股骨头坏死不同保髋手术后髋关节功能的网状Meta分析
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摘要
背景:股骨头坏死的保髋手术治疗方案决策是近年来讨论的热点,目前已有研究者开发出多种保髋手术联合治疗方案,最佳治疗方案仍存在争议。目的:对比不同保髋手术治疗股骨头坏死术后髋关节功能差异。方法:计算机检索PubMed、Embase、The Cochrane Library、中国生物医学文献数据库、中国知网、万方和维普数据库,根据纳入与排除标准进行文献筛选、质量评价和数据提取后进行网状Meta分析。结果与结论:①共纳入23项随机对照试验,合计1 248髋,涉及12种手术治疗方案;②对纳入研究分析后,结果显示在纳入的治疗方案中,髓芯减压术联合自体或异体松质骨植骨与游离血管化腓骨移植术的术后末次随访髋关节Harris评分可能是最高的;③髓芯减压术联合输注骨髓间充质干细胞与钽棒植入的术后末次随访髋关节Harris评分可能排名第二;④上述结论仍需设计合理的高质量随机对照试验进一步证实。
BACKGROUND: Hip joint preserving surgeries for osteonecrosis of femoral head has been a hotspot in recent years. At present, researchers have developed a variety of hip joint preserving surgical treatment programs, and the optimal treatment plan is still controversial.OBJECTIVE: To compare the postoperative hip function of different hip joint preserving surgeries for osteonecrosis of femoral head.METHODS: PubMed, Embase, The Cochrane Library, CBM, CNKI, WanFang and VIP databases were searched. According to the inclusion and exclusion criteria, literature screening, quality evaluation and data extraction were performed, and the network meta-analysis was conducted.RESULTS AND CONCLUSIONS:(1) A total of 23 randomized controlled trials were included, involving a total of 1 248 hips and 12 surgical treatment options.(2) Meta-analysis results showed that the Harris hip score at postoperative last follow-up of the core decompression combined with bone grafting and free vascularized fibular grafting was the highest.(3) Core decompression combined with bone marrow mesenchymal stem cells and tantalum rod was the second.(4) The above conclusions need to be further confirmed by high-quality randomized controlled trials.
BACKGROUND: Hip joint preserving surgeries for osteonecrosis of femoral head has been a hotspot in recent years. At present, researchers have developed a variety of hip joint preserving surgical treatment programs, and the optimal treatment plan is still controversial.OBJECTIVE: To compare the postoperative hip function of different hip joint preserving surgeries for osteonecrosis of femoral head.METHODS: PubMed, Embase, The Cochrane Library, CBM, CNKI, WanFang and VIP databases were searched. According to the inclusion and exclusion criteria, literature screening, quality evaluation and data extraction were performed, and the network meta-analysis was conducted.RESULTS AND CONCLUSIONS:(1) A total of 23 randomized controlled trials were included, involving a total of 1 248 hips and 12 surgical treatment options.(2) Meta-analysis results showed that the Harris hip score at postoperative last follow-up of the core decompression combined with bone grafting and free vascularized fibular grafting was the highest.(3) Core decompression combined with bone marrow mesenchymal stem cells and tantalum rod was the second.(4) The above conclusions need to be further confirmed by high-quality randomized controlled trials.
引文
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[2]张颖,刘又文,冯立志,等.非创伤性早期股骨头坏死患者保髋术中钽棒和异体腓骨支撑股骨头的效果比较[J].山东医药,2015,55(48):5-8.
[3]Swarup I,Lee YY,Movilla P,et al.Common factors associated with osteonecrosis of the femoral head in young patients requiring total hip arthroplasty.Hip Int.2015;25(3):232-236.
[4]Chotivichit A,Korwutthikulrangsri E,Pornrattanamaneewong C,et al.Core decompression with bone marrow injection for the treatment of femoral head osteonecrosis.J Med Assoc Thai.2014;97 Suppl 9:S139-S143.
[5]何帮剑,厉驹,吕一,等.髓芯减压联合干细胞移植与钽棒植入术治疗Ⅱ期非创伤性股骨头坏死的临床研究[J].中国骨伤,2016,29(12):1119-1124.
[6]雷广志.研究髓芯减压联合钽金属棒植入治疗股骨头坏死的效果[J].中国现代药物应用,2018,12(2):16-17.
[7]李霏霰,吴齐英,李新志,等.髓心减压术联合自体骨髓干细胞移植治疗老年缺血性股骨头坏死的疗效[J].中国老年学杂志,2016,36(22):5671-5672.
[8]李民,李书奎,陈汉文,等.髓芯减压后自体Mcs移植治疗早期股骨头坏死效果[J].齐鲁医学杂志,2016,31(3):340-341+343.
[9]田润,李越,王坤正,等.髓芯减压联合纳米羟基磷灰石/聚酰胺66杆治疗股骨头坏死的前瞻性研究[J].中华解剖与临床杂志,2017,22(3):201-207.
[10]赵程锦,冯阳阳,周煜虎.髓芯减压植骨术结合富血小板血浆治疗股骨头缺血性坏死的疗效及术后并发症临床观察[J].中国临床研究,2017,30(7):878-882.
[11]Arbeloa-Gutierrez L,Dean CS,Chahla J,et al.Core decompression augmented with autologous bone marrow aspiration concentrate for early avascular necrosis of the femoral head.Arthrosc Tech.2016;5(3):e615-e620.
[12]王谦,黄国鑫,陈磊,等.髓芯减压联合自体骨髓间充质干细胞移植治疗股骨头坏死:安全和有效性的Meta分析[J].中国组织工程研究,2018,22(17):2733-2739.
[13]Gao YS,Chen SB,Jin DX,et al.Modified surgical techniques of free vascularized fibular grafting for treatment of the osteonecrosis of femoral head:results from a series of 407cases.Microsurgery.2013;33(8):646-651.
[14]郑吉波.髓心减压钽棒假体植入治疗股骨头坏死的临床疗效[J].中国医药导报,2012,9(16):187-188.
[15]Cao L,Guo C,Chen J,et al.Free vascularized fibular grafting improves vascularity compared with core decompression in femoral head osteonecrosis:a randomized clinical trial.Clin Orthop Relat Res.2017;475(9):2230-2240.
[16]JW G.ARCO Intronational stage of osteonecrosis.ARCONewsl.1993;5:79-82.
[17]康鹏德,裴福兴,王坤正.股骨头坏死的宾夕法尼亚大学分期[J].中国矫形外科杂志,2004,12(Z3):136-137.
[18]Ficat RP.Idiopathic bone necrosis of the femoral head.early diagnosis and treatment.J Bone Joint Surg Br.1985;67(1):3-9.
[19]Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.an end-result study using a new method of result evaluation.JBone Joint Surg.1969;51(4):737-755.
[20]吴婷婷,刘丹璐,黄娇,等.偏倚风险评估工具在针刺Cochrane系统评价中的应用[J].中国循证医学杂志,2014,14(3):361-364.
[21]张天嵩,钟文昭,李博.实用循证医学方法学.2版[M].长沙:中南大学出版社,2014.
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