Wang Xiaole, Hu Liyou, Wei Bo, Wang Jian, Hou Decai, Deng Xiaolei
Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jingshi Road 16369, Jinan, 250014, China.
Liaoning University of Traditional Chinese Medicine, Chongshan Road 79, Shenyang, 110032, China.
Stem Cell Res Ther. 2024 Jan 25;15(1):21. doi: 10.1186/s13287-024-03635-1.
Regenerative techniques combined with core decompression (CD) are commonly used to treat osteonecrosis of the femoral head (ONFH). However, no consensus exists on regeneration therapy combined with CD that performs optimally. Therefore, we evaluated six regenerative therapies combined with CD treatment using a Bayesian network meta-analysis (NMA).
We searched PubMed, Embase, Cochrane Library, and Web of Science databases. Six common regeneration techniques were categorized into the following groups with CD as the control group: (1) autologous bone graft (ABG), (2) autologous bone graft combined with bone marrow aspirate concentrate (ABG + BMAC), (3) bone marrow aspirate concentrate (BMAC), (4) free vascular autologous bone graft (FVBG), (5) expanded mesenchymal stem cells (MSCs), and (6) platelet-rich plasma (PRP). The conversion rate to total hip arthroplasty (THA) and progression rate to femoral head necrosis were compared among the six treatments.
A total of 17 literature were included in this study. In the NMA, two of the six treatment strategies demonstrated higher response in preventing the progression of ONFH than CD: MSCs (odds ratio [OR]: 0.098, 95% confidence interval [CI]: 0.0087-0.87) and BMAC (OR: 0.27, 95% CI: 0.073-0.73). Additionally, two of the six treatment strategies were effective techniques in preventing the conversion of ONFH to THA: MSCs (OR: 0.062, 95% CI: 0.0038-0.40) and BMAC (OR: 0.32, 95% CI: 0.1-0.074). No significant difference was found among FVBG, PRP, ABG + BMAC, ABG, and CD in preventing ONFH progression and conversion to THA (P > 0.05).
Our NMA found that MSCs and BMAC were effective in preventing ONFH progression and conversion to THA among the six regenerative therapies. According to the surface under the cumulative ranking value, MSCs ranked first, followed by BMAC. Additionally, based on our NMA results, MSCs and BMAC following CD may be necessary to prevent ONFH progression and conversion to THA. Therefore, these findings provide evidence for the use of regenerative therapy for ONFH.
再生技术联合髓芯减压（CD）常用于治疗股骨头坏死（ONFH）。然而，对于联合CD的最佳再生治疗方案尚无共识。因此，我们使用贝叶斯网络荟萃分析（NMA）评估了六种联合CD治疗的再生疗法。
我们检索了PubMed、Embase、Cochrane图书馆和Web of Science数据库。将六种常见的再生技术分为以下几组，以CD作为对照组：（1）自体骨移植（ABG），（2）自体骨移植联合骨髓抽吸浓缩物（ABG + BMAC），（3）骨髓抽吸浓缩物（BMAC），（4）游离血管自体骨移植（FVBG），（5）扩增的间充质干细胞（MSCs），以及（6）富血小板血浆（PRP）。比较了六种治疗方法中全髋关节置换术（THA）的转化率和股骨头坏死的进展率。
本研究共纳入17篇文献。在NMA中，六种治疗策略中的两种在预防ONFH进展方面显示出比CD更高的反应：MSCs（比值比[OR]：0.098，95%置信区间[CI]：0.0087 - 0.87）和BMAC（OR：0.27，95% CI：0.073 - 0.73）。此外，六种治疗策略中的两种是预防ONFH转化为THA的有效技术：MSCs（OR：0.062，95% CI：0.0038 - 0.40）和BMAC（OR：0.32，95% CI：0.1 - 0.074）。在预防ONFH进展和转化为THA方面，FVBG、PRP、ABG + BMAC、ABG和CD之间未发现显著差异（P > 0.05）。
我们的NMA发现，在六种再生疗法中，MSCs和BMAC在预防ONFH进展和转化为THA方面是有效的。根据累积排序值下的面积，MSCs排名第一，其次是BMAC。此外，根据我们的NMA结果，CD后使用MSCs和BMAC可能有必要预防ONFH进展和转化为THA。因此，这些发现为ONFH再生治疗的应用提供了证据。
