title: Clinical effect of hyperbaric oxygen therapy in the treatment of femoral head necrosis : A systematic review and meta-analysis.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Zunyi Medical College, Guizhou, China.|Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Cardiovascular Medicine, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China.|Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
authors.forename: Ziliang
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Medicine, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China.|Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
authors.forename: Lang
authors.initials: L
authors.lastname: Li
authors.affiliation: Affiliated Zhongshan Hospital of Dalian University, Dalian, China. 1115196377@qq.com.
authors.forename: Dewei
authors.initials: D
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D005271:Femur Head Necrosis / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000208:ethnology* / Q000517:prevention & control*; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D016896:Treatment Outcome; D055815:Young Adult
keywords: Asian; Bias; Bone; Microcirculation; Pain