富血小板血浆治疗膝骨关节炎时对疼痛和身体功能的时间效应：随机对照试验的系统评价和荟萃分析

The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials.

作者信息

Shen Longxiang, Yuan Ting, Chen Shengbao, Xie Xuetao, Zhang Changqing

机构信息

Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital affiliated to Shanghai Jiaotong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China.

Section of Clinical Epidemiology, Institute of Orthopaedic Traumatology affiliated to Shanghai Jiaotong University, 600 Yishan Road, Shanghai, 200233, China.

出版信息

J Orthop Surg Res. 2017 Jan 23;12(1):16. doi: 10.1186/s13018-017-0521-3.

BACKGROUND

Quite a few randomized controlled trials (RCTs) investigating the efficacy of platelet-rich plasma (PRP) for treatment of knee osteoarthritis (OA) have been recently published. Therefore, an updated systematic review was performed to evaluate the temporal effect of PRP on knee pain and physical function.

METHODS

Pubmed, Embase, Cochrane library, and Scopus were searched for human RCTs comparing the efficacy and/or safety of PRP infiltration with other intra-articular injections. A descriptive summary and quality assessment were performed for all the studies finally included for analysis. For studies reporting outcomes concerning Western Ontario and McMaster Universities Arthritis Index (WOMAC) or adverse events, a random-effects model was used for data synthesis.

RESULTS

Fourteen RCTs comprising 1423 participants were included. The control included saline placebo, HA, ozone, and corticosteroids. The follow-up ranged from 12 weeks to 12 months. Risk of bias assessment showed that 4 studies were considered as moderate risk of bias and 10 as high risk of bias. Compared with control, PRP injections significantly reduced WOMAC pain subscores at 3, 6, and 12 months follow-up (p = 0.02, 0.004, <0.001, respectively); PRP significantly improved WOMAC physical function subscores at 3, 6, and 12 months (p = 0.002, 0.01, <0.001, respectively); PRP also significantly improved total WOMAC scores at 3, 6 and 12 months (all p < 0.001); nonetheless, PRP did not significantly increased the risk of post-injection adverse events (RR, 1.40 [95% CI, 0.80 to 2.45], I = 59%, p = 0.24).

CONCLUSIONS

Intra-articular PRP injections probably are more efficacious in the treatment of knee OA in terms of pain relief and self-reported function improvement at 3, 6 and 12 months follow-up, compared with other injections, including saline placebo, HA, ozone, and corticosteroids.

REVIEW REGISTRATION

PROSPERO CRD42016045410 . Registered 8 August 2016.

背景

最近发表了不少关于富血小板血浆（PRP）治疗膝关节骨关节炎（OA）疗效的随机对照试验（RCT）。因此，进行了一项更新的系统评价，以评估PRP对膝关节疼痛和身体功能的短期影响。

方法

检索Pubmed、Embase、Cochrane图书馆和Scopus，查找比较PRP注射与其他关节内注射的疗效和/或安全性的人体RCT。对最终纳入分析的所有研究进行描述性总结和质量评估。对于报告有关西安大略和麦克马斯特大学关节炎指数（WOMAC）结果或不良事件的研究，采用随机效应模型进行数据合成。

结果

纳入了14项RCT，共1423名参与者。对照包括生理盐水安慰剂、透明质酸（HA）、臭氧和皮质类固醇。随访时间为12周-12个月。偏倚风险评估显示，4项研究被认为偏倚风险为中度，10项为高度。与对照相比，PRP注射在随访3、6和12个月时显著降低了WOMAC疼痛亚评分（p分别为0.02、0.004、<0.001）；PRP在3、6和12个月时显著改善了WOMAC身体功能亚评分（p分别为0.002、0.01、<0.001）；PRP在3、6和12个月时也显著改善了WOMAC总分（所有p<0.001）；尽管如此，PRP并未显著增加注射后不良事件的风险（RR，1.40[95%CI，0.80至2.45]，I² = 59%，p = 0.24）。