髓芯减压植骨联合应用富血小板血浆治疗股骨头坏死的有效性Meta分析

Clinical efficacy of core decompression and bone grafting combined with application of platelet-rich plasma for treatment of osteonecrosis of femoral head:a meta-analysis

目的:评价髓芯减压植骨联合应用富血小板血浆(platelet-rich plasma,PRP)治疗股骨头坏死的有效性。方法:应用计算机检索PubMed、Embase、Cochrane Library、中国知网、万方数据库、维普网,搜集应用髓芯减压植骨联合应用PRP治疗股骨头坏死的随机对照试验文献,试验组采用髓芯减压植骨联合应用PRP治疗、对照组采用髓芯减压植骨治疗。检索时限均为数据库建立至2020年12月。经文献检索、文献筛选、数据提取及偏倚风险评价后,采用RevMan5.3软件对术后髋关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、术后Harris髋关节评分、影像学改善率及人工髋关节置换率进行Meta分析。结果:共纳入13项随机对照试验。Meta分析结果显示,试验组患者的术后髋关节疼痛VAS评分低于对照组[I^(2)=83%,MD=-0.81,95%CI(-1.05,-0.57),P=0.000],术后Harris髋关节评分高于对照组[I^(2)=87%,MD=7.88,95%CI(6.00,9.76),P=0.000],影像学改善率高于对照组[I^(2)=4%,OR=5.12,95%CI(2.90,9.02),P=0.000],人工髋关节置换率低于对照组[I^(2)=0%,OR=0.32,95%CI(0.12,0.82),P=0.020]。结论:现有的证据表明,髓芯减压植骨联合应用PRP治疗股骨头坏死的疗效优于单纯的髓芯减压植骨治疗。

Objective:To evaluate the clinical efficacy of core decompression and bone grafting combined with application of platelet-rich plasma(PRP)in treatment of osteonecrosis of femoral head(ONFH).Methods:All the randomized controlled trial(RCT)articles about core decompression and bone grafting combined with application of PRP for treatment of ONFH included from database establishing to De-cember 2020 were retrieved from the PubMed,Embase,Cochrane Library,China National Knowledge Internet,W anfang Database and Vip Database through computer.The patients in experimental group were treated with core decompression and bone grafting combined with PRP,while the ones in control group with core decompression and bone grafting alone.The articles were retrieved and screened and the informa-tion was extracted independently by two researchers according to the inclusion and exclusion criteria.The bias risk of the research in the ar-ticles was evaluated by using RCT bias risk assessment tools recommended by Cochrane systematic evaluation handbook,and then a Meta-analysis on postoperative hip pain visual analogue scale(VAS)score,postoperative Harris hip score,imaging improvement rate and artificial hip replacement rate was conducted by using RevMan5.3 software.Results:Thirteen articles were included in the final analysis.The results of Meta-analysis revealed that the postoperative hip pain VAS score and artificial hip replacement rate were lower,while the postoperative Harris hip score and imaging improvement rate were higher in experimental group compared to control group(I^(2)=83%,MD=-0.81,95%CI(-1.05,-0.57),P=0.000;I^(2)=0%,OR=0.32,95%CI(0.12,0.82),P=0.020;I^(2)=87%,MD=7.88,95%CI(6.00,9.76),P=0.000;I^(2)=4%,OR=5.12,95%CI(2.90,9.02),P=0.000).Conclusion:Available evidences suggest that core decompression and bone grafting combined with application of PRP has better clinical efficacy compared to core decompression and bone grafting alone in treat-ment of ONFH.