Akhta Muzammil, Razick Daniel, Amani Noorhan, Aamer Sonia, Wen Jimmy, Shelton Trevor, Wang Dean
Orthopaedic Surgery, College of Medicine, California Northstate University, 9700 W Taron Dr, Elk Grove, CA 95757, USA.
Utah Valley Orthopaedics, Provo, 1157 North 300 West, Provo, UT 84604, USA.
J Hip Preserv Surg. 2025 Apr 11;12(3):186-194. doi: 10.1093/jhps/hnaf018. eCollection 2025 Aug.
This systematic review aims to evaluate clinical outcomes for arthroscopic-assisted core decompression (AACD) for avascular necrosis (AVN) of the femoral head. A literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed in PubMed, Embase, and Scopus. Nine studies were included, five comparing AACD with isolated core decompression (CD) and four evaluating outcomes of only AACD. A total of 358 patients (462 hips, 71.8% male) underwent AACD. In the five comparative studies, the AACD and isolated CD groups had 97.6% (72.2-100.0%) and 98.5% (81.0-100.0%) of hips with precollapse AVN, respectively. The modified Harris hip score, reported in five comparative studies, was significantly higher in the AACD group in four studies and not significantly different in one study. The visual analog scale pain score, reported in two comparative studies, was significantly lower in the AACD group in one study and not significantly different in the other study. The collapse rate ranged from 2.9% to 14.0% at a mean follow-up of 37.9 months in the AACD group and from 14.6% to 28.6% at a mean follow-up of 34.7 months in the isolated CD group, with all five comparative studies reporting significantly higher collapse rates in the isolated CD group. In the four AACD only studies, 42.9-100.0% of hips had precollapse AVN with the collapse rate ranging from 23.2% to 45.5% at a mean follow-up of 39.2 months. Patients undergoing AACD for treatment of AVN of the femoral head demonstrate excellent patient-reported outcomes and low rate of collapse and complications, with a possibility of superior outcomes compared to isolated CD.
本系统评价旨在评估关节镜辅助下核心减压术（AACD）治疗股骨头缺血性坏死（AVN）的临床疗效。按照系统评价和Meta分析的首选报告项目（PRISMA）指南，在PubMed、Embase和Scopus数据库中进行了文献检索。共纳入9项研究，其中5项将AACD与单纯核心减压术（CD）进行比较，4项仅评估AACD的疗效。共有358例患者（462髋，男性占71.8%）接受了AACD治疗。在5项比较研究中，AACD组和单纯CD组中处于塌陷前期AVN的髋关节分别占97.6%（72.2% - 100.0%）和98.5%（81.0% - 100.0%）。5项比较研究报告了改良Harris髋关节评分，其中4项研究显示AACD组的评分显著更高，1项研究显示两组无显著差异。2项比较研究报告了视觉模拟量表疼痛评分，其中1项研究显示AACD组显著更低，另一项研究显示两组无显著差异。AACD组平均随访37.9个月时塌陷率为2.9%至14.0%，单纯CD组平均随访34.7个月时塌陷率为14.6%至28.6%，所有5项比较研究均报告单纯CD组的塌陷率显著更高。在4项仅关于AACD的研究中，42.9% - 100.0%的髋关节处于塌陷前期AVN，平均随访39.2个月时塌陷率为23.2%至45.5%。接受AACD治疗股骨头AVN的患者显示出良好的患者报告结局、低塌陷率和并发症发生率，与单纯CD相比可能有更好的疗效。
