PDF(Pubmed)
Abstract：
OBJECTIVE: It is unclear whether less acetabular coverage is associated with the failure of core decompression (CD) for osteonecrosis of the femoral head (ONFH). This study aimed to investigate the clinical outcomes of CD for ONFH with small- or medium-sized pre-collapse lesions, and determine what factors, especially acetabular anatomical parameters, predict the failure of CD.
METHODS: Between January 2010 and December 2022, we retrospectively reviewed 269 consecutive CDs in 188 patients diagnosed with ONFH with small- or medium-sized pre-collapse lesions. The Kaplan-Meier method was used to evaluate the survival rate of CD for ONFH with progression of collapse or conversion to total hip arthroplasty (THA) as the endpoint. Univariate and multivariate logistic regression analyses were conducted to identify the potential risk factors for the failure of CD. Receiver operating characteristic (ROC) curve analysis was further performed with conversion to THA as the endpoint to determine the predictive value of these factors.
RESULTS: The overall 5-year survival rate of CD for ONFH with small- or medium-sized pre-collapse lesions was 74.3% (95% confidence interval (CI) 69.0%-81.1%) with progression of collapse as the endpoint and 83.9% (95% CI 79.3%-88.7%) with conversion to THA as the endpoint. Univariate logistic regression analysis showed that bilateral affected hips was significantly associated with progression of collapse, and center-edge angle (CEA), sharp angle, acetabular head index (AHI), as well as acetabular depth ratio (ADR) were significantly associated with both progression of collapse and conversion to THA. Multivariate logistic regression analysis further indicated that CEA and AHI were independent risk factors for both progression of collapse and conversion to THA. ROC curve analysis with conversion to THA as the endpoint revealed that the cutoff values for CEA and AHI were 26.8° (sensitivity = 74.4%, specificity = 78.6%, area under the curve (AUC) = 0.809) and 79.8 (sensitivity = 78.4%, specificity = 73.8%, AUC = 0.818), respectively.
CONCLUSIONS: CD showed satisfactory clinical outcomes for ONFH with small- or medium-sized pre-collapse lesions where less acetabular coverage with a CEA < 26.8° or AHI < 79.8 was identified as an independent risk factor for the failure of CD.
METHODS: Between January 2010 and December 2022, we retrospectively reviewed 269 consecutive CDs in 188 patients diagnosed with ONFH with small- or medium-sized pre-collapse lesions. The Kaplan-Meier method was used to evaluate the survival rate of CD for ONFH with progression of collapse or conversion to total hip arthroplasty (THA) as the endpoint. Univariate and multivariate logistic regression analyses were conducted to identify the potential risk factors for the failure of CD. Receiver operating characteristic (ROC) curve analysis was further performed with conversion to THA as the endpoint to determine the predictive value of these factors.
RESULTS: The overall 5-year survival rate of CD for ONFH with small- or medium-sized pre-collapse lesions was 74.3% (95% confidence interval (CI) 69.0%-81.1%) with progression of collapse as the endpoint and 83.9% (95% CI 79.3%-88.7%) with conversion to THA as the endpoint. Univariate logistic regression analysis showed that bilateral affected hips was significantly associated with progression of collapse, and center-edge angle (CEA), sharp angle, acetabular head index (AHI), as well as acetabular depth ratio (ADR) were significantly associated with both progression of collapse and conversion to THA. Multivariate logistic regression analysis further indicated that CEA and AHI were independent risk factors for both progression of collapse and conversion to THA. ROC curve analysis with conversion to THA as the endpoint revealed that the cutoff values for CEA and AHI were 26.8° (sensitivity = 74.4%, specificity = 78.6%, area under the curve (AUC) = 0.809) and 79.8 (sensitivity = 78.4%, specificity = 73.8%, AUC = 0.818), respectively.
CONCLUSIONS: CD showed satisfactory clinical outcomes for ONFH with small- or medium-sized pre-collapse lesions where less acetabular coverage with a CEA < 26.8° or AHI < 79.8 was identified as an independent risk factor for the failure of CD.
摘要：
目的：目前尚不清楚股骨头坏死（ONFH）的髓芯减压（CD）失败是否与髋臼覆盖减少有关。本研究旨在探讨CD治疗ONFH伴小型或中型塌陷前病变的临床结果。并确定哪些因素，尤其是髋臼解剖参数,预测CD的故障。
方法：2010年1月至2022年12月，我们回顾性分析了188例确诊为ONFH的小型或中型塌陷前病变患者的269例连续CD。Kaplan-Meier方法用于评估ONFH的CD生存率，以塌陷或转换为全髋关节置换术（THA）的进展为终点。进行单因素和多因素logistic回归分析以确定CD失败的潜在危险因素。进一步进行受试者工作特征(ROC)曲线分析,以转化为THA作为终点,以确定这些因素的预测值。
结果：ONFH伴小型或中型塌陷前病变的CD5年总生存率为74.3％（95％置信区间（CI）69.0％-81.1％），以塌陷进展为终点，以转化为THA为终点的83.9％（95％CI79.3％-88.7％）。单因素logistic回归分析显示双侧髋关节受累与塌陷进展显著相关,和中心边缘角(CEA)，锐角,髋臼头指数(AHI),髋臼深度比（ADR）与塌陷和转化为THA的进展显着相关。多因素Logistic回归分析进一步表明，CEA和AHI是塌陷进展和转换为THA的独立危险因素。以转化为THA为终点的ROC曲线分析显示，CEA和AHI的截止值为26.8°（灵敏度=74.4%，特异性=78.6%，曲线下面积（AUC）=0.809）和79.8（灵敏度=78.4％，特异性=73.8%，AUC=0.818),分别。
结论：CD显示ONFH具有小或中型塌陷前病变的临床结果令人满意，其中CEA<26.8°或AHI<79.8的髋臼覆盖率较低被确定为CD失败的独立危险因素。
方法：2010年1月至2022年12月，我们回顾性分析了188例确诊为ONFH的小型或中型塌陷前病变患者的269例连续CD。Kaplan-Meier方法用于评估ONFH的CD生存率，以塌陷或转换为全髋关节置换术（THA）的进展为终点。进行单因素和多因素logistic回归分析以确定CD失败的潜在危险因素。进一步进行受试者工作特征(ROC)曲线分析,以转化为THA作为终点,以确定这些因素的预测值。
结果：ONFH伴小型或中型塌陷前病变的CD5年总生存率为74.3％（95％置信区间（CI）69.0％-81.1％），以塌陷进展为终点，以转化为THA为终点的83.9％（95％CI79.3％-88.7％）。单因素logistic回归分析显示双侧髋关节受累与塌陷进展显著相关,和中心边缘角(CEA)，锐角,髋臼头指数(AHI),髋臼深度比（ADR）与塌陷和转化为THA的进展显着相关。多因素Logistic回归分析进一步表明，CEA和AHI是塌陷进展和转换为THA的独立危险因素。以转化为THA为终点的ROC曲线分析显示，CEA和AHI的截止值为26.8°（灵敏度=74.4%，特异性=78.6%，曲线下面积（AUC）=0.809）和79.8（灵敏度=78.4％，特异性=73.8%，AUC=0.818),分别。
结论：CD显示ONFH具有小或中型塌陷前病变的临床结果令人满意，其中CEA<26.8°或AHI<79.8的髋臼覆盖率较低被确定为CD失败的独立危险因素。
