非关节置换术治疗股骨头缺血坏死的循证医学评价

A Systemic Review of the Treatment of Avascular Femoral Head Necrosis

目的 :对非关节置换术治疗股骨头缺血坏死的疗效进行客观的评价。方法 :应用国际Cochrane协作网的系统评价方法对非关节置换术治疗股骨头缺血坏死的随机对照研究、病例对照研究和前后对照研究进行系统评价和Meta-分析。结果 :共纳入 35个实验 ,30 87个病例。手术治疗与非手术治疗的比值比 (OR)为 6 .6 2 ,电刺激治疗与非电刺激治疗的比值比 (OR)为 1.5 6。在不同的手术方式中 ,髓芯减压术有效率为 5 5 .8%,截骨术有效率为 71%,骨移植术有效率为 76 .6 %。结论 :对股骨头缺血坏死主张进行手术治疗 ,骨移植疗效最好 ,其次是截骨和髓芯减压 ,电刺激治疗有一定的疗效。

Objective:To assess the efficacy of non hip replacement treatment of the avascular femoral head necrosis.Method:A systemic review of all the relevant randomized controlled trials,case controlled studies and before-after studies was performed.Results:It included 35 trials and 3087 patients.The odds ratio of operation versus non operation is 6.62,while the odds ratio of electric stimulation versus non electric stimulation is 1.56.In these different surgical ways,the effective rates of core decompression,osteotomy and bone grafting are 55.8%,71%and 76.6% respectively.Conclusions:Operation is recommended to treat the avascular femoral head necrosis,bone grafting is the best way,then followed by osteotomy and core decompression.Electric stimulation has some positive effect.