干细胞移植联合髓芯减压治疗早中期股骨头坏死的Meta分析

Stem cell transplantation combined with core decompression for treatment of early-middle osteonecrosis of the femoral head:a meta analysis

目的:评价干细胞移植联合髓芯减压治疗早中期股骨头坏死(osteonecrosisofthefemoralhead,ONFH)的临床疗效。方法:应用计算机检索万方、中国知网、维普、中国生物医学文献数据库及PubMed、Springer、Embase数据库中关于干细胞移植联合髓芯减压治疗早中期ONFH的随机对照临床研究文献,检索时限为建库至2020年6月。试验组采用干细胞移植联合髓芯减压治疗ONFH,对照组采用单纯髓芯减压治疗。由2名研究者根据纳入和排除标准独立检索、筛选文献并提取资料,采用Cochrane偏倚风险评估工具对纳入文献的质量进行评估,采用RevMan5.3软件进行Meta分析。结果:共检索出587篇文献,最终纳入13篇文献。Meta分析结果表明,试验组术后Harris髋关节评分高于对照组[I^(2)=45%,P=0.080;MD=11.80,95%CI(10.66,12.94)],西安大略和麦克马斯特大学骨关节炎指数低于对照组[I^(2)=0%,P=0.650;MD=-17.87,95%CI(-19.34,-16.40)],术后髋关节疼痛视觉模拟量表评分低于对照组[I^(2)=86%,P=0.000;MD=-1.32,95%CI(-1.60,-1.05)],术后股骨头严重塌陷或关节退行性变的发生率低于对照组[I^(2)=0%,P=0.960;OR=0.18,95%CI(0.08,0.39)],术后股骨头坏死区面积占股骨头面积的百分比低于对照组[I^(2)=0%,P=0.790;MD=-5.44,95%CI(-6.44,-4.45)]。结论:现有的证据表明,干细胞移植联合髓芯减压治疗早中期ONFH的临床疗效优于单纯髓芯减压。

Objective:To evaluate the clinical curative effects of stem cell transplantation(SCT)combined with core decompression(CD)for treatment of early-middle osteonecrosis of the femoral head(ONFH).Methods:All the randomized controlled trial(RCT)articles about SCT combined with CD for treatment of early-middle ONFH included from database establishing to June 2020 were retrieved from Wanfang Database, China National Knowledge Internet, VIP Database, Chinese Biomedical Literature Database, PubMed, Springer and Embase through computer.The patients in experimental group were treated with SCT and CD,while the ones in control group were merely treated with CD.The articles were retrieved and screened and the information was extracted independently by two searchers according to the inclusion and exclusion criteria.The methodological quality of research in the articles was evaluated by using Cochrane risk bias assessment tools and a Meta-analysis was conducted by using RevMan5.3 software.Results:Five hundred and eighty-seven articles were searched out.After screening, 13 articles were included in the final analysis.The results of Meta-analysis revealed that the postoperative Harris hip scores were higher, while the Western Ontario and McMaster Universities(WOMAC)osteoarthritis indexes, the postoperative hip pain visual analogue scale(VAS)scores, incidence of severe collapse of femoral head or degeneration of joint and proportion of femoral head necrotic area to whole femoral head area were lower in experimental group compared to control group(I^(2)=45%,P=0.080;MD=11.80,95%CI(10.66,12.94);I^(2)=0%,P=0.650;MD=-17.87,95%CI(-19.34,-16.40);I^(2)=86%,P=0.000;MD=-1.32,95%CI(-1.60,-1.05);I^(2)=0%,P=0.960;OR=0.18,95%CI(0.08,0.39);I^(2)=0%,P=0.790;MD=-5.44,95%CI(-6.44,-4.45)).Conclusion:Available evidences suggest that the clinical curative effect of combination therapy of SCT and CD is better than that of monotherapy of CD in treatment of early-middle ONFH.