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Clinical effect of hyperbaric oxygen therapy in the treatment of femoral head necrosis

A systematic review and meta-analysis

Klinische Wirksamkeit der hyperbaren Sauerstofftherapie bei Femurkopfnekrose

Systematische Übersicht und Metaanalyse

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Abstract

Background

Although many clinical studies have shown that hyperbaric oxygen (HBO) therapy in the treatment of femoral head necrosis can significantly improve clinical symptoms and patients’ quality of life, this conclusion has not been systematically evaluated. Therefore, a meta-analysis was performed to systematically evaluate the clinical effect of HBO therapy in the treatment of femoral head necrosis.

Methods

PubMed, Embase, and Web of Science databases, as well as the reference lists of relevant studies published before August 2016 were systematically searched using terms related to HBO and femoral head necrosis. Fixed or random effects models were used to estimate the pooled risk ratio (RR) with 95% confidence intervals (CI). Several subgroup analyses, sensitivity analyses, and publication bias tests were carried out to explore potential study heterogeneity and bias.

Results

Nine studies involving 305 controls and 318 HBO cases were included. The clinical effect in the HBO therapy group was 4.95-times higher than in the control group (odds ratio, OR = 4.95, 95% CI [3.24,7.55], P < 0.00001) and the difference was statistically significant. According to the principle of subgroup analysis, the population was divided into Asian and non-Asian subpopulations. Subgroup analyses showed that the clinical effect in the HBO therapy group was 4.77-times higher than that of the control group of the Asian subpopulation (OR = 4.77, 95% CI [3.06,7.44], P < 0.00001) and 7.07-times than that of the control group of the non-Asian subpopulation (OR = 7.07, 95% CI [1.77,28.27], P < 0.00001).

Conclusion

The results of this study showed that HBO therapy can significantly improve the clinical treatment effect in patients with femoral head necrosis, and that this treatment approach is worthy of clinical application.

Zusammenfassung

Hintergrund

In vielen klinischen Studien wurde zwar der Nachweis erbracht, dass die hyperbare Sauerstofftherapie (HBO-Therapie) zur Behandlung der Femurkopfnekrose die klinischen Symptome und die Lebensqualität des Patienten signifikant verbessern kann, aber diese Schlussfolgerung ist bisher nicht systematisch untersucht worden. Daher wurde eine Metaanalyse durchgeführt, um die klinische Wirksamkeit der HBO-Therapie systematisch bei Femurkopfnekrose zu ermitteln.

Methoden

Dazu wurden die Datenbanken PubMed, Embase und Web of Science sowie die Literaturverzeichnisse relevanter Studien, die vor August 2016 publiziert worden waren, systematisch unter Verwendung von Schlagwörtern im Zusammenhang mit HBO-Therapie und Femurkopfnekrose durchsucht. Zur Berechnung des gepoolten Risikoverhältnisses (RR) und der 95%-Konfidenzintervalle (95%-KI) wurden Fixed-Effect- oder Random-Effect-Modelle eingesetzt. Verschiedene Subgruppenanalysen, Sensitivitätsanalysen und Test auf Publikationsbias wurden durchgeführt, um potenzielle Studienheterogenität und -bias zu untersuchen.

Ergebnisse

In die Auswertung wurden 9 Studien mit 305 Kontrollen und 318 Fällen mit HBO-Therapie eingeschlossen. Die klinische Wirksamkeit war in der Gruppe mit HBO-Therapie 4,95-mal höher als in der Kontrollgruppe (Odds Ratio, OR: 4,95; 95%-KI: 3,24–7,55; p < 0,00001), dieser Unterschied war statistisch signifikant. Gemäß den Prinzipien der Subgruppenanalyse wurde die Population unterteilt in eine asiatische und eine nichtasiatische Subpopulation. Die Subgruppenanalysen ergaben, dass die klinische Wirksamkeit in der HBO-Therapie-Gruppe 4,77-mal höher als in der Kontrollgruppe der asiatischen Subpopulation war (OR = 4,77, 95%-KI: 3,06–7,44; p < 0,00001) und 7,07-mal höher als die der Kontrollgruppe der nichtasiatischen Subpopulation (OR: 7,07; 95%-KI: 1,77–28,27; p < 0,00001).

Schlussfolgerung

Die Ergebnisse der vorliegenden Studie zeigen, dass eine HBO-Therapie die Wirksamkeit der klinischen Behandlung bei Patienten mit Femurkopfnekrose signifikant verbessern kann und dass dieser Behandlungsansatz es wert ist, klinisch eingesetzt zu werden.

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Acknowledgements

This work was supported by grants from the leading talents of science in Liaoning 2010 (022), the key discipline construction of evidence-based public health in Liaoning.

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Authors and Affiliations

  1. Zunyi Medical College, Guizhou, China

    Wei Li MD

  2. Affiliated Zhongshan Hospital of Dalian University, Dalian, China

    Wei Li MD, Wei Wang MD, Kun Wang MD & Dewei Zhao MD

  3. Department of Cardiovascular Medicine, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China

    Ziliang Ye MD & Lang Li PhD

  4. Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China

    Ziliang Ye MD & Lang Li PhD

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Correspondence to Dewei Zhao MD.

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Conflict of interest

W. Li , Z. Ye , W. Wang , K. Wang, L. Li, and D. Zhao declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors. Institutional review board approval and patient consent were not required for this meta-analysis of observational studies.

Additional information

Wei Wang and Ziliang Ye contributed equally to this work.

Wei Li, Ziliang Ye, and Wei Wang discussed and developed the question for this review; Wei Li and Ziliang Ye carried out the searches; Wei Li, Ziliang Ye, and Wei Wang assessed the eligibility of studies for inclusion, extracted data, and carried out all analyses. All authors were involved in interpretation and discussion of results. Kun Wang wrote the first draft of this paper and it was reviewed by Lang Li and Dewei Zhao. Lang Li and Dewei Zhao were involved in interpretation and discussion of results. All authors agreed on the final draft of this manuscript.

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Li, W., Ye, Z., Wang, W. et al. Clinical effect of hyperbaric oxygen therapy in the treatment of femoral head necrosis. Orthopäde 46, 440–446 (2017). https://doi.org/10.1007/s00132-016-3360-8

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