Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China.
Beijing University of Chinese Medicine, No.11 North Third Ring Road East, Chaoyang District, Beijing, 100029, China.
J Orthop Surg Res. 2024 Aug 10;19(1):472. doi: 10.1186/s13018-024-04964-w.
Despite hip function typically deteriorating in the post-collapse stage of osteonecrosis of the femoral head (ONFH), some patients can still demonstrate long-term favorable hip function, a state termed "survival with collapse". This study aims to identify the characteristics of patients suitable for "survival with collapse" in cases of ONFH.
This cross-sectional study included 65 patients (87 hips) diagnosed with post-collapse ONFH for ≥ 3 years (average 9.1 years, range 3-23 years). Hip function was assessed using the Harris Hip Score (HHS). Demographic, clinical, and radiographic data were compared between the favorable group (HHS > 80) and the poor group (HHS ≤ 80). Independent protective factors for hip function were identified by multivariate analysis and receiver operating characteristic (ROC) curve analysis was further applied to evaluate these factors' diagnostic efficacy.
The favorable and poor groups included 46 and 41 hips, respectively. Significant differences were found in body mass index (BMI), Association Research Circulation Osseous (ARCO) stage, collapse degree, Japanese Investigation Committee (JIC) classification, necrotic size, and hip subluxation between the two groups (p < 0.05). Multivariate logistic regression identified collapse < 3 mm(OR:14.49, 95%CI: 3.52-59.68, p < 0.001), JIC types B (OR: 11.08, 95% CI: 1.07-115.12, p < 0.05) and C1(OR: 5.18, 95% CI: 1.47-18.20, p < 0.05) as independent protective factors for hip function, while BMI (OR: 0.76, 95% CI: 0.59-0.97, p = 0.029) was an independent risk factor. ROC curve analysis demonstrated that both collapse degree (AUC = 0.798, sensitivity = 91.3%, specificity = 68.3%, p < 0.0001) and JIC classification (AUC = 0.787, sensitivity = 80.4%, specificity = 73.2%, p < 0.0001) had satisfactory diagnostic value for hip function. Combining JIC classification and collapse degree (AUC = 0.868, sensitivity = 76.1%, specificity = 85.4%, p < 0.0001) significantly enhanced diagnostic efficacy compared to using either alone (p < 0.05).
In ONFH, femoral head collapse does not necessarily determine a poor prognosis. Patients with mild collapse (< 3 mm) and preserved anterolateral wall are more likely to retain satisfactory hip function, making them candidates for "survival with collapse."
尽管在股骨头坏死（ONFH）塌陷后阶段髋关节功能通常会恶化，但仍有一些患者可长期保持良好的髋关节功能，这种情况被称为“塌陷后存活”。本研究旨在确定适合 ONFH 患者“塌陷后存活”的特征。
本横断面研究纳入了 65 例（87 髋）诊断为塌陷后 ONFH 至少 3 年（平均 9.1 年，范围 3-23 年）的患者。使用 Harris 髋关节评分（HHS）评估髋关节功能。比较髋关节功能良好组（HHS＞80）和不良组（HHS≤80）的患者的人口统计学、临床和影像学数据。采用多变量分析确定髋关节功能的独立保护因素，并进一步应用受试者工作特征（ROC）曲线分析评估这些因素的诊断效果。
髋关节功能良好组和不良组分别纳入 46 髋和 41 髋。两组在体重指数（BMI）、Association Research Circulation Osseous（ARCO）分期、塌陷程度、日本骨坏死研究协会（JIC）分类、坏死面积和髋关节半脱位等方面存在显著差异（p＜0.05）。多变量逻辑回归分析确定塌陷＜3mm（OR：14.49，95%CI：3.52-59.68，p＜0.001）、JIC 类型 B（OR：11.08，95%CI：1.07-115.12，p＜0.05）和 C1（OR：5.18，95%CI：1.47-18.20，p＜0.05）为髋关节功能的独立保护因素，而 BMI（OR：0.76，95%CI：0.59-0.97，p=0.029）为髋关节功能的独立危险因素。ROC 曲线分析表明，塌陷程度（AUC=0.798，敏感性=91.3%，特异性=68.3%，p＜0.0001）和 JIC 分类（AUC=0.787，敏感性=80.4%，特异性=73.2%，p＜0.0001）对髋关节功能均具有良好的诊断价值。将 JIC 分类和塌陷程度结合（AUC=0.868，敏感性=76.1%，特异性=85.4%，p＜0.0001）与单独使用任一指标相比（p＜0.05），显著提高了诊断效能。
在 ONFH 中，股骨头塌陷不一定预示着预后不良。塌陷程度较轻（＜3mm）且前外侧壁保存完好的患者更有可能保留满意的髋关节功能，成为“塌陷后存活”的候选者。
