Nekrosis Caput Femoris

Nekrosis Caput Femoris

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Definisi

Nekrosis caput femoris atau sering disebut dengan avaskular nekrosis adalah istilah medis yang digunakan untuk kematian jaringan tulang di bagian caput femur. Kematian jaringan tulang tersebut akibat kurangnya suplai darah ke bagian caput tulang tersebut. Kematian jaringan tulang paha ini akan mengakibatkan kolaps pada tulang. Proses terjadinya kematian jaringan tulang ini biasanya memakan waktu yang berbulan-bulan hingga bertahun-tahun.

Caput femoris adalah bagian dari tulang femur yang letaknya dibagian terdekat sumbu tubuh dan berbentuk seperti kepala. Caput diambil dari bahasa latin yang artinya kepala. Angka kejadian dari nekrosis caput femoris cukup sering (10.000-20.000 kasus baru setiap tahun di Amerika Serikat). Penyebab dari nekrosis caput femoris pun bervariasi bisa dari trauma maupun non-trauma. Pembuluh darah dari femur bersumber dari caput femur yang merupakan cabang dari arteri femoralis. Biasanya nekrosis caput femoris terjadi pada penggunaan steroid dosis tinggi atau penggunaan alkohol yang berlebihan. Setiap orang berpotensi terkena nekrosis caput femoris. Namun, penyakit ini terjadi pada populasi dewasa dengan rentang usia 30 hinggal 50 tahun.

 

Penyebab

Sangat banyak hal yang bisa menyebabkan Anda terkena nekrosis caput femoris. Berikut ini merupakan penyebab paling sering dari nekrosis caput femoris:

Trauma

Merupakan penyebab tersering nekrosis caput femoris. Trauma dapat menyebabkan dislokasi caput femur dari mangkoknya yang disebut acetabulum. Dislokasi ini dapat menyebabkan kerusakan pembuluh darah dan dapat menyebabkan nekrosis caput femoris. Angka kejadian nekrosis caput femoris cukup sering, yakni sebesar 10% dari fraktur collum femoris dan 10-25% dari dislokasi panggul.

 

Kelainan Bawaan Sickle Cell Disease

Penyakit sickle cell disease merupakan penyakit dimana sel darah merah memiliki bentuk yang tidak sesuai dari yang normal. Ketika hal tersebut terjadi, maka sel darah merah yang berfungsi membawa oksigen ke seluruh tubuh tidak dapat masuk ke tulang femur sehingga menyebabkan iskemia yang berujung kepada nekrosis caput femoris.

 

Penyakit autoimun

Penyakit autoimun sering dikaitkan dengan penggunaan steroid jangka panjang yang dapat berpotensi menimbulkan nekrosis caput femoris.

 

Anda dapat membaca mengenai lupus eritematosus kulit, di sini: Lupus Eritematosus Kulit - Definisi, Penyebab, Gejala dan Pengobatannya

 

Leg-Calve-Perthes

Merupakan penyebab nekrosis caput femoris pada anak anak yang masih belum diketahui dengan jelas penyebabnya.

 

Faktor Risiko

Ada beberapa faktor risiko yang menyebabkan Anda lebih mungkin untuk terkena nekrosis caput femoris. Berikut ini merupakan faktor nekrosis caput femoris:

  • Cedera atau trauma, sangat berpotensi untuk merusak pembuluh darah pada bagian tulang femur.
  • Penggunaan steroid. Penggunaan steroid terutama steroid dosis tinggi memiliki risiko yang tinggi untuk terkena nekrosis caput femoris.
  • Kecanduan Alkohol. Kecanduan alkohol juga sangat memungkinkan terjadinya nekrosis caput femoris.
  • Pengobatan penyakit tertentu. Pengobatan kanker seperti radioterapi juga dapat berhubungan dengan kejadian nekrosis caput femoris.

 

Jika Anda ingin mengetahui lebih lanjut  fraktur femur, Anda dapat membaca di sini: Fraktur Femur - Definisi, Penyebab, Gejala dan Pengobatannya

 

Gejala

Pada beberapa pasien, pasien mungkin tidak mengalami gejala. Terutama pada gejala awal nekrosis caput femoris. Ketika sudah berlanjut, pasien biasanya akan mengalami:

  • Nyeri bagian panggul yang menjalar hingga ke tulang belakang
  • Nyeri panggul ketika berjalan dan mendaki
  • Nyeri panggul berkurang ketika istirahat
  • Terkadang, nyeri panggul tidak hilang ketika istirahat.

 

Diagnosis

Dokter Anda akan melakukan wawancara mengenai keluhan yang Anda alami seperti nyeri bagian panggul yang menjalar hingga ke tulang belakang. Dokter juga akan bertanya apakah nyeri diperparah aktivitas dan berkurang ketika istirahat. Dokter juga akan bertanya riwayat penyakit yang Anda alami seperti kelainan darah serta dokter juga akan bertanya mengenai kebiasaan Anda seperti penggunaan obat steroid jangka panjang, atau pecandu alkohol.

Setelah dokter melakukan wawancara, dokter akan melakukan beberapa pemeriksaan fisik. Ada beberapa pemeriksaan fisik meliputi:

  • Dokter akan menilai apakah sudah ada deformitas pada kaki
  • Dokter juga akan melakukan tindakan abduksi dan internal rotasi untuk melihat nyeri pada tulang
  • Dokter juga akan melihat keterbatasan gerak yang Anda alami
  • Dokter juga akan menyentuh bagian panggul Anda untuk menilai nyeri atau tidak dibagian panggul

Setelah melakukan pemeriksaan fisik, dokter mungkin akan melakukan beberapa pemeriksaan kepada Anda, meliputi:

  • Sinar X. Sinar X dapan melihat apakah ada fraktur pada tulang Anda.
  • MRI merupakan pemeriksaan menggunakan medan magnet yang dapat melihat jaringan lunak Anda. Ketika Anda di MRI dokter akan dapat melihat hingga kerusakan jaringan sekitar tulang femur Anda.
  • Bone scanning. Zat radioaktif akan ditembakkan ke vena dan akan dilihat melalui gambaran radiologi apakah ada permasalahan bagian pembuluh darah femur.

 

Tata Laksana

Pengobatan dari nekrosis caput femoris memiliki tujuan yaitu mencegah kerusakan tulang lebih lanjut. Terapi bergantung pada beberapa faktor, yaitu nyeri dan hasi MRI temuan. Hal ini bisa dilakukan dengan konservatif maupun tindakan invasif.

Obat-Obatan

Pada tahap awal obat-obatan dapat menghilangkan gejala, berikut ini obat-obatan yang akan diberikan dokter Anda.

  • Obat anti-inflamasi non-steroid dapat digunakan untuk meredakan nyeri pada nekrosis caput femoris
  • Obat osteoporosis. Obat osteoporosis dapat menghambat progresivitas nekrosis.
  • Obat kolestrol. Obat ini dapat menghambat blokade kolestrol yang dapat menyebabkan nekrosis caput femoris
  • Obat yang dapat membuka pembuluh darah
  • Obat pengencer darah

 

Anda dapat membaca selengkapnya mengenai osteoporosis, di sini: Osteoporosis - Definisi, Penyebab, Gejala dan Pengobatannya

 

Tindakan Invasif

Pada gejala yang sudah parah seseorang membutuhkan operasi untuk menangani nekrosis caput femoris. Berikut ini pilihan operasi yang dapat mengobati nekrosis caput femoris:

  • Core Decompression. Dokter bedah akan mengikis bagian dalam tulang Anda guna untuk mengurangi nyeri dan memungkinkan untuk jaringan tulang baru dan pembuluh darah untuk tumbuh.
  • Bone graft. Prosedur ini dapat memperkuat area yang terkena nekrosis.
  • Bone reshaping. Pinggir dari tulang akan di kikis untuk memperbaiki sendi.
  • Joint replacement. Jika tulang telah kolaps dokter akan membantu untuk mengganti bagian sendi Anda dengan bahan metal.

 

Komplikasi

Jika tidak diobati, penyakit nekrosis caput femoris dapat semakin parah dan mengalami kolaps tulang. Nekrosis caput femoris juga bisa menyebabkan inflamasi yang parah pada sendi.

 

Pencegahan

Untuk menghindari kejadian nekrosis caput femoris, Anda dapat melakukan langkah berikut ini.

  • Batasi konsumsi alkohol. Konsumsi alkohol yang berlebihan dapat menyebabkan Nekrosis caput femoris.
  • Jaga kadar kolestrol Anda agar tetap rendah. Lemak dapat menghambat suplai pembuluh darah pada tulang.
  • Pantau penggunaan steroid. Selalu tanyakan ke dokter dan selalu beritahu dokter jika Anda menggunakan steroid jangka panjang.
  • Berhenti merokok

 

Kapan Harus ke Dokter?

Jika Anda mengalami nyeri bagian panggul, segera kunjungi dokter Anda. Pengobatan segera akan mempercepat penyembuhan dan memberikan hasil yang baik.

 

Mau tahu informasi seputar penyakit lainnya? Cek di sini, ya!

 

 

Writer : dr Arifin Muhammad Siregar
Editor :
  • dr. Monica Salim
Last Updated : Kamis, 13 April 2023 | 11:05

Statpearl. Femoral Head Necrosis. 2022

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    • WebController.php#779aicare_prod_new8.29msupdate `posts` set `views_count` = 815 where `id` = 6207
      Bindings
      • 0: 815
      • 1: 6207
      Backtrace
      • app/Http/Controllers/WebController.php:779
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • ActivityLogger.php#174aicare_prod_new6.68msinsert into `activity_log` (`log_name`, `properties`, `batch_uuid`, `event`, `subject_id`, `subject_type`, `description`, `updated_at`, `created_at`) values ('default', '[]', null, 'updated', 6207, 'App\\Models\\Admin\\Post', 'updated', '2025-01-12 21:01:46', '2025-01-12 21:01:46')
      Bindings
      • 0: default
      • 1: []
      • 2: 
      • 3: updated
      • 4: 6207
      • 5: App\Models\Admin\Post
      • 6: updated
      • 7: 2025-01-12 21:01:46
      • 8: 2025-01-12 21:01:46
      Backtrace
      • vendor/spatie/laravel-activitylog/src/ActivityLogger.php:174
      • vendor/spatie/laravel-activitylog/src/Traits/LogsActivity.php:88
      • app/Http/Controllers/WebController.php:779
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
    • single-post-healthpedia.blade.php#37aicare_prod_new1.29msselect * from `users` where `users`.`id` = 45 limit 1
      Bindings
      • 0: 45
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.single-post-healthpedia:37
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new6.32msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 7520 and `categories`.`deleted_at` is null
      Bindings
      • 0: 7520
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new5.22msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 5637 and `categories`.`deleted_at` is null
      Bindings
      • 0: 5637
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new4.86msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 3701 and `categories`.`deleted_at` is null
      Bindings
      • 0: 3701
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new5.16msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 7380 and `categories`.`deleted_at` is null
      Bindings
      • 0: 7380
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new5.15msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 3992 and `categories`.`deleted_at` is null
      Bindings
      • 0: 3992
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new5.44msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 7411 and `categories`.`deleted_at` is null
      Bindings
      • 0: 7411
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new5.53msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 402 and `categories`.`deleted_at` is null
      Bindings
      • 0: 402
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#11aicare_prod_new940μsselect * from `categories` where `categories`.`id` = 6 and `categories`.`deleted_at` is null limit 1
      Bindings
      • 0: 6
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.partials.article-popular:11
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new5.52msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 6076 and `categories`.`deleted_at` is null
      Bindings
      • 0: 6076
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#122aicare_prod_new1.03msselect * from `pages` where `slug` = 'about-us' limit 1
      Bindings
      • 0: about-us
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:122
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#547aicare_prod_new980μsselect * from `faqs` limit 1
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:547
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
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      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      Backtrace
      • view::layouts.v2.web_layout:551
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    App\Models\Admin\Category
    18Category.php#?
    App\Models\Admin\Post
    13Post.php#?
    App\Models\Admin\Tag
    3Tag.php#?
    App\Models\TermPolicy
    3TermPolicy.php#?
    App\User
    2User.php#?
    App\Models\Admin\Healthpedia
    1Healthpedia.php#?
    App\Models\Admin\Page
    1Page.php#?
    App\Models\Admin\Faq
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