Arirachakaran Alisara, Sukthuayat Amnat, Sisayanarane Thaworn, Laoratanavoraphong Sorawut, Kanchanatawan Wichan, Kongtharvonskul Jatupon
Orthopedics Department, Police General Hospital, Bangkok, Thailand.
Orthopedics Department, Lerdsin General Hospital, Bangkok, Thailand.
J Orthop Traumatol. 2016 Jun;17(2):101-12. doi: 10.1007/s10195-015-0376-5. Epub 2015 Sep 11.
Clinical outcomes between the use of platelet-rich plasma (PRP), autologous blood (AB) and corticosteroid (CS) injection in lateral epicondylitis are still controversial.
A systematic review and network meta-analysis of randomized controlled trials was conducted with the aim of comparing relevant clinical outcomes between the use of PRP, AB and CS injection. Medline and Scopus databases were searched from inception to January 2015. A network meta-analysis was performed by applying weight regression for continuous outcomes and a mixed-effect Poisson regression for dichotomous outcomes.
Ten of 374 identified studies were eligible. When compared to CS, AB injection showed significantly improved effects with unstandardized mean differences (UMD) in pain visual analog scale (VAS), Disabilities of Arm Shoulder and Hand (DASH), Patient-Related Tennis Elbow Evaluation (PRTEE) score and pressure pain threshold (PPT) of -2.5 (95 % confidence interval, -3.5, -1.5), -25.5 (-33.8, -17.2), -5.3 (-9.1, -1.6) and 9.9 (5.6, 14.2), respectively. PRP injections also showed significantly improved VAS and DASH scores when compared with CS. PRP showed significantly better VAS with UMD when compared to AB injection. AB injection has a higher risk of adverse effects, with a relative risk of 1.78 (1.00, 3.17), when compared to CS. The network meta-analysis suggested no statistically significant difference in multiple active treatment comparisons of VAS, DASH and PRTEE when comparing PRP and AB injections. However, AB injection had improved DASH score and PPT when compared with PRP injection. In terms of adverse effects, AB injection had a higher risk than PRP injection.
This network meta-analysis provided additional information that PRP injection can improve pain and lower the risk of complications, whereas AB injection can improve pain, disabilities scores and pressure pain threshold but has a higher risk of complications.
Level I evidence.
在肱骨外上髁炎中，使用富血小板血浆（PRP）、自体血（AB）和皮质类固醇（CS）注射的临床疗效仍存在争议。
进行了一项随机对照试验的系统评价和网状Meta分析，目的是比较使用PRP、AB和CS注射的相关临床疗效。检索了Medline和Scopus数据库从创建到2015年1月的文献。通过对连续结局应用加权回归和对二分结局应用混合效应泊松回归进行网状Meta分析。
在374项已识别的研究中，有10项符合条件。与CS相比，AB注射在疼痛视觉模拟量表（VAS）、手臂肩部和手部功能障碍（DASH）、患者相关网球肘评估（PRTEE）评分和压痛阈值（PPT）方面的未标准化平均差异（UMD）显示出显著改善，分别为-2.5（95%置信区间，-3.5，-1.5）、-25.5（-33.8，-17.2）、-5.3（-9.1，-1.6）和9.9（5.6，14.2）。与CS相比，PRP注射在VAS和DASH评分方面也显示出显著改善。与AB注射相比，PRP在VAS方面的UMD显著更好。与CS相比，AB注射的不良反应风险更高，相对风险为1.78（1.00，3.17）。网状Meta分析表明，在比较PRP和AB注射时，VAS、DASH和PRTEE的多种积极治疗比较中无统计学显著差异。然而，与PRP注射相比，AB注射的DASH评分和PPT有所改善。在不良反应方面，AB注射的风险高于PRP注射。
这项网状Meta分析提供了额外信息，即PRP注射可改善疼痛并降低并发症风险，而AB注射可改善疼痛、残疾评分和压痛阈值，但并发症风险更高。
I级证据。
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