Title : Minimally invasive surgery for osteonecrosis of the femoral head (Clinical case)
Abstract:
Osteonecrosis (aseptic or avascular necrosis) of the femoral head is a severe disabling disease that often develops in young people of working age (the average age is 33-45 years) and is associated with the death of bone cells in a certain area of bone tissue, usually caused by a violation of local blood supply. Idiopathic (primary) and secondary osteonecrosis are commonly distinguished. In Russia, aseptic necrosis has not been identified in the incidence structure of the musculoskeletal system of the adult population, although according to calculations and extrapolation of foreign data, from 5 to 8 thousand new cases of the disease should be detected annually. According to foreign authors, the number of patients ranges from 1.5 to 4.7% of the total number of patients with orthopedic pathology, and the number of total hip replacements performed for aseptic necrosis ranges from 5 to 18% of those performed annually. For example, in the UK, there are between 1.4 and 3.0 cases of osteonecrosis per 100,000 people, of which 75.9% are femoral heads.
Early diagnosis, as well as methods of effective conservative treatment of aseptic necrosis of the femoral head to severe hip dysfunction requiring surgical treatment, has always been a serious problem. Despite a fairly wide range of possibilities for conservative treatment of the early stages of this disease, reliable and long-term results of effective treatment technologies for this complex pathology have not yet been obtained.
However, in China at the end of the 20th century, the technology of treating a wide variety of diseases, including this complex pathology, called acupuncture, or acupuncture treatment, was developed. This technology has been isolated into a separate medical specialty in China and, as a result of its effectiveness, has become widespread in more than 40 countries around the world.
Purpose: Using the example of a specific clinical case of osteonecrosis, to familiarize doctors of the relevant specialties with the possibilities of needle knife technology, which is new for domestic practice. A 34-year-old patient was diagnosed with bilateral aseptic necrosis of the femoral heads and total hip replacement was recommended. The alternative was acupuncture treatment. The treatment was carried out according to the scheme recommended by the Chinese specialists of the AOSIDI clinic (Chengdu, China). A good clinical result was obtained with full labor, social rehabilitation and absence of pain syndrome. The treatment results were confirmed by multispiral computed tomography and functional tests. The presented clinical case and materials on the use of a needle knife demonstrate that the technology is currently one of the few ways to effectively treat minimally invasive aseptic necrosis of the femoral heads, which is relevant during the period of active development of the consequences of covid19 with a significantly increased number of patients suffering from osteonecrosis. The simplicity and cheapness of the proposed treatment method, the minimum number of contraindications and the outpatient nature of treatment make the needle knife technology one of the most attractive for doctors of various specialties in the treatment of such complex pathology as the early stages of aseptic necrosis of the femoral head.
