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Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.\"
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.\"
摘要：
背景：尽管在股骨头坏死（ONFH）塌陷后阶段髋关节功能通常会恶化，一些患者仍然可以表现出长期良好的髋关节功能，一个被称为“崩溃生存”的状态。这项研究旨在确定在ONFH病例中适合“塌陷生存”的患者的特征。
方法：这项横断面研究包括65例（87髋）患者，诊断为塌陷后ONFH≥3年（平均9.1年，范围3-23年)。使用Harris髋关节评分（HHS）评估髋关节功能。人口统计,临床,比较有利组（HHS>80）和较差组（HHS≤80）之间的影像学数据。通过多变量分析确定了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）曲线分析来评估这些因素的诊断效能。
结果：优和劣组包括46和41臀部，分别。体重指数（BMI）存在显着差异，关联研究循环骨性（ARCO）阶段，塌陷程度,日本调查委员会（JIC）分类，坏死大小，两组髋关节半脱位（p<0.05）。多变量逻辑回归确定塌陷<3mm（OR：14.49，95CI：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，BMI(OR:0.76,95%CI:0.59~0.97,p=0.029)是独立危险因素。ROC曲线分析表明两者塌陷程度(AUC=0.798,灵敏度=91.3%,特异性=68.3%，p<0.0001）和JIC分类（AUC=0.787，灵敏度=80.4%，特异性=73.2%，p<0.0001）对髋关节功能具有令人满意的诊断价值。结合JIC分类和塌陷程度(AUC=0.868,灵敏度=76.1%,特异性=85.4%，p<0.0001）与单独使用任一者相比，诊断功效显着增强（p<0.05）。
结论：在ONFH中，股骨头塌陷不一定决定预后不良.轻度塌陷（<3mm）和保留前外侧壁的患者更有可能保持满意的髋关节功能。使他们成为“崩溃生存”的候选人。\"
方法：这项横断面研究包括65例（87髋）患者，诊断为塌陷后ONFH≥3年（平均9.1年，范围3-23年)。使用Harris髋关节评分（HHS）评估髋关节功能。人口统计,临床,比较有利组（HHS>80）和较差组（HHS≤80）之间的影像学数据。通过多变量分析确定了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）曲线分析来评估这些因素的诊断效能。
结果：优和劣组包括46和41臀部，分别。体重指数（BMI）存在显着差异，关联研究循环骨性（ARCO）阶段，塌陷程度,日本调查委员会（JIC）分类，坏死大小，两组髋关节半脱位（p<0.05）。多变量逻辑回归确定塌陷<3mm（OR：14.49，95CI：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，BMI(OR:0.76,95%CI:0.59~0.97,p=0.029)是独立危险因素。ROC曲线分析表明两者塌陷程度(AUC=0.798,灵敏度=91.3%,特异性=68.3%，p<0.0001）和JIC分类（AUC=0.787，灵敏度=80.4%，特异性=73.2%，p<0.0001）对髋关节功能具有令人满意的诊断价值。结合JIC分类和塌陷程度(AUC=0.868,灵敏度=76.1%,特异性=85.4%，p<0.0001）与单独使用任一者相比，诊断功效显着增强（p<0.05）。
结论：在ONFH中，股骨头塌陷不一定决定预后不良.轻度塌陷（<3mm）和保留前外侧壁的患者更有可能保持满意的髋关节功能。使他们成为“崩溃生存”的候选人。\"
