Abstract：
There are many treatment options for patients who have osteonecrosis of the femoral head (ONFH) and management strategies vary widely both among and within individual countries. Although many researchers have attempted to elucidate the optimal strategies for managing this disease, the lack of large-scale randomized control trials and the lack of agreement on disease staging have curtailed the development of clear-cut guidelines.
The Association Research Circulation Osseous (ARCO) group sought to address three questions for the management of patients who have ONFH: 1) What imaging studies are most sensitive and specific for the diagnostic evaluation of patients who have ONFH?; 2) What is the best treatment strategy for preventing disease progression in patients who have pre-collapse lesions?; and 3) What is the best treatment strategy for patients who have post-collapse disease? The Patient, Intervention, Comparison, and Outcome (PICO) format was used to formulate the search strategy for each research question. A systematic review will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ARCO participants have been allocated to three groups, each representing one of the PICO questions. After qualitative and quantitative analysis of the data extracted from studies pertaining to each of the three research questions, a set of evidence-based clinical practice guidelines will be proposed for the management of patients who have ONFH.
It is not always clear which treatment method is optimal for the management of ONFH. Thus, many surgeons have developed and performed various procedures based on patient-specific factors. As there is no consensus on the optimal treatment for various stages of disease, it was clear that developing evidence-based clinical practice guidelines would provide more structure and uniformity to management of these patients. Therefore, the results of this systematic review will lead to the development guidelines that may improve patient-care strategies and result in better outcomes for patients who have ONFH.
The Association Research Circulation Osseous (ARCO) group sought to address three questions for the management of patients who have ONFH: 1) What imaging studies are most sensitive and specific for the diagnostic evaluation of patients who have ONFH?; 2) What is the best treatment strategy for preventing disease progression in patients who have pre-collapse lesions?; and 3) What is the best treatment strategy for patients who have post-collapse disease? The Patient, Intervention, Comparison, and Outcome (PICO) format was used to formulate the search strategy for each research question. A systematic review will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ARCO participants have been allocated to three groups, each representing one of the PICO questions. After qualitative and quantitative analysis of the data extracted from studies pertaining to each of the three research questions, a set of evidence-based clinical practice guidelines will be proposed for the management of patients who have ONFH.
It is not always clear which treatment method is optimal for the management of ONFH. Thus, many surgeons have developed and performed various procedures based on patient-specific factors. As there is no consensus on the optimal treatment for various stages of disease, it was clear that developing evidence-based clinical practice guidelines would provide more structure and uniformity to management of these patients. Therefore, the results of this systematic review will lead to the development guidelines that may improve patient-care strategies and result in better outcomes for patients who have ONFH.
摘要：
对于股骨头坏死（ONFH）的患者，有许多治疗选择，并且各个国家之间和内部的管理策略差异很大。尽管许多研究人员试图阐明治疗这种疾病的最佳策略，缺乏大规模随机对照试验,以及在疾病分期方面缺乏共识,这限制了明确指南的制定.
协会研究循环骨（ARCO）小组试图解决治疗ONFH患者的三个问题：1）对ONFH患者的诊断评估最敏感和特异性的影像学检查？；2）预防塌陷前病变患者疾病进展的最佳治疗策略是什么？；3）塌陷后疾病患者的最佳治疗策略是什么？患者，干预,比较,结果（PICO）格式用于制定每个研究问题的搜索策略。将根据系统审查和荟萃分析（PRISMA）指南的首选报告项目进行系统审查。ARCO参与者已被分配到三组，每个代表一个PICO问题。在对从与三个研究问题有关的研究中提取的数据进行定性和定量分析之后，将针对ONFH患者的治疗提出一套循证临床实践指南.
并不总是清楚哪种治疗方法对于ONFH的管理是最佳的。因此，许多外科医生根据患者的特定因素开发并执行了各种手术。由于对不同阶段的疾病的最佳治疗尚无共识，很明显,制定循证临床实践指南将为这些患者的管理提供更多的结构和统一性.因此,本系统综述的结果将导致制定指南,该指南可能会改善患者护理策略,并为患有ONFH的患者带来更好的结局.
协会研究循环骨（ARCO）小组试图解决治疗ONFH患者的三个问题：1）对ONFH患者的诊断评估最敏感和特异性的影像学检查？；2）预防塌陷前病变患者疾病进展的最佳治疗策略是什么？；3）塌陷后疾病患者的最佳治疗策略是什么？患者，干预,比较,结果（PICO）格式用于制定每个研究问题的搜索策略。将根据系统审查和荟萃分析（PRISMA）指南的首选报告项目进行系统审查。ARCO参与者已被分配到三组，每个代表一个PICO问题。在对从与三个研究问题有关的研究中提取的数据进行定性和定量分析之后，将针对ONFH患者的治疗提出一套循证临床实践指南.
并不总是清楚哪种治疗方法对于ONFH的管理是最佳的。因此，许多外科医生根据患者的特定因素开发并执行了各种手术。由于对不同阶段的疾病的最佳治疗尚无共识，很明显,制定循证临床实践指南将为这些患者的管理提供更多的结构和统一性.因此,本系统综述的结果将导致制定指南,该指南可能会改善患者护理策略,并为患有ONFH的患者带来更好的结局.
