股骨头坏死不同保髋手术后髋关节功能的网状Meta分析

Postoperative hip function of different hip joint preserving surgeries for osteonecrosis of femoral head: a network meta-analysis

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.