血小板浓缩物对人膝关节前交叉韧带重建中移植物成熟和移植物-骨界面愈合的影响：对照试验的系统评价。
The effect of platelet concentrates on graft maturation and graft-bone interface healing in anterior cruciate ligament reconstruction in human patients: a systematic review of controlled trials.
机构信息
Sports Medicine Research Laboratory, Department of Orthopedic Surgery, Children's Hospital Boston, Harvard Medical School, Cambridge, Massachusetts 02115, USA.
出版信息
Arthroscopy. 2011 Nov;27(11):1573-83. doi: 10.1016/j.arthro.2011.06.003. Epub 2011 Aug 20.
PURPOSE
To systematically review the current evidence for the effects of platelet concentrates on (1) graft maturation and (2) graft-bone interface healing in anterior cruciate ligament (ACL) reconstruction in human, controlled trials and for ensuing differences in clinical outcomes.
METHODS
A systematic search of PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews was performed for controlled trials of human ACL reconstruction with and without platelet concentrates. Data validity was assessed, and data were collected on graft maturation, graft-bone interface healing, and clinical outcome.
RESULTS
Eight studies met the inclusion criteria. Seven studies reported on graft maturation with significantly better outcomes in the platelet groups in 4, and there were large differences in means in an additional 2 studies. Five studies reported on tunnel healing, and 4 found no difference between groups. Three studies assessed clinical outcome but found no differences, regardless of whether they had shown a beneficial effect (1 of 3) or no effect (2 of 3) of platelets on graft and tunnel healing.
CONCLUSIONS
The current best evidence suggests that the addition of platelet concentrates to ACL reconstruction may have a beneficial effect on graft maturation and could improve it by 20% to 30% on average, but with substantial variability. The most likely mode of action is that treatment with platelets accelerates graft repopulation and remodeling, and this interpretation is supported by the existing data and is biologically plausible. However, the current evidence also shows only a very limited influence of platelet concentrates on graft-bone interface healing and no significant difference in clinical outcomes.
LEVEL OF EVIDENCE
Level III, systematic review of Level I, II, and III studies.
目的
系统评价目前关于富血小板浓缩物对（1）移植物成熟和（2）前交叉韧带（ACL）重建中移植物-骨界面愈合的影响的证据，包括人类对照试验，以及随后在临床结果方面的差异。
方法
对PubMed、CINAHL（护理与联合健康文献累积索引）、Embase、Cochrane 对照试验中心注册库和 Cochrane 系统评价数据库进行了系统检索，检索内容为使用和不使用富血小板浓缩物的 ACL 重建的人类对照试验。评估数据有效性，并收集移植物成熟、移植物-骨界面愈合和临床结果的数据。
结果
8 项研究符合纳入标准。7 项研究报告了移植物成熟情况，其中血小板组的结果明显更好，有 2 项研究的均值差异较大。5 项研究报告了隧道愈合情况，4 项研究发现组间无差异。3 项研究评估了临床结果，但无论是否显示血小板对移植物和隧道愈合有有益作用（3 项中的 1 项）或无作用（3 项中的 2 项），均未发现差异。
结论
目前的最佳证据表明，在 ACL 重建中添加富血小板浓缩物可能对移植物成熟有有益影响，平均可提高 20%至 30%，但具有很大的可变性。最有可能的作用机制是血小板治疗加速移植物再定植和重塑，这一解释得到了现有数据的支持，并且在生物学上是合理的。然而，目前的证据也仅显示富血小板浓缩物对移植物-骨界面愈合的影响非常有限，对临床结果也没有显著影响。
证据等级
三级，对一级、二级和三级研究的系统评价。
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