Extracellular vesicles (EVs), have been utilised for the diagnosis and treatment of osteonecrosis of femoral head (ONFH). Hence, we aimed to review the available evidence on the potential roles of EVs in ONFH systematically. The PubMed, EMBASE, and Science Citation Index databases were searched exhaustively from inception to June 2020. All in vitro and in vivo studies on the use of EVs in ONFH diagnosis and treatment were included. The final analysis included 14 studies. These studies were categorised according to the cell source, target cell types, secreted product types, production method, storage, and study design. The animal model, together with the ONFH induction method, used in the in vivo studies was also considered. For in vivo studies, effects on cellular proliferation and apoptosis and bone and vascular tissues and biomarkers for ONFH diagnosis were assessed, whereas in the in vitro studies, effects on EVs internalization; proliferation, viability, and migration; osteogenic and adipogenic differentiation; apoptosis; and angiogenesis were evaluated. Both in vitro and in vivo studies showed promoting effects of EVs on proliferation, osteogenic differentiation, and angiogenesis and inhibitory effects on apoptosis and adipogenic differentiation in both glucocorticoid-induced and traumatic ONFH models. Additionally, EVs in blood showed diagnostic potential for ONFH. This systemic review provides a deeper understanding of the role of EVs, thereby facilitating the development of novel therapeutic strategies.

细胞外囊泡（EVs）已被用于股骨头坏死（ONFH）的诊断和治疗。因此，我们旨在系统地审查有关电动汽车在ONFH中潜在作用的现有证据。从开始到2020年6月，对PubMed，EMBASE和《科学引文索引》数据库进行了详尽的搜索。包括了所有在EVF诊断和治疗中使用EV的体外和体内研究。最终分析包括14个研究。这些研究根据细胞来源，靶细胞类型，分泌产物类型，生产方法，贮藏和研究设计进行了分类。还考虑了在体内研究中使用的动物模型以及ONFH诱导方法。对于体内研究评估了对ONFH诊断的细胞增殖和凋亡以及骨和血管组织以及生物标记物的影响，而在体外研究中，评估了对电动汽车内在化的影响；扩散，生存能力和迁移；成骨和成脂分化；细胞凋亡 和血管生成进行了评估。二者在体外和体内研究表明，在糖皮质激素诱导和创伤性ONFH模型中，电动汽车均具有促进增殖，成骨分化和血管生成的作用，以及对细胞凋亡和成脂分化的抑制作用。此外，血液中的电动汽车对ONFH具有诊断潜力。这项系统的综述使人们对电动汽车的作用有了更深入的了解，从而促进了新型治疗策略的发展。