CI=(1.245-12.494), P=0.020;comminution of femoral neck pressure side and tension side cortex, Exp(B)= 23.761, 95%CI=(3.805-148.374), P=0.001) were independent risk factors for avascular necrosis after internal fixation of femoral neck fracture. Garden type Ⅲ/Ⅳ was not an independent risk factor in this study [Exp (B) = 1.985, 95%CI=(0.436-9.032), P=0.375]. High energy injury, preoperative waiting time (>48 h) and comminution of femoral neck cortex were independent risk factors for aseptic necrosis of femoral head. In addition, cortical comminution on the pressure side and tension side of the femoral neck is a strong prognostic risk factor for aseptic necrosis of the femoral head, because it indicates a more serious and complex injury mechanism.

Perthes disease. Etiology. Symptoms. Physiotherapy

Many Pediatric Orthopedic Departments in Europe treat children with aseptic necrosis of femoral head. The illness is known in orthopedics as Legg - Waldenström - Calve - Perthes disease, described as the Perthes disease, or LCP disease. The treatment in all Orthopedics Centers mostly is similar - conservative, by physiotherapy and in cases with deformity of proximal end of femur-like varus deformity, partially dislocation / lateralization of femoral head-is done surgery. In many congresses and symposia-discussions about causes of the Perthes disease are very controversial. In our article we describe the causes of this illness. We are providing a lot of evidence that etiology is connected with trauma and concerned mostly children with symptoms of Minimal Brain Dysfunctions (MBD).

Aseptic Necrosis of Femoral Head - Clinical Study.

Femoral head osteonecrosis is a disease characterized by the decrease of blood vascularization in the femoral head, which leads to death of the osteocytes, demineralization and resorption of bone spans, change of trabecular architecture, with the reduction of the bone mechanical resistance and collapse of the articular surface in the femoral head. Left untreated, the disease may have a rapid progression, leading to severe symptoms, with significant articular dysfunction, functional impotence and a serious impact on the patient’s quality of life. The prevalence of the disease is ever growing all over the world, affecting mainly people in their 30s, 40s or 50s. In the present study, we analyzed a number of 76 patients with femoral head osteonecrosis with severe symptoms that required a surgical treatment. There was observed that more than ¾ of the investigated patients were males, while 81.58% were younger than 60 years old. Among the identified risk factors, smoking came first, followed by alcohol intake, obesity and chronic administration of corticosteroids. A very high percentage of patients (84.21%) were diagnosed in stages III and IV of the disease.

Редкий случай гиподисфибриногенемии у пациента без гематомезенхимальной дисплазии

Фибриноген и коллаген являются важнейшими протеинами межклеточного матрикса, оказывающие прямое влияние как на дифференцировку мезенхимальных стволовых клеток, так и на остеогенез. Кроме того, в клинической практике встречаются случаи протекания данного синдрома не в классическом виде, которые требуют более углубленного изучения звеньев патогенеза и разработки оптимальной коррекции заболевания. Нами проведен поиск литературных данных по ключевым словам в базах данных PubMed, UpToDate, BMJ. Представлен обзор современных научных данных и результаты наблюдения редкого клинического случая у пациента с гиподисфибриногенемией с проявлениями асептического некроза головок бедренных костей без гематомезенхимальной дисплазии. Заключение: В целом, в настоящее время подробно изучены различные аспекты клинико-биохимического патогенеза аномалий фибриногена, но остаются «белые пятна» в изучении тонких патогенетических механизмов на молекулярно-генетическом уровне, а именно: катаболизм белка, реакции раздельного синтеза отдельных полипептидных цепей фибриногена в разных тканях. Остается нерешенным вопрос о целесообразности применения корригирующих гемостаз препаратов таргетного действия при отсутствии у пациента выраженных тромботических и геморрагических проявлений. Fibrinogen and collagen are the most important intercellular matrix proteins that directly effect on the differentiation of mesenchymal stem cells and osteogenesis. In addition, there are non-classical cases of this syndrome that require indepth study of pathogenesis and optimal disease correction. We examined literature data by keywords in databases PubMed, UpToDate, BMJ. We presented a review of current scientific data and observation results of a rare clinical case in a patient with hypodysfibrinogenemia without hematomesenchymal dysplasia with manifestations of aseptic necrosis of femoral heads. Conclusions: In general, various aspects of clinical and biochemical pathogenesis of fibrinogen abnormalities are currently studied in detail, but there are “white spots” in the study of sophisticated pathogenetic mechanisms at the molecular genetic level, namely protein catabolism, the reaction of separate synthesis of individual fibrinogen polypeptide chains in different tissues. Unresolved is the question of applicability of hemostatic corrective drugs in the absence of expressed thrombotic and hemorrhagic manifestations.

Болезнь Легга-Кальве-Пертеса и асептический некроз головки бедренной кости: МРТ–семиотика терминальных стадий заболевания с исходом в деформирующий артроз

Болезнь Легга-Кальве-Пертеса и асептический некроз головки бедренной кости: МРТ–семиотика терминальных стадий заболевания с исходом в деформирующий артроз

Study on the outcome of patients with aseptic femoral head necrosis treated with percutaneous multiple small-diameter drilling core decompression: a retrospective cohort study based on magnetic resonance imaging and equivalent sphere model analysis

BackgroundAseptic necrosis of the femoral head (ANFH) has a high incidence in the community and causes substantial problems with health as well as economic and social stress. Core decompression is the most commonly used treatment for early ANFH. Although many studies have reported on the efficacy of femoral head core decompression surgery for ANFH, there are still some shortcomings in assessing the severity of femoral head necrosis, the location distribution, and changes in necrotic lesions before and after surgery. Magnetic resonance imaging (MRI) and equivalent sphere model analysis were used to further clarify the clinical efficacy of percutaneous multiple small-diameter drilling core decompression in patients with ANFH.MethodsFrom July 2013 to November 2016, 24 patients (32 cases of the hip joint) with ANFH who underwent percutaneous multiple small-diameter drilling core decompression were selected, and a retrospective analysis was conducted. MRI as well as VAS, OHS-C, and HHS scores were used to evaluate joint function in all patients before and 6, 12, and 24 months after the operation.ResultsTwenty-four months after the operation, 10 hips were amputated. The survival rates of alcoholic femoral head necrosis (AFNH), idiopathic femoral head necrosis (IFHN), and steroid-induced femoral head necrosis (SIFHN) patients at 24 months were 100%, 85.7% (− 2 hips), and 0.0% (− 8 hips), respectively. The MRI and equivalent sphere analysis results revealed that the anterior superior medial quadrant was the area most prone to osteonecrosis, and the posterior superior medial quadrant was the area second most prone to necrosis. After the operation, the average percentage of the AFHN necrosis area in the total volume of the femoral head decreased from 14.5 to 10.3%, and the average percentage of the IFHN necrosis area decreased from 16.3 to 9.2%; however, the average percentage of the necrosis area for SIFHN increased from 30.4 to 33.1%.ConclusionPercutaneous multiple small-diameter drilling core decompression significantly reduced the lesion volume for AFHN and IFHN, but the effect on SIFHN was not good.