Andriolo Luca, Merli Giulia, Tobar Carlos, Altamura Sante Alessandro, Kon Elizaveta, Filardo Giuseppe
II Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.
Nano-Biotechnology Laboratory-NaBi, Research and Innovation Technology Department, Bologna, Italy.
Int Orthop. 2018 Jul;42(7):1689-1704. doi: 10.1007/s00264-018-3787-0. Epub 2018 Feb 6.
The aim of this study was to document the available evidence on the use of regenerative techniques for the treatment of femoral head osteonecrosis (or avascular necrosis of femoral head, AVN) and to understand their benefit compared to core decompression (CD) alone in avoiding failure and the need for total hip replacement (THR).
The search was conducted on three medical electronic databases according to PRISMA guidelines. The studies reporting number and timing of failures were included in a meta-analysis calculating cumulative survivorship with a Kaplan-Mayer curve. Moreover, the results on failures in treatment groups reported in RCT were compared with those documented in control groups, in order to understand the benefit of biological therapies compared to CD for the treatment of AVN.
Forty-eight studies were included in this systematic review, reporting results of different types of regenerative techniques: mesenchymal stem cell implantation in the osteonecrotic area, intra-arterial infiltration with mesenchymal stem cells, implantation of bioactive molecules, or platelet-rich plasma. Overall, reported results were good, with a cumulative survivorship of 80% after ten year follow-up, and better results when regenerative treatments were combined to CD compared to CD alone (89.9% vs 70.6%, p < 0.0001).
Regenerative therapies offer good clinical results for the treatment of AVN. The combination of CD with regenerative techniques provides a significant improvement in terms of survivorship over time compared with CD alone. Further studies are needed to identify the best procedure and the most suitable patients to benefit from regenerative treatments for AVN.
本研究的目的是记录有关使用再生技术治疗股骨头坏死（或股骨头缺血性坏死，AVN）的现有证据，并了解与单纯髓芯减压（CD）相比，其在避免治疗失败和全髋关节置换（THR）需求方面的益处。
根据PRISMA指南在三个医学电子数据库中进行检索。报告失败数量和时间的研究纳入荟萃分析，用Kaplan - Mayer曲线计算累积生存率。此外，将随机对照试验（RCT）中治疗组的失败结果与对照组记录的结果进行比较，以了解生物疗法与CD相比在治疗AVN方面的益处。
本系统评价纳入了48项研究，报告了不同类型再生技术的结果：间充质干细胞植入坏死区域、间充质干细胞动脉内注射、生物活性分子植入或富血小板血浆。总体而言，报告结果良好，十年随访后的累积生存率为80%，与单纯CD相比，再生治疗与CD联合使用时效果更好（89.9%对70.6%，p < 0.0001）。
再生疗法在治疗AVN方面提供了良好的临床效果。与单纯CD相比，CD与再生技术的联合应用在长期生存率方面有显著改善。需要进一步研究以确定最佳治疗方法和最适合从AVN再生治疗中获益的患者。
