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Abstract：
BACKGROUND: 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).
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
摘要：
背景：再生技术结合髓芯减压（CD）通常用于治疗股骨头坏死（ONFH）。然而,对于再生疗法联合CD的效果最佳，尚无共识。因此,我们使用贝叶斯网络荟萃分析(NMA)评估了6种再生疗法联合CD治疗.
方法：我们搜索了PubMed，Embase,科克伦图书馆,和WebofScience数据库。以CD为对照组，将六种常用的再生技术分为以下几组：（1）自体骨移植（ABG），（2）自体骨移植联合骨髓穿刺液浓缩液（ABG+BMAC），（3）骨髓穿刺液浓缩物（BMAC），（4）游离血管自体骨移植（FVBG），(5)扩增间充质干细胞(MSCs),和(6)富血小板血浆(PRP)。比较6种治疗方法的全髋关节置换术（THA）转化率和股骨头坏死进展率。
结果：本研究共纳入17篇文献。在NMA,与CD: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)相比,6种治疗策略中的2种在预防ONFH进展方面表现出更高的反应.此外,6种治疗策略中有2种是防止ONFH向THA:MSCs(OR:0.062,95%CI:0.0038-0.40)和BMAC(OR:0.32,95%CI:0.1-0.074)转化的有效技术.FVBG之间无显著差异,PRP,ABG+BMAC,ABG,和CD在预防ONFH进展和转化为THA方面（P>0.05）。
结论：我们的NMA发现，在六种再生疗法中，MSCs和BMAC可有效预防ONFH进展和转化为THA。根据表面下的累计排名值，MSCs排名第一,其次是BMAC。此外,根据我们的NMA结果,CD后的MSC和BMAC可能是防止ONFH进展和转化为THA所必需的。因此,这些发现为使用再生疗法治疗ONFH提供了证据.
方法：我们搜索了PubMed，Embase,科克伦图书馆,和WebofScience数据库。以CD为对照组，将六种常用的再生技术分为以下几组：（1）自体骨移植（ABG），（2）自体骨移植联合骨髓穿刺液浓缩液（ABG+BMAC），（3）骨髓穿刺液浓缩物（BMAC），（4）游离血管自体骨移植（FVBG），(5)扩增间充质干细胞(MSCs),和(6)富血小板血浆(PRP)。比较6种治疗方法的全髋关节置换术（THA）转化率和股骨头坏死进展率。
结果：本研究共纳入17篇文献。在NMA,与CD: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)相比,6种治疗策略中的2种在预防ONFH进展方面表现出更高的反应.此外,6种治疗策略中有2种是防止ONFH向THA:MSCs(OR:0.062,95%CI:0.0038-0.40)和BMAC(OR:0.32,95%CI:0.1-0.074)转化的有效技术.FVBG之间无显著差异,PRP,ABG+BMAC,ABG,和CD在预防ONFH进展和转化为THA方面（P>0.05）。
结论：我们的NMA发现，在六种再生疗法中，MSCs和BMAC可有效预防ONFH进展和转化为THA。根据表面下的累计排名值，MSCs排名第一,其次是BMAC。此外,根据我们的NMA结果,CD后的MSC和BMAC可能是防止ONFH进展和转化为THA所必需的。因此,这些发现为使用再生疗法治疗ONFH提供了证据.
