University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada.
Arthroscopy. 2013 Dec;29(12):2037-48. doi: 10.1016/j.arthro.2013.09.006.
The purpose of this systematic review was to synthesize the available Level I and Level II literature on platelet-rich plasma (PRP) as a therapeutic intervention in the management of symptomatic knee osteoarthritis (OA).
A systematic review of Medline, Embase, Cochrane Central Register of Controlled Trials, PubMed, and www.clinicaltrials.gov was performed to identify all randomized controlled trials and prospective cohort studies that evaluated the clinical efficacy of PRP versus a control injection for knee OA. A random-effects model was used to evaluate the therapeutic effect of PRP at 24 weeks by use of validated outcome measures (Western Ontario and McMaster Universities Arthritis Index, visual analog scale for pain, International Knee Documentation Committee Subjective Knee Evaluation Form, and overall patient satisfaction).
Six Level I and II studies satisfied our inclusion criteria (4 randomized controlled trials and 2 prospective nonrandomized studies). A total of 577 patients were included, with 264 patients (45.8%) in the treatment group (PRP) and 313 patients (54.2%) in the control group (hyaluronic acid [HA] or normal saline solution [NS]). The mean age of patients receiving PRP was 56.1 years (51.5% male patients) compared with 57.1 years (49.5% male patients) for the group receiving HA or NS. Pooled results using the Western Ontario and McMaster Universities Arthritis Index scale (4 studies) showed that PRP was significantly better than HA or NS injections (mean difference, -18.0 [95% confidence interval, -28.8 to -8.3]; P < .001). Similarly, the International Knee Documentation Committee scores (3 studies) favored PRP as a treatment modality (mean difference, 7.9 [95% confidence interval, 3.7 to 12.1]; P < .001). There was no difference in the pooled results for visual analog scale score or overall patient satisfaction. Adverse events occurred more frequently in patients treated with PRP than in those treated with HA/placebo (8.4% v 3.8%, P = .002).
As compared with HA or NS injection, multiple sequential intra-articular PRP injections may have beneficial effects in the treatment of adult patients with mild to moderate knee OA at approximately 6 months. There appears to be an increased incidence of nonspecific adverse events among patients treated with PRP.
Level II, systematic review of Level I and II studies.
本系统评价的目的是综合现有关于富血小板血浆（PRP）作为治疗药物干预手段治疗症状性膝骨关节炎（OA）的 I 级和 II 级文献。
对 Medline、Embase、Cochrane 中央对照试验注册库、PubMed 和 www.clinicaltrials.gov 进行系统检索，以确定所有评估 PRP 与 OA 对照注射治疗效果的随机对照试验和前瞻性队列研究。采用随机效应模型，使用经过验证的结局测量指标（西安大略和麦克马斯特大学关节炎指数、疼痛视觉模拟评分、国际膝关节文献委员会主观膝关节评估表和整体患者满意度）评估 24 周时 PRP 的治疗效果。
6 项 I 级和 II 级研究符合纳入标准（4 项随机对照试验和 2 项前瞻性非随机研究）。共纳入 577 例患者，其中 264 例（45.8%）患者接受 PRP 治疗，313 例（54.2%）患者接受透明质酸（HA）或生理盐水（NS）治疗。接受 PRP 治疗的患者平均年龄为 56.1 岁（51.5%为男性），而接受 HA 或 NS 治疗的患者平均年龄为 57.1 岁（49.5%为男性）。使用西安大略和麦克马斯特大学关节炎指数量表（4 项研究）进行的汇总结果显示，PRP 明显优于 HA 或 NS 注射（平均差异，-18.0 [95%置信区间，-28.8 至-8.3]；P <.001）。同样，国际膝关节文献委员会评分（3 项研究）也支持 PRP 作为一种治疗方式（平均差异，7.9 [95%置信区间，3.7 至 12.1]；P <.001）。在汇总的视觉模拟评分或整体患者满意度结果中没有差异。与接受 HA/安慰剂治疗的患者相比，接受 PRP 治疗的患者不良反应更常见（8.4%比 3.8%，P =.002）。
与 HA 或 NS 注射相比，多次关节内序贯 PRP 注射可能在大约 6 个月时对轻至中度膝骨关节炎的成年患者具有有益的治疗效果。接受 PRP 治疗的患者中，非特异性不良反应的发生率似乎更高。
II 级，对 I 级和 II 级研究的系统评价。
