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

doi:10.3969/j.issn.2095-4344.1215

Abstract

Abstract:

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.

Key words: osteonecrosis of femoral head, core decompression, bone grafting, bone marrow mesenchymal stem cells, free vascularized fibula, tantalum rod, platelet-rich plasma, nano-hydroxyapatite, network meta-analysis, the National Natural Science Foundation of China

CLC Number:

R459.9

Zhang Chi, Lü Haoyuan, Zhang Xiaoyun, Lin Zonghan, Chen Yueping, Zhu Jianglong, Long Feipan, Huang Junli, Mei Pengfei . Postoperative hip function of different hip joint preserving surgeries for osteonecrosis of femoral head: a network meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(16): 2585-2593.

Figures/Tables 7

2.4 直接Meta分析 3篇文献涉及髓芯减压术联合钽棒置入对比髓芯减压术联合植骨术后末次随访Harris评分[6，44，49]，异质性较大(P=0.060，I2=64.5%)，采用随机效应模型合并结果，髓芯减压术联合钽棒置入术后末次随访Harris评分高于髓芯减压术联合植骨(MD=9.15，95%CI[6.90，11.40])。3篇文献涉及髓芯减压术联合钽棒置入对比髓芯减压术后末次随访Harris评分[39，45，47]，异质性较大(P=0.022，I2=73.8%)，采用随机效应模型合并结果，髓芯减压术联合钽棒置入术后末次随访Harris评分与髓芯减压术相当(MD=1.63，95%CI[-2.33，5.59])。3篇文献涉及髓芯减压术联合骨髓间充质干细胞对比髓芯减压术后末次随访Harris评分[8，40-41]，异质性较大(P=0.008，I2=79.4%)，采用随机效应模型合并结果，髓芯减压术联合骨髓间充质干细胞术后末次随访Harris评分高于髓芯减压术(MD=9.23，95%CI[2.02，16.44])。2篇文献涉及髓芯减压术联合骨髓间充质干细胞与植骨对比髓芯减压术后末次随访Harris评分[42，46]，异质性较大(P=0.131，I2=56.2%)，采用随机效应模型合并结果，髓芯减压术联合骨髓间充质干细胞与植骨的术后末次随访Harris评分高于髓芯减压术(MD=10.43，95%CI[3.49，17.36])。2篇文献涉及髓芯减压术联合骨髓间充质干细胞与植骨对比髓芯减压术联合植骨的术后末次随访Harris评分[7，50]，异质性小(P=0.912，I2=0.0%)，采用固定效应模型合并结果，髓芯减压术联合骨髓间充质干细胞与植骨的术后末次随访Harris评分高于髓芯减压术联合植骨(MD=12.23，95%CI[10.62，13.85])。 2篇文献涉及髓芯减压术联合植骨与富血小板血浆与植骨对比髓芯减压术联合植骨术后末次随访Harris评分[10，48]，异质性小(P=0.582，I2=0.0%)，采用固定效应模型合并结果，髓芯减压术联合植骨与富血小板血浆术后末次随访Harris评分高于髓芯减压术联合植骨(MD=9.08，95%CI[5.03，13.13])。1篇文献涉及髓芯减压术联合钽棒置入对比髓芯减压术联合腓骨移植术后末次随访Harris评分[14]，结果显示髓芯减压术联合植骨与富血小板血浆的术后末次随访Harris评分与髓芯减压术联合植骨相当(MD=-0.31，95%CI[-2.51，1.89])。1篇文献涉及髓芯减压术联合植骨与游离血管化腓骨移植对比髓芯减压术后末次随访Harris评分[15]，结果显示髓芯减压术联合植骨与游离血管化腓骨移植的术后末次随访Harris评分高于髓芯减压术(MD=14.00，95%CI[11.51，16.49])。1篇文献涉及髓芯减压术联合纳米羟基磷灰石/聚酰胺66杆与多孔可吸收生物玻璃骨对比髓芯减压术联合植骨术后末次随访Harris评分[9]，结果显示髓芯减压术联合纳米羟基磷灰石/聚酰胺66杆与多孔可吸收生物玻璃骨的术后末次随访Harris评分高于髓芯减压术联合植骨(MD=9.28，95%CI[6.49，12.07])。1篇文献涉及髓芯减压术联合植骨与钽棒置入对比髓芯减压术联合钽棒置入术后末次随访Harris评分[43]，结果显示髓芯减压术联合植骨与钽棒置入术后末次随访Harris评分高于髓芯减压术联合钽棒置入(MD=5.10，95%CI[0.24，9.96])。1篇文献涉及髓芯减压术联合骨髓间充质干细胞与钽棒置入对比髓芯减压术联合钽棒置入术后末次随访Harris评分[38]，结果显示髓芯减压术联合骨髓间充质干细胞与钽棒置入术后末次随访Harris评分高于髓芯减压术联合钽棒置入(MD=9.63，95%CI[6.82，12.44])。1篇文献涉及髓芯减压术联合骨髓间充质干细胞对比髓芯减压术联合钽棒置入术后末次随访Harris评分[5]，结果显示髓芯减压术联合骨髓间充质干细胞的术后末次随访Harris评分与髓芯减压术联合钽棒置入相当(MD=-1.37，95%CI[-6.91，4.17])。1篇文献涉及髓芯减压术联合植骨与钽棒置入对比髓芯减压术联合植骨与腓骨移植术后末次随访Harris评分[2]，结果显示髓芯减压术联合植骨与钽棒置入术后末次随访Harris评分高于髓芯减压术联合植骨与腓骨移植(MD=4.88，95%CI[4.11，5.65])。1篇文献涉及髓芯减压术联合植骨与腓骨移植对比髓芯减压术后末次随访Harris评分[51]，结果显示髓芯减压术联合植骨与腓骨移植的术后末次随访Harris评分高于髓芯减压术(MD=5.80，95%CI[2.61，8.99])。 2.5 网状Meta分析 2.5.1 网状证据图总共纳入了23篇文献，12种治疗方案构成23对直接比较，有实线连接则证明2种治疗方案之间存在直接比较证据，无连线则证明未发现直接比较证据，见图3。 2.5.2 不一致性检测 23对直接比较构成了1个三角形闭环与2个四边形闭环，Z检验结果表明95%CI界值下限均为1，P > 0.05，表明各闭环具有一致性，见图4。 2.5.3 节点分裂模型节点分裂分析结果显示各P值均> 0.05，说明各治疗方法的直接比较结果与间接比较结果具有一致性，可运用一致性模型实施网状Meta分析，见图5。 2.5.4 发表偏倚作Egger’s检验P=0.519>0.1，说明无明显发表偏倚。Egger’s线性回归图见图6。"

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