Wang Jiaqian, Xu Peirong, Zhou Liang
Department of Orthopaedic, Wuxi No 5 People's Hospital, Wuxi, Jiangsu, China.
Department of Orthopedics, Lianshui County People's Hospital, Huai'an, Jiangsu, China.
Front Cell Dev Biol. 2023 Mar 22;11:995816. doi: 10.3389/fcell.2023.995816. eCollection 2023.
The purpose of our study is to compare the effects of core decompression (CD) and bone grafting (BG) on osteonecrosis of the femoral head (ONFH). And evaluate the efficacy of CD based on cell therapy to provide guidance for the dose and number of cells. We searched PubMed, Embase, and the Cochrane Library between 2012 and 2022, with keywords including "osteonecrosis of the femoral head", "core decompression" and "bone grafting". We selected comparative studies of CD and BG, and the comparison of CD combined with bone marrow (BM) transplantation and CD alone. Changes in hip pain were assessed by VAS, hip function were assessed by HHS and WOMAC, and THA conversion rate was used as an evaluation tool for femoral head collapse. From these three aspects, the dose of bone marrow and the number of cells transplantation were subgroup analyzed. Eleven studies were used to compare the efficacy of CD and BG. There was no significant difference in HHS, and the THA conversion rate of BG was significantly lower than that of CD. Thirteen CD studies based on cell therapy were included in the meta-analysis. Bone marrow aspiration concentrate (BMAC) can significantly improve VAS (mean difference (MD), 10.15; 95% confidence intervals (CI) 7.35 to 12.96, < 0.00001) and reduce THA conversion rate (odds ratio (OR), 2.38; 95% CI 1.26 to 4.47, = 0.007). Medium dose bone marrow fluid has a lower -value in THA conversion rate. The values of bone marrow mononuclear cells (BMMC) of 10 magnitude in VAS score were lower. In general, there is no consensus on the use of BG in the treatment of ONFH. The enhancement of cell-based CD procedure shows promising results. Using 20 mL BMAC and 10 magnitude BMMC is likely to achieve better results.
我们研究的目的是比较髓芯减压（CD）和骨移植（BG）对股骨头坏死（ONFH）的影响。并评估基于细胞治疗的髓芯减压的疗效，为细胞剂量和数量提供指导。我们检索了2012年至2022年期间的PubMed、Embase和Cochrane图书馆，关键词包括“股骨头坏死”、“髓芯减压”和“骨移植”。我们选择了CD和BG的对比研究，以及CD联合骨髓（BM）移植与单纯CD的对比研究。通过视觉模拟评分法（VAS）评估髋部疼痛变化，通过髋关节 Harris 评分（HHS）和 Western Ontario and McMaster Universities 骨关节炎指数（WOMAC）评估髋关节功能，并将全髋关节置换（THA）转化率作为股骨头塌陷的评估工具。从这三个方面对骨髓剂量和细胞移植数量进行亚组分析。11项研究用于比较CD和BG的疗效。HHS无显著差异，BG的THA转化率显著低于CD。13项基于细胞治疗的CD研究纳入荟萃分析。骨髓抽吸浓缩物（BMAC）可显著改善VAS（平均差值（MD），10.15；95%置信区间（CI）7.35至12.96，P<0.00001）并降低THA转化率（比值比（OR），2.38；95%CI 1.26至4.47，P=0.007）。中等剂量骨髓液在THA转化率方面具有较低的P值。10^6数量级的骨髓单个核细胞（BMMC）在VAS评分中的P值较低。总体而言，在ONFH治疗中使用BG尚无共识。基于细胞的髓芯减压手术显示出有前景的结果。使用20 mL BMAC和10^6数量级的BMMC可能会取得更好的效果。
