髓心减压并自体骨髓干细胞移植术治疗早期股骨头坏死疗效与安全性的系统评价

Effectiveness and safety of core decompression combined transplantation of autologous bone mesenchymal stem cells in early stage osteonecrosis of the femoral head

[目的]系统评价髓心减压并自体骨髓干细胞移植术治疗早期股骨头坏死的疗效及安全性。[方法]计算机检索PubMed、EMBase、Cochrane database of systematic review、Cochrane Controlled Trials Register、中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)等数据库中关于髓心减压并自体骨髓干细胞移植(CDBMSC)与单纯髓心减压(CD)治疗早期股骨头坏死的相关文献,检索日期截止到2012年10月,纳入符合条件的文献,提取相关数据输入RevMan 5.0软件进行统计学分析。评价指标Harris评分及坏死面积采用加权均数法(MD)评价,影像学进展、术后THA比例及并发症发生率采用优势比(OR)评价。[结果]共纳入随机对照研究2篇,非随机对照研究6篇,样本总量为357例391髋。质量评价结果显示纳入研究质量不高、发生偏倚的可能性较大。Meta分析结果显示,CDBMSC能够显著提高患者术后Harris评分[MD=9.60,95%CI(5.52,13.69),P<0.000 01],减缓影像学上的进展[OR=0.20,95%CI(0.10,0.40),P<0.000 01],而术后THA比例、术后坏死面积及并发症无统计学意义。[结论]CDBMSC可能是治疗早期股骨头坏死的有效方法;由于本研究存在一定的局限性,结论有待进一步多中心、大样本随机对照研究的验证。

[ Objective] To assess the effectiveness and safety of core decompression（CD） combined transplantation of autologous bone mesenchymal stem ceils （CDBMSC） in early stage osteoneerosis of the femoral head through a meta-analysis. [ Method] Literatures about CDBMSC and CD before October 2012 were identified from the PubMed, EMBase, Cochrane database of systematic review, Cochrane Controlled Trials Register, CNKI and VIP databases. The papers met the criteria were collected. And then we extracted the data of HHS, progression of the femoral necrosis, volume of the femoral head necrosis, THA rate and complications, which were evaluated by Review Manager 5.0 for meta analysis. Weighted mean difference （MD） of HHS and volume of the femoral head necrosis,odds ratio（OR） of progression of the femoral necrosis,THA rate and complications in the two group were calculated across the study. [ Result] Two RCTs and 6 nRCTs met the selection criteria, involving 357 patients 391 hips. The methodological quality of all trials was low with possibility of bias. The meta-analyses showed that CDBMSC can increase the postoperative Harris score [ MD = 9.60,95% CI （5.52,13.69）, P 〈 0. 000 01 ] and postpone the progression of osteonecrosis of the femoral head [ OR = 0.20,95 % CI （0.10,0.40）, P 〈 0.000 01 ], while there was no significant difference between the two groups in the rate of THA, volume of the femoral head necrosis and complications. [ Conclusion] CDBMSC may be the effective method for treatment of stage osteonecrosis of the femoral head. Because of some limitations of this study, more high quality RCTs are required.