Meta-analysis of efficacy of two different approaches to femoral head decompression
YANG Kairui1, 2, DONG Hui1, 3, YANG Yang1, 4, WANG Kai1, 5, XING Jian1, 6, and XIA Qun1, 7
1.Logistics University of Chinese People’s Armed Police Force, Tianjin 300309, China; 2.Outpatient Department,the 960th Hospital of the PLA Joint Logistics Support Force, Jinan 250031, China; 3.Health Company,Army 32134 of PLA, Tianjin 301900, China; 4.Health Company,Army 69230 of PLA, Wusu 833300, China; 5.Health Company,Army 91428 of PLA, Ningbo 315456, China; 6.Health Company,Army 31697 of PLA, Dalian 116000, China; 7.Department of Orthopedics, Featured Medical Center of Chinese People’s Armed Police Force, Tianjin 300162,China
Abstract：Objective To evaluate the efficacy of treating osteonecrosis of the femoral head(ONFH) with femoral head decompression combined with platelet-rich plasma and with femoral decompression alone.Methods Randomized clinical controlled trials (RCTs) which compared the therapeutic effects between femoral head decompression and platelet-rich plasma combined with surgery in both native and foreign language databases from inception to March 15, 2019 were retrieved from such databases as PubMed, Cochrane Library, CNKI and VIP. Related information was obtained and the quality of the study was evaluated.RevMan software was used for meta-analysis.Results Six studies involving 266 patients (307 hips) were included in this paper.There were 156 hips in the PRP group and 151 hips in the control group. The result of meta-analysis showed that compared with simple femoral head decompression, platelet-rich plasma combined with femoral head decompression could improve hip function Harris score MD=8.65[95%CI (7.12,10.18)]. The excellent rate of Harris score was increased OR=5.09[95%CI (2.40,10.80)]while the postoperative VAS score was reduced MD=-0.47[95%CI (-0.69,-0.25)], so was the disease progression rate OR=0.19[95%CI (0.06,0.57)]. There was statistically significant difference between the two groups.Conclusions Compared with simple femoral head decompression, platelet-rich plasma combined with femoral head decompression for femoral head osteonecrosis can achieve better clinical results.
杨凯锐, 董辉, 杨洋, 王恺, 邢健, 夏群. 股骨头坏死两种治疗方法的有效性比较Meta分析[J]. 武警医学, 2019, 30(10): 861-865.
YANG Kairui, DONG Hui, YANG Yang, WANG Kai, XING Jian, and XIA Qun. Meta-analysis of efficacy of two different approaches to femoral head decompression. Med. J. Chin. Peop. Armed Poli. Forc., 2019, 30(10): 861-865.
Plancher K D, Razi A. Management of osteonecrosis of the femoral head[J]. Orthop Clin N Am, 1997, 28(3): 461-477.
[2]
Shah K N, Racine J, Jones L C, et al. Pathophysiology and risk factors for osteonecrosis[J]. Curr Rev Musculoskelet Med, 2015, 8(3): 201-209.
[3]
Quanjun C, Botchwey E A. Emerging ideas: treatment of precollapse osteonecrosis using stem cells and growth factors[J]. Clin Orthop Relat Res, 2011, 469(9): 2665-2669.
[4]
Lee E Y, Yun J L. Glucocorticoids as an etiologic factor[M]. Berlin: Springer, 2014: 204-205.
[5]
Anna C R, Quanjun C. Osteonecrosis of the femoral head[J]. Orthop Clin N Am, 2019, 50(2): 139-149.
[6]
Larson E, Jones L C, Goodman S B, et al. Early stage osteonecrosis of the femoral head: where are we and where are we going in year 2018?[J]. Int Orthop, 2018, 42(Suppl 1): 1-6.
None. Guideline for diagnostic and treatment of osteonecrosis of the femoral head[J]. Orthop Surg, 2015, 7(3): 200-207.
[9]
Roth A, Beckmann J, Bohndorf K, et al. S3 Guideline non-traumatic adult femoral head necrosis[J]. Arch Orthop Traum Surg, 2015, 136(2): 165-174.
[10]
Sánchez A R, Sheridan P J, Kupp L I. Is platelet-rich plasma the perfect enhancement factor? A current review[J]. Int J Oral Max Impl, 2015, 18(1): 93-103.
Han Y, Huang H, Pan J, et al. Meta-analysis comparing platelet-rich plasma vs hyaluronic acid injection in patients with knee osteoarthritis[J]. Pain Med, 2019, 24(3): 1-12.
[13]
Connell B O, Wragg N M, Wilson S L. The use of PRP injections in the management of knee osteoarthritis[J]. Cell and Tissue Res, 2019, 376(2): 143-152.
Ando W, Yamamoto K, Koyama T, et al. Radiologic and clinical features of misdiagnosed idiopathic osteonecrosis of the femoral head[J]. Orthop, 2016, 40(1): e117-e123.
[21]
Kubo T, Ueshima K, Saito M, et al. Clinical and basic research on steroid induced osteonecrosis of the femoral head in Japan[J]. J Orthop Sci, 2016, 21(4): 407-413.
[22]
Dick V D J, Lipalo M, Jurek P, et al. Osteonecrosis of the femoral head: evaluation and treatment[J]. J Am Acad Orthop Surg, 2015, 23(2): 69-70.
[23]
Choi H R, Steinberg M E, Cheng E Y. Osteonecrosis of the femoral head: diagnosis and classification systems[J]. Curr Rev Musculoskeletal Med, 2015, 8(3): 1-11.
[24]
Pierce T P, Jauregui J J, Cherian J J, et al. Imaging evaluation of patients with osteonecrosis of the femoral head[J]. Curr Rev Musculoskeletal Med, 2015, 8(3): 221-227.
[25]
Banerjee S, Issa K, Pivec R, et al. Osteonecrosis of the hip: treatment options and outcomes[J]. Orthop Clin N Am, 2013, 44(4): 463-476.
[26]
Pierce T P, Jauregui J J, Elmallah R K, et al. A current review of core decompression in the treatment of osteonecrosis of the femoral head[J]. Curr Rev Musculoskeletal Med, 2015, 8(3): 1-5.
[27]
Mont M A, Jones L C, Hungerford D S. Nontraumatic osteonecrosis of the femoral head: ten years later[J]. J Bone Joint Surg Am, 2006, 88(5): 1117-1132.
[28]
Pepke W, Kasten P, Beckmann N A, et al. Core decompression and autologous bone marrow concentrate for treatment of femoral head osteonecrosis: a randomized prospective study[J]. Orthop Rev, 2016, 8(1): 6162.
2019, Vol. 30 
