分析长期保守治疗成功的股骨头坏死病例特点，总结保守治疗股骨头坏死的临床经验。

回顾性分析2009年10月至2024年10月于广州中医药大学第一附属医院接受保守治疗，且连续随访时间超过5年的股骨头坏死患者。记录患者国际骨循环研究协会（ARCO）分期、日本骨坏死研究会（JIC）分型、股骨头受累面积百分比，进行描述性分析。根据影像学转归特点，将病例分为长期稳定型、内侧塌陷型、软骨下骨折修复型。

共纳入16例患者，随访时间8（7，12）年，其中长期稳定型10例，内侧塌陷型5例，软骨下骨折修复型1例。长期稳定型中，1例JIC C1型患者股骨头受累面积为轻度，3例股骨头受累面积为重度但病灶位于内侧（JIC A型），其余6例股骨头受累面积均为轻度或中度，JIC分型均为A或B型。5例内侧塌陷型股骨头受累面积均为重度，其中4例均观察到“塌陷-停止-修复”过程。软骨下骨折修复型1例为JIC C1型，股骨头受累面积为中度，外侧皮质保留，软骨下骨折线于8年内消失。

JIC A和B型最适合进行保守治疗，通常能够获得长期稳定，即使坏死面积较大发生塌陷，也多趋于自限甚至修复，预后良好；JIC C1型患者若股骨头受累面积为轻度或中度，外侧皮质保留，仍有可能获得长期稳定甚至软骨下骨折修复，但鉴别较难，建议联合使用外侧壁保留角或中日友好医院分型进行量化评估。

To analyze the characteristics of patients with osteonecrosis of the femoral head (ONFH) who achieved long-term success with conservative treatment and to summarize clinical experience in the conservative management of ONFH.

A retrospective analysis was conducted on patients with ONFH who received conservative treatment at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2009 to October 2024, with a continuous follow-up of more than five years. The Association Research Circulation Osseous (ARCO) stage, Japanese Investigation Committee (JIC) classification, and percentage of femoral head involvement were recorded and descriptively analyzed. According to the imaging outcomes, the cases were classified into three types: long-term stable type, medial collapse type, and subchondral fracture repair type.

A total of 16 patients were included, with a follow-up duration of 8 (7, 12) years. Among them, 10 cases were classified as long-term stable type, five as medial collapse type, and one as subchondral fracture repair type. In the long-term stable group, one patient with JIC type C1 had mild femoral head involvement, three patients had severe involvement but with lesions located medially (JIC type A), and the remaining six patients had mild or moderate involvement with JIC type A or B. All the five medial collapse cases had severe femoral head involvement, and four of them exhibited a "collapse-arrest-repair" process. The single subchondral fracture repair case was JIC type C1 with moderate femoral head involvement and preserved lateral cortex; the subchondral fracture line disappeared within eight years.

JIC types A and B are the most suitable candidates for conservative treatment, generally achieving long-term stability. Even when collapse occurs due to a large necrotic area, it tends to be self-limiting or even repair, with a favorable prognosis. For patients with JIC type C1, if the percentage of femoral head involvement is mild or moderate and the lateral cortex is preserved, long-term stability or even healing of subchondral fracture is still possible. However, identification is more difficult. It is recommended to combine quantitative assessments such as the preserved angle of the lateral wall or the China-Japan Friendship Hospital (CJFH) classification.