Muchedzi Tendai Aswad, Roberts Simon B
Trauma and Orthopaedics, Bundaberg Base Hospital, Queensland, Australia.
Trauma and Orthopaedics, University of Edinburgh, South Eastern Scotland Deanery, UK.
Surgeon. 2018 Aug;16(4):250-258. doi: 10.1016/j.surge.2017.08.004. Epub 2017 Sep 22.
Platelet rich plasma (PRP) has been suggested to be effective in the management of knee osteoarthritis. Review of current literature reveals conflicting evidence regarding the benefits of PRP in treating knee OA. Preclinical evidence supports the use of PRP injections to promote a favorable environment for joint tissue healing, targeting not only cartilage but also synovial and meniscal tissues which has a positive effect on delaying the progression of OA. Growth factors found in platelet granules are postulated to influence outcomes in knee OA and after total knee arthroplasty (TKA).
A systematic review of studies investigating the use of PRP in knee osteoarthritis and following TKA, was performed by searching the following databases for randomised clinical trials and pseudo-randomised clinical and comparative trials comparing the use of PRP to treat knee osteoarthritis and following TKA: MedLine, EMBASE, Science Direct, PubMed, and the Cochrane Library. The primary outcomes were patient reported measures including pain (visual analog scale (VAS)), quality of life scores, and knee function.
A total of 2328 participants were analyzed across 17 included studies and pooled results showed a statistically significant reduction in pain in favor of PRP following TKA but not in non-surgical management of knee OA (P < 0.0001 and 0.13 respectively). No clinical benefit of PRP was found on quality of life and knee function (P = 0.07 and 0.05) following TKA, although a statistical improvement in knee function was demonstrated in patients with knee OA after PRP injection (P < 0.0001). There was no statistically significant clinical benefit of PRP on secondary outcomes including wound scores and length of hospital stay (p = 0.33 and 0.31, respectively). There was no statistically significant difference in respect to blood loss and overall symptoms in favor of PRP compared to control group following TKA (p = 0.37).
This systematic review demonstrated no long-term statistically significant improvement in patient validated outcomes and secondary outcomes both in patients with knee OA or following TKA for OA. However PRP has been shown to have short to medium-term benefits in pain control after TKA and activities of daily living in patients with OA.
富血小板血浆（PRP）已被认为在膝关节骨关节炎的治疗中有效。对当前文献的回顾显示，关于PRP治疗膝关节骨关节炎的益处存在相互矛盾的证据。临床前证据支持使用PRP注射来促进关节组织愈合的有利环境，其不仅针对软骨，还针对滑膜和半月板组织，这对延缓骨关节炎的进展具有积极作用。血小板颗粒中发现的生长因子被认为会影响膝关节骨关节炎和全膝关节置换术（TKA）后的治疗效果。
通过在以下数据库中搜索比较使用PRP治疗膝关节骨关节炎及TKA后的随机临床试验、伪随机临床试验和对照试验，对研究PRP在膝关节骨关节炎及TKA中的应用进行了系统评价：医学在线数据库（MedLine）、荷兰医学文摘数据库（EMBASE）、科学Direct数据库、PubMed数据库和考克兰图书馆。主要结局是患者报告的指标，包括疼痛（视觉模拟评分法（VAS））、生活质量评分和膝关节功能。
在纳入的17项研究中，共分析了2328名参与者，汇总结果显示，TKA后PRP组疼痛有统计学意义的显著减轻，但在膝关节骨关节炎的非手术治疗中无此效果（分别为P < 0.0001和0.13）。TKA后，未发现PRP对生活质量和膝关节功能有临床益处（P = 0.07和0.05），尽管PRP注射后膝关节骨关节炎患者的膝关节功能有统计学意义的改善（P < 0.0001）。PRP对包括伤口评分和住院时间在内的次要结局无统计学意义的临床益处（分别为p = 0.33和0.31）。与TKA后的对照组相比，PRP组在失血和总体症状方面无统计学意义的显著差异（p = 0.37）。
该系统评价表明，无论是膝关节骨关节炎患者还是OA患者TKA后，患者验证的结局和次要结局在长期均无统计学意义的显著改善。然而，PRP已被证明在TKA后的疼痛控制和OA患者的日常生活活动方面具有短期至中期益处。
