The Third Clinical of Medical School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Front Endocrinol (Lausanne). 2023 Mar 13;14:1137786. doi: 10.3389/fendo.2023.1137786. eCollection 2023.
Osteonecrosis of the femoral head (ONFH) is a disabling and intractable orthopedic disease largely affecting young and middle-aged groups. Current standard of treatment relies on the collapse of femoral head as a predictor for prognosis. However, a wide range of variability in repair potentials is observed in patients with femoral head collapse. Therefore, the present study aimed to evaluate the accuracy of femoral head collapse as a predictor and to propose the necrotic lesion boundary as a novel yet reliable measure for ONFH prognosis.
A retrospective cross-sectional study was conducted at the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 203 hips with ONFH from 134 patients were included. The occurrences and progression of femoral head collapse were recorded. Necrosis lesion boundary was quantified and classified for each case based on anteroposterior view intact ratio (APIR) and the frog-leg view intact ratio (FLIR) as independent variables. Dependent variables were defined as progressive collapse or terminal collapse for Association Research Circulation Osseous (ARCO) stage II and III respectively. Logistic regression analysis, Receiver Operating Characteristic (ROC) curve and Kaplan-Meier (K-M) survival analysis was performed and results were interpreted.
Out of the 106 hips in ARCO stage II, 31 hips collapsed with further progression, while 75 hips had no collapse or collapse with repair of the necrotic areas. Out of the 97 hips in ARCO stage IIIA, the collapse continued to progress in 58 hips while the necrotic areas were repaired in 39 hips. Logistic regression analysis demonstrated that both APIR and FLIR, were independent risk factors. Further ROC curve analysis indicated that the cutoff values of APIR and FLIR could be considered as indications for evaluating the prognosis of ONFH. Contrary to the traditional view of poor prognosis after femoral head collapse, K-M survival analysis demonstrated a high value of APIR and FLIR for ONFH prognosis.
The present study found that the occurrence of collapse is an oversimplified predictor for ONFH prognosis. The collapse of the femoral head in ONFH does not predict a poor prognosis. The necrosis lesion boundary has a high value in predicting ONFH prognosis and informing clinical treatment strategies.
股骨头坏死（ONFH）是一种致残性和难治性骨科疾病，主要影响中青年人群。目前的治疗标准依赖于股骨头塌陷作为预后预测指标。然而，在股骨头塌陷的患者中，修复潜力存在广泛的变异性。因此，本研究旨在评估股骨头塌陷作为预测指标的准确性，并提出坏死病变边界作为一种新的、可靠的 ONFH 预后评估方法。
这是一项在广州中医药大学第一附属医院进行的回顾性横断面研究，共纳入了 134 名患者的 203 髋 ONFH 患者。记录了股骨头塌陷的发生和进展情况。根据前后位完整率（APIR）和蛙腿位完整率（FLIR）将每个病例的坏死病变边界进行量化和分类。将 ARCO 分期 II 和 III 分别定义为进展性塌陷或终末期塌陷作为因变量。进行逻辑回归分析、受试者工作特征（ROC）曲线和 Kaplan-Meier（K-M）生存分析，并对结果进行解释。
在 ARCO 分期 II 中，106 髋中有 31 髋出现进展性塌陷，而 75 髋无塌陷或坏死区修复性塌陷。在 ARCO 分期 IIIA 中，97 髋中有 58 髋继续进展性塌陷，而 39 髋坏死区修复性塌陷。逻辑回归分析表明，APIR 和 FLIR 均为独立危险因素。进一步的 ROC 曲线分析表明，APIR 和 FLIR 的截断值可作为评估 ONFH 预后的指标。与传统观点认为股骨头塌陷后预后较差相反，K-M 生存分析表明，APIR 和 FLIR 值高的患者 ONFH 预后较好。
本研究发现，塌陷的发生是对 ONFH 预后的一种过于简化的预测指标。ONFH 中股骨头的塌陷并不能预测预后不良。坏死病变边界在预测 ONFH 预后和指导临床治疗策略方面具有较高的价值。
