Migliorini Filippo, Maffulli Nicola, Baroncini Alice, Eschweiler Jörg, Tingart Markus, Betsch Marcel
Department of Orthopedics, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52064, Aachen, Germany.
Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA, Italy; Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, E1 4DG London, England, UK; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB Stoke on Trent, England, UK.
Surgeon. 2023 Apr;21(2):85-98. doi: 10.1016/j.surge.2021.12.004. Epub 2022 Jan 4.
Several hip preserving techniques have been described for the management of osteonecrosis of the femoral head (ONFH). This systematic review identified prognostic factors in the treatment of ONFH that are associated with treatment failure and conversion to total hip arthroplasty (THA).
This study followed the PRISMA guidelines. The literature search was conducted in November 2021. All clinical trials comparing two or more treatments for femoral head osteonecrosis were accessed. A multivariate analysis was performed to investigate the association between baseline characteristics and the surgical outcome. A multiple linear model regression analysis through the Pearson Product-Moment Correlation Coefficient (r) was used.
Data from 88 articles (6112 procedures) were retrieved. Female gender was associated with increased time to THA (P = 0.03) and reduced rate of THA (P = 0.03). Longer symptom duration before treatment was associated with shorter time to failure (P = 0.03). Increased pre-treatment VAS was associated with reduced time to failure (P = 0.03) and time to THA (P = 0.04). Reduced pre-treatment hip function was associated with increased rate of THA (P = 0.02) and failure (P = 0.005). Patient age and BMI, aetiology, time from surgery to full weight bearing and the side did not show evidence of a statistically significant association with the surgical outcome.
Male gender, longer symptom duration before treatment, higher VAS scores, and lower HHS scores were negative prognostic factors after treatment for osteonecrosis of the femoral head.
已描述了几种用于治疗股骨头缺血性坏死（ONFH）的保髋技术。本系统评价确定了ONFH治疗中与治疗失败及转为全髋关节置换术（THA）相关的预后因素。
本研究遵循PRISMA指南。于2021年11月进行文献检索。纳入了所有比较两种或更多种治疗股骨头缺血性坏死方法的临床试验。进行多变量分析以研究基线特征与手术结果之间的关联。采用通过Pearson积差相关系数（r）进行的多元线性模型回归分析。
检索到来自88篇文章（6112例手术）的数据。女性与THA时间延长（P = 0.03）及THA发生率降低（P = 0.03）相关。治疗前症状持续时间较长与失败时间较短相关（P = 0.03）。治疗前视觉模拟评分（VAS）升高与失败时间缩短（P = 0.03）及THA时间缩短（P = 0.04）相关。治疗前髋关节功能降低与THA发生率升高（P = 0.02）及失败率升高（P = 0.005）相关。患者年龄、体重指数、病因、从手术到完全负重的时间及患侧与手术结果未显示出统计学显著关联的证据。
男性、治疗前症状持续时间较长、VAS评分较高及髋关节Harris评分（HHS）较低是股骨头缺血性坏死治疗后的不良预后因素。
