Center for Evidence-Based Orthopaedics, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
J Bone Joint Surg Am. 2012 Feb 15;94(4):298-307. doi: 10.2106/JBJS.K.00154.
The recent emergence of autologous blood concentrates, such as platelet-rich plasma, as a treatment option for patients with orthopaedic injuries has led to an extensive debate about their clinical benefit. We conducted a systematic review and meta-analysis to determine the efficacy of autologous blood concentrates in decreasing pain and improving healing and function in patients with orthopaedic bone and soft-tissue injuries.
We searched MEDLINE and Embase for randomized controlled trials or prospective cohort studies that compared autologous blood concentrates with a control therapy in patients with an orthopaedic injury. We identified additional studies by searching through the bibliographies of eligible studies as well as the archives of orthopaedic conferences and meetings.
Twenty-three randomized trials and ten prospective cohort studies were identified. There was a lack of consistency in outcome measures across all studies. In six randomized controlled trials (n = 358) and three prospective cohort studies (n = 88), the authors reported visual analog scale (VAS) scores when comparing platelet-rich plasma with a control therapy across injuries to the acromion, rotator cuff, lateral humeral epicondyle, anterior cruciate ligament, patella, tibia, and spine. The use of platelet-rich plasma provided no significant benefit up to (and including) twenty-four months across the randomized trials (standardized mean difference, -0.34; 95% confidence interval [CI], -0.75 to 0.06) or the prospective cohort studies (standardized mean difference, -0.20; 95% CI, -0.64 to 0.23). Both point estimates suggested a small trend favoring platelet-rich plasma, but the associated wide confidence intervals were consistent with nonsignificant effects.
The current literature is complicated by a lack of standardization of study protocols, platelet-separation techniques, and outcome measures. As a result, there is uncertainty about the evidence to support the increasing clinical use of platelet-rich plasma and autologous blood concentrates as a treatment modality for orthopaedic bone and soft-tissue injuries.
自体血浓缩物（如富含血小板的血浆）作为骨科损伤患者的治疗选择最近出现，这引发了关于其临床益处的广泛争论。我们进行了系统评价和荟萃分析，以确定自体血浓缩物在减轻疼痛、改善骨科骨和软组织损伤患者的愈合和功能方面的疗效。
我们在 MEDLINE 和 Embase 中搜索了比较骨科损伤患者自体血浓缩物与对照治疗的随机对照试验或前瞻性队列研究。我们通过查阅合格研究的参考文献以及骨科会议和会议档案，确定了其他研究。
确定了 23 项随机试验和 10 项前瞻性队列研究。所有研究的结局指标均不一致。在 6 项随机对照试验（n = 358）和 3 项前瞻性队列研究（n = 88）中，作者报告了比较富含血小板的血浆与对照治疗在肩峰、肩袖、肱骨外上髁、前交叉韧带、髌骨、胫骨和脊柱损伤时的视觉模拟量表（VAS）评分。在随机试验（标准化均数差，-0.34；95%置信区间[CI]，-0.75 至 0.06）或前瞻性队列研究（标准化均数差，-0.20；95%CI，-0.64 至 0.23）中，富含血小板的血浆在长达（包括）24 个月的时间内没有提供显著益处。两个点估计都表明富含血小板的血浆略有优势，但相关的宽置信区间与无显著效果一致。
目前的文献受到研究方案、血小板分离技术和结局指标缺乏标准化的困扰。因此，对于支持将富含血小板的血浆和自体血浓缩物作为骨科骨和软组织损伤的治疗方法的临床应用证据存在不确定性。
