Department of Sports Medicine, The Hague Medical Centre Antoniushove, Leidschendam, The Netherlands.
Br Med Bull. 2010;95:63-77. doi: 10.1093/bmb/ldq006. Epub 2010 Mar 2.
Chronic degenerative tendinopathies are frequent and difficult to treat. Tendon healing and regeneration may be improved by injecting autologous growth factors obtained from the patient's blood. Autologous growth factors can be injected with autologous whole blood or platelet-rich plasma (PRP). Electronic databases were searched for prospective clinical trials on treatment with autologous growth factors of patients with chronic tendinopathy. Chronic tendinopathy in this study included wrist extensors, flexors, plantar fasciopathy and patellar tendinopathy. Studies examining the treatment of other tendinopathies were not identified. The Physiotherapy Evidence Database score was used to examine the methodological quality of the assessment, and a qualitative analysis was performed with the levels of evidence. There are many proposed treatment options for chronic tendinopathy. Treatments in the form of injections with autologous whole blood or PRP are increasingly used in clinical practice. There are high expectations of these regenerative injections, and there is a clear need for effective conservative therapies. All studies showed that injections of autologous growth factors (whole blood and PRP) in patients with chronic tendinopathy had a significant impact on improving pain and/or function over time. However, only three studies using autologous whole blood had a high methodological quality assessment, and none of them showed any benefit of an autologous growth factor injection when compared with a control group. At present, there is strong evidence that the use of injections with autologous whole blood should not be recommended. There were no high-quality studies found on PRP treatment. There is limited evidence to support the use of injections with PRP in the management of chronic tendinopathy. There is growing interest in the working mechanisms of autologous growth factors. The amount and mixture of growth factors produced using different cell separating systems are largely unknown and it is also uncertain whether platelet activation prior to injection is necessary. These variables should be taken into account when starting clinical studies. A good experimental model for studying tendinopathy would be helpful for basic research. Future clinical studies using a proper control group, randomization, blinding and validated disease-specific outcome measures for pain and function are needed.
慢性退行性肌腱病较为常见且难以治疗。通过向患者自身血液中提取的自体生长因子注射,可以改善肌腱的愈合和再生。自体生长因子可与自体全血或富含血小板的血浆(PRP)一起注射。检索电子数据库以查找关于慢性肌腱病患者自体生长因子治疗的前瞻性临床试验。本研究中的慢性肌腱病包括腕伸肌、屈肌、足底筋膜炎和髌腱病。未发现检查其他肌腱病治疗的研究。使用物理治疗证据数据库评分检查评估的方法学质量,并使用证据水平进行定性分析。慢性肌腱病有许多治疗方法。越来越多的临床实践中使用自体全血或 PRP 注射的治疗方法。这些再生注射受到高度期待,但显然需要有效的保守治疗。所有研究都表明,慢性肌腱病患者自体生长因子(全血和 PRP)注射随着时间的推移对改善疼痛和/或功能具有显著影响。但是,只有三项使用自体全血的研究具有较高的方法学质量评估,并且与对照组相比,没有一项研究显示自体生长因子注射有任何益处。目前,有强有力的证据表明,不应推荐使用自体全血注射。没有发现关于 PRP 治疗的高质量研究。有有限的证据支持在慢性肌腱病管理中使用 PRP 注射。自体生长因子的作用机制引起了广泛关注。使用不同细胞分离系统产生的生长因子的数量和混合物在很大程度上是未知的,并且在注射前是否需要血小板激活也不确定。在开始临床研究时应考虑这些变量。一个良好的用于研究肌腱病的实验模型将有助于基础研究。需要进行未来的临床研究,使用适当的对照组、随机化、盲法和验证疾病特异性疼痛和功能结局测量。
Br Med Bull. 2010-3-2
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