Division of Joint Osteopathy and Traumatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, People's Republic of China.
Centre for Orthopaedic Translational Research, School of Surgery, The University of Western Australia, M Block, QE2 Medical Centre, Monash Ave., Nedlands, WA, 6009, Australia.
J Orthop Surg Res. 2023 Aug 2;18(1):560. doi: 10.1186/s13018-023-04025-8.
Accumulated clinical trials had been focused on stem cell therapy in combination of core decompression (CD) in the treatment of avascular necrosis of the femoral head (ANFH). Nonetheless, the results were inconclusive. Here, we performed a systematic review and meta-analysis of previous randomized controlled trials (RCTs) and retrospective studies to assess whether combined stem cell augmentation with CD improved the outcomes of ANFH compared with CD alone.
The current study included 11 RCTs and 7 retrospective studies reporting the clinical outcomes of a total of 916 patients and 1257 hips. 557 and 700 hips received CD and CD plus stem cell therapy, respectively. To compare CD with CD plus stem cell therapy, we examined the clinical evaluating scores, the occurrence of the femoral head, radiologic progression and conversion to total hip arthroplasty (THA).
Only 10 studies reported significantly greater improvement in hip functions while combining stem cell procedure with CD. The pooled results in subgroup analysis indicated that stem cell group had a lower collapse rate on a mid-term basis (P = 0.001), when combined with mechanical support (P < 0.00001), and with extracted stem cells (P = 0.0002). Likewise, stem cell group had a lower radiographic progression rate at 2- to 5-year follow-up [P = 0.003], when combined with structural grafting (P < 0.00001), and with extracted stem cells (P = 0.004). Stem cell therapy resulted in an overall lower THA conversion rate (P < 0.0001) except that at a follow-up longer than 5 years.
Stem cell therapy combined with core decompression was more effective in preventing collapse, radiographic progression and conversion to THA. Trial Registration The current protocol has been registered in PROSPERO with the registration number: CRD42023417248.
许多临床试验都集中在干细胞治疗联合核心减压术（CD）治疗股骨头坏死（ANFH）上。然而，结果并不确定。在这里，我们对以前的随机对照试验（RCT）和回顾性研究进行了系统回顾和荟萃分析，以评估与单独 CD 相比，联合干细胞增强治疗是否能改善 ANFH 的结果。
本研究纳入了 11 项 RCT 和 7 项回顾性研究，共报告了 916 名患者和 1257 髋的临床结果。557 髋和 700 髋分别接受了 CD 和 CD 加干细胞治疗。为了比较 CD 与 CD 加干细胞治疗，我们检查了临床评估评分、股骨头的发生、影像学进展和转换为全髋关节置换术（THA）的情况。
只有 10 项研究报告称，将干细胞手术与 CD 联合使用时，髋关节功能有显著改善。亚组分析的汇总结果表明，在中期（P = 0.001），结合机械支撑（P < 0.00001）和提取干细胞（P = 0.0002）时，干细胞组的塌陷率较低。同样，在 2 至 5 年的随访中，干细胞组的影像学进展率较低[P = 0.003]，当与结构性移植物（P < 0.00001）和提取干细胞（P = 0.004）联合使用时。干细胞治疗总体上降低了 THA 转换率（P < 0.0001），但在随访时间超过 5 年时除外。
干细胞治疗联合核心减压术在预防塌陷、影像学进展和向 THA 转换方面更有效。试验注册 本方案已在 PROSPERO 中注册，注册号为：CRD42023417248。
