Ischemic or ischaemia means an deficient blood supply to the some cells, tissues, variety meats or parts that cause by the obstructor or bottleneck of the blood vass. While mortification means a decease of some cells, tissues, variety meats or parts due to the hypoxia status.
Ischemic mortification of bone can besides be called as osteonecrosis, avascular mortification ( AVN ) or sterile mortification. It is a bone decease status which cause by the hapless blood supply ( hypoxia ) to the some country. It will ensuing in break or collapses the whole full bone. It is normally happen at the hip and shoulder countries but sometimes can besides impact other big articulations such as articulatio genus, mortise joint, carpus and cubitus.
Normally, osteonecrosis will associated with bone conditions, arthritis-like conditions, joint conditions and musculoskeletal conditions ( article 1 ) . In United State, approximately 20 000 people per twelvemonth are holding this job. This disease can impact any age group but it is more common on people at the age of 20 – 50.
Causes of osteonecrosis can be divided into two which are ; post-traumatic & amp ; non-traumatic. Post-traumatic is the most frequent cause of osteonecrosis. Some of the illustrations of post-traumatic are disruption or displaced break. Minor hurt is non believed to acquire osteonecrosis and major hurts normally non consequences in osteonecrosis. But if the hurts are involve blood vass, the per centum of the patients of holding osteonecrosis are high.
Non-traumatic cause means is osteonecrosis happen without history of injury. Several hazard factors that may be attributed with non-traumatic are already found by a few of scientist. But, there are so many hypotheses given about the cogency of the hazard factors found. But, there are some people who wholly healthy with no hazard factors are experience this disease. This is usually called idiopathic or unknown cause.
The hazard factors of osteonecrosis can besides be spliting by two classs which are ; definite hazard and likely. Some illustrations of definite hazard factors are major injury breaks, reaping hook cell disease, malignant neoplastic disease, arterial disease, Caisson disease, disruptions, postirradition, chemotherapy, and Gauncher ‘s disease.
While illustrations of likely hazard factors of osteonecrosis are high dosage of steroid intervention for illustration lupus, blood coagulating upset, pancreatitis, intoxicant maltreatment, kidney disease and graft, lipid perturbations, liver tissues perturbation, blood upset, liver disease and smoke.
INCIDENCE ( IN MALAYSIA COMPARE TO OTHER COUNTRY )
MORTALITY / MORBIDITY,
Osteonecrosis is the job of break of the blood flow to the bone. It is ever affects castanetss that merely hold individual terminal blood supply such as humerus, wrist bones, thighbone and scree. The indirect circulations of these castanetss are limited. Due to the break of the vascular supply, it will ensue of mortification of bone marrow, cerebral mantle and medullary bone are theorized to be cause by the several mechanisms such as vascular occlusion, altered lipid metamorphosis, intravascular curdling, mending procedure, primary cell decease and mechanical emphasis.
SIGNS & A ; SYMPTOMS
Any surgical processs have their ain benefits and hazards. Before any intervention is taken to the patient, the benefits poetries hazard should be understand. Some of the intervention have higher grade of success but have a higher grade of hazard excessively. Other processs may hold lower grade of success but besides have a lower grade of hazard. The intervention can be divided on two classs which are ; surgical intervention and non-surgical intervention. Examples of surgical intervention are core decompression, bone grafting, osteotomy, femoral caput resurfacing ( FHR ) , femoral caput replacing and entire hip replacing. Then, the illustrations of the non-surgical interventions are protected weight bearing, lipid take downing agents, decoagulants, hypertensive medicines, drug surveies and bisphosphonate.
Core decompression is the procedure of taking a stopper of bone that out from the involved country. This surgical procedure will make a hole in the bone and to avoid break through the hole, the patient demand to rest about six hebdomads. This process is really first-class in the hurting alleviation but non effectual on detaining the patterned advance of the disease in the long term.
Osteonecrosis will do some of the bone died. To near this job is by taking the bone that has been dead and make full the bone transplant inside the empty infinite. The bone transplant can be taken either from the patient itself or from bone bank. The chance of this processs to success are depends upon the bone measure that has been died.
Osteotomy ( Cuting the Bone )
Normally osteonecrosis go on on the weight bearing castanetss. Basically, bone that is non involved in the osteonecrosis can be cut which is the below country of engagement. So that, the uninvolved country can go new weight bearing country. This process is non common any longer.
Femoral Head Resurfacing ( FHR )
FHR is the procedure of engrafting a metal hemisphere on the femoral caput. But, metal caput Oklahoman will have on out the socket and entire hip replacing process should be done.
Femoral Head Replacement
The procedure of femoral caput replacing is done by seting root inside the femoral bone. But it is extended than FHR process. It is little more hard to be revised compared to FHR. Then, femoral caput replacing besides has no strong grounds to go more successful so FHR.
Entire Hip Replacement ( THR )
THR is the most successful processs that rate normally over 95 % . But this process is uncommon for the younger patients that have a life anticipation more than 40 to 50 old ages. THR are non believed will last long within those old ages.
Protected Weight Bearing
Protected weight bearing merely can detaining the procedure of osteonecrosis. Some of the patients will non be able to make some surgery but it is recommended to protect their weight bearing. But, protected weight bearing entirely is non an equal intervention for bring arounding osteonecrosis.
Lipid Lowering Agents
There are two hypotheses given that osteonecrosis possibly associated with lipoids ( fats ) . The first hypothesis is some cells possibly dies or malfunction due to the increasing figure of the fats within the cells. For the 2nd hypothesis is there is an increasing the figure of lipocytes ( fat cells ) in the bone marrow of the morbid articulation.
Osteonecrosis are besides associated with the unnatural degrees of some factors that involved in the blood vesture systems. Some surveies had been done to the 28 patients and the patients are given Enoxaparin which is a drug that used to forestall blood vesture for 12 hebdomads. The consequences given that after two old ages, the patients ‘ hip had non progressed past the early phase and most of them do non necessitate surgery.
This medicine usually used to handle high blood force per unit area. Some surveies shown that the affected bone of osteonecrosis will increase their force per unit area. Biopsy of the castanetss will alleviate the bone force per unit area and relieves the hurting.
Drugs are non experimental and merely can be prescribed by doctor. But, it is depend on the doctors experience and single circumstance such as the patterned advance of the disease and size of the affected country. But drug surveies are non the standard intervention.
Bisphosphonate is one of the drugs classs which usually used to handle osteoporosis. 60 patients have been evaluated by giving bisphosphonate and a satisfied ground is produce. The patients besides should be advice that tries to avoid from weight bearing on their affected side.