ABSTRACT
BACKGROUND: Femoral head necrosis is a multifactorial disease, and has the youth oriented tendency. It often results in femoral head collapse and leads to total hip arthroplasty. Thus, finding a secure and effective treatment is of clinical benefits to relieve patients' suffering and to reduce social economic burden. Bone marrow mesenchymal stem cells (BMSCs) transplantation has been used in the clinical practice of femoral head necrosis. However, the conclusion remains controversial. OBJECTIVE: To access the safety and efficacy of the core decompression combined with autologous BMSCs transplantation in patients with femoral head necrosis by using meta-analysis approach. METHODS: Randomized clinical controlled trials (RCTs) which compared the therapeutic effects between core decompression combined with autologous BMSCs and core decompression were systematically retrieved from inception to June 20, 2017 in PubMed, The Cochrane Library (Issue 5, 2017), Embase, CNKI, CBM, VIP and WanFang databases. After extraction of the information and evaluation of the study quality, a meta-analysis was performed by RevMan software. RESULTS AND CONCLUSION: Eight RCTs with 323 patients (395 hips), 193 hips in BMSCs group and 202 in conventional therapeutic group, were ultimately included. The revisit time was 12-60 months. The overall quality of the trials was considered moderate-high. The results of meta-analysis show that compared with core decompression alone, autologous BMSCs transplantation combined with core decompression could alleviate the pain [Visual Analogue Scale: mean difference ( MD)=-0.39, 95% confidence interval (CI) (-0.76,-0.01)], enhance the joint function [Harris score: 12 months MD=7.16, 95%CI (3.88, 10.44) and 24 months MD=11.16, 95%CI (8.32, 14.00)], decrease the rate of disease progression in radiography [odds ratio=0.23, 95%CI (0.09, 0.55)]. Although there was no statistical significance between two groups, BMSCs transplantation had trend to reduce the rate of total hip arthroplasty [risk ratio=0.44, 95%CI (0.19, 1.03)]. No obvious complications were found in the course of BMSCs therapy. Given the above, autologous BMSCs transplantation combined with core decompression is a secure and effective therapeutic method for femoral head necrosis.
ABSTRACT
BACKGROUND:Stem cell transplantation has been used in the clinical treatment of spinal cord injury.However,the efficacy and safety are still controversial.Although there are many approaches for stem cell transplantation,which one is better is unclear as yet.OBJECTIVE:To systematically evaluate the efficacy and safety of stem cell transplantation for spinal cord injury,and to compare the therapeutic difference in stem cell transplantation via different approaches.METHODS:A computer-based online search was conducted in PubMed,The Cochrane Library (Issue 4,2016),Embase,CNKI,VIP,CBM,and Wan-Fang databases up to May 13,2016 to screen the relevant randomized clinical controlled trials of stem cells in the treatment of spinal cord injury.Two reviewers independently selected the studies,extracted information,and assessed the quality of included trials.Data extracted from eligible studies was pooled and meta-analyzed using Stata13.1 and Gemtc0.14.3 software.RESULTS AND CONCLUSION:A total of 10 randomized controlled trials involving 546 patients (294 in stem cells group and 252 in rehabilitation treatment group) were included.The results of meta-analysis showed that stem cell transplantation had an advantage over rehabilitation treatment in increasing American Spinal Cord Injury Association (ASIA) motor score,ASIA sensory score,Barthel Index,and decreasing the bladder residual urine volume.The incidence of low fever,abdominal distension,headache,lower limb numbness,and meningeal irritation was 14％,7％,7％,8％,and 7％,respectively.Taking the rehabilitation treatment as a common reference,the results of the network meta-analysis showed that there were no significant differences in ASIA motor score,ASIA sensory score,Barthel Index,and incidence of complications among subarachnoid injection,intravenous injection,and intralesional injection.Compared with the rehabilitation treatment,only stem cell transplantation via subarachnoid injection had significant differences in ASIA motor score [MD=9.77,95％CI (0.26,21.46)],and ASIA sensory score [MD=25.79,95％CI (10.07,45.27)].To conclude,the stem cells transplantation via subarachnoid injection is considered the most effective transplantation method.Due to the limitations of the included studies,more high-quality randomized controlled trials are required to verify the above conclusion.In addition,future studies should focus on the long-term efficacy and safety of stem cell transplantation in the treatment of spinal cord injury,and should investigate the clinical effects on spinal cord injury with different ASIA grades,types of stem cells,and transplantation time.