Ling Yan, Wang Shu
Department of Rehabilitation, Research Center of Sports Rehabilitation of Shandong Department of Rehabilitation, Shandong Sports Hospital, Jinan, China.
Medicine (Baltimore). 2018 Sep;97(37):e12110. doi: 10.1097/MD.0000000000012110.
Plantar fasciitis is a common cause of heel pain, which often results in significant morbidity. There have been several treatment options that are used for plantar fasciitis, including nonsteroidal anti-inflammatory drugs, orthoses, physical therapy, and steroid injections.
The aim of this meta-analysis was to compare the effects of platelet-rich plasma (PRP) and other treatments in patients with plantar fasciitis.
Medline, Web of Science, and Embase were systematically searched to identify relevant trials.
Randomized controlled trials (RCTs) that compared the effects of PRP and other treatments on plantar fasciitis were included.
The main outcomes included changes from baseline in visual analog scale (VAS) score, American Orthopaedic Foot and Ankle Society Score (AOFAS), and Roles-Maudsley score (RMS). Results were expressed as weight mean difference (WMD) with 95% confidence interval (95% CI). The meta-analysis was performed using a fixed-effects or random-effects model according to heterogeneity.
Ten RCTs involving a total of 445 patients with plantar fasciitis were included. Among these studies, 9 compared PRP with steroid, and 1 compared PRP with whole blood.Four studies were categorized as being at low risk of bias, and the remaining 6 as being at unclear risk of bias.Pooled estimates suggested that PRP had greater changes in VAS and AOFAS scores than other treatments. However, it had no benefit effect in the RMS.Subgroup analysis for VAS and AOFAS showed that PRP had superior effect than other treatments at 12 months, but not at the 1, 3, 6 months.Subgroup analysis based on treatment regimens demonstrated that PRP was more effective than steroid in the change from baseline in AOFAS, but not in VAS and RMS scores.
AUTHORS' CONCLUSION: PRP was as effective as other treatments in reducing pain and improving function in patients with plantar fasciitis. Subgroup analysis indicated that PRP had better effect than steroid in AOFAS Score and its effect was durable in a long term. However, considering the potential limitations in this study, more large-scale RCTs are needed to confirm the current findings.
足底筋膜炎是足跟痛的常见原因，常导致明显的发病率。目前有多种治疗足底筋膜炎的方法，包括非甾体类抗炎药、矫形器、物理治疗和类固醇注射。
本荟萃分析的目的是比较富血小板血浆（PRP）与其他治疗方法对足底筋膜炎患者的疗效。
系统检索了Medline、科学网和Embase以识别相关试验。
纳入比较PRP与其他治疗方法对足底筋膜炎疗效的随机对照试验（RCT）。
主要结局包括视觉模拟量表（VAS）评分、美国矫形足踝协会评分（AOFAS）和罗尔斯-莫兹利评分（RMS）相对于基线的变化。结果以加权均数差（WMD）及95%置信区间（95%CI）表示。根据异质性采用固定效应或随机效应模型进行荟萃分析。
纳入了10项共涉及445例足底筋膜炎患者的RCT。在这些研究中，9项比较了PRP与类固醇，1项比较了PRP与全血。4项研究被归类为低偏倚风险，其余6项为偏倚风险不明确。汇总估计表明，PRP在VAS和AOFAS评分上的变化大于其他治疗方法。然而，在RMS方面没有有益效果。VAS和AOFAS的亚组分析表明，PRP在12个月时比其他治疗方法效果更好，但在1、3、6个月时并非如此。基于治疗方案的亚组分析表明，PRP在AOFAS相对于基线的变化方面比类固醇更有效，但在VAS和RMS评分方面并非如此。
PRP在减轻足底筋膜炎患者疼痛和改善功能方面与其他治疗方法效果相当。亚组分析表明，PRP在AOFAS评分方面比类固醇效果更好，且其效果长期持久。然而，考虑到本研究的潜在局限性，需要更多大规模的RCT来证实目前的研究结果。
