Core decompression versus other joint preserving treatments for osteonecrosis of the femoral head: a meta-analysis
Core decompression versus other joint preserving treatments for osteonecrosis of the femoral head: a meta-analysis
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DOI：
10.1093/bmb/ldw010
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发表时间：
2016-06-01
影响因子：
6.7
通讯作者：
Maffulli, Nicola
中科院分区：
文献类型：
--
作者：
Sadile, Francesco;Bernasconi, Alessio;Maffulli, Nicola
前言：股骨头坏死(ONFH)导致髋关节骨关节炎(HOA)，在关节保留术(JPT)中，髓芯减压术(CD)的作用仍有争议。我们评估了CD与所有其他JPT相比在延缓自然骨坏死演变为HOA方面的有效性。数据来源：按照PRISMA检查表，搜索Medline和Scope us数据库。研究对象为15至70岁的ONFH患者，至少随访24个月。评估的结果是患者的临床状态、放射学进展和全髋关节置换术(THA)或进一步手术(FS)的需要。对每个报道的结果计算风险比(RR)。纳入随机对照试验、随机对照试验和前瞻性研究。同意区域：共有12项研究(776名患者)符合纳入标准。临床结果(RR=1.14；95%可信区间0.58~2.32；P=0.05)、放射学进展(RR=1.64；95%可信区间1.14~2.35；P=0.05)和是否需要全髋关节置换术(RR=1.52；95%可信区间0.95~2.45；P=0.05)提示与CD相比，其他JPT略有优势。争议区域：初步研究的高度异质性是我们研究的主要限制。成长要点：核心减压术治疗ONFH的疗效和有效性充其量也不比其他关节保留策略好。最近的科学证据似乎表明，这种手术不如其他关节保存策略成功。对于开展研究来说是及时的：需要进一步的研究来确定ONFH的最佳治疗方法。
Introduction: Osteonecrosis of femoral head (ONFH) leads to hip osteoarthritis (HOA); among joint preserving treatments (JPT), the role of core decompression (CD) is still debated. We assessed the efficacy of CD compared with all other JPT in delaying the natural osteonecrosis evolution to HOA.Sources of data: Following the PRISMA checklist, the Medline and Scopus databases were searched. Fifteen-to 70-year-old subjects with ONFH with a minimum follow-up of 24 months were considered. The outcomes evaluated were patient clinical status, radiographic progression and total hip arthroplasty (THA) or further surgery (FS) need. Risk ratio (RR) was calculated for every outcome reported. RCT, CCT and prospective studies were included.Areas of agreement: A total of 12 studies (776 patients) met the inclusion criteria. Clinical outcome (RR = 1.14; 95% CI 0.58-2.32; P = 0.05), radiographic progression (RR = 1.64; 95% CI 1.14-2.35; P = 0.05) and the need for THA/FS (RR = 1.52; 95% CI 0.95-2.45; P = 0.05) suggested a slight superiority of other JPT compared with CD.Areas of controversy: High heterogeneity of the primary investigations was the main limitation of our study.Growing points: The efficacy and effectiveness of core decompression for ONFH are, at best, no better than other joint preserving strategies. The more recent scientific evidence seems to suggest that such procedure is less successful than other joint preserving strategies.Areas timely for developing research: Further studies are needed to identify the best therapeutic approach to the ONFH.