From the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan (Y-JC, Y-CW, J-WC, W-CT, T-YY); Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (Y-KT); College of Medicine, Chang Gung University, Taoyuan City, Taiwan (J-WC, W-CT, T-YY); and Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan (T-YY).
Am J Phys Med Rehabil. 2019 May;98(5):343-352. doi: 10.1097/PHM.0000000000001070.
This review article evaluated the efficacy of autologous blood-derived products, including whole blood and platelet-rich plasma, in reducing pain and improving function compared with corticosteroids for plantar fasciopathy patients.
Literature comparing autologous blood-derived product and corticosteroids for the treatment of plantar fasciopathy was systematically reviewed. Twelve randomized controlled trials and four quasi-experimental studies were included. The visual analog scale pain score and American Orthopedic Foot and Ankle Society hindfoot score were evaluated at 1.5, 3, and 6 mos' follow-up. Subgroup analyses were performed concerning platelet-rich plasma preparation techniques, injection regiments, and study designs.
Corticosteroids were found to reduce pain more effectively than whole blood at 1.5 and 3 mos, but the effect disappeared at 6 mos. Platelet-rich plasma reduced pain more effectively at 6 mos' postinjection than corticosteroids. However, there was no significant difference in the American Orthopedic Foot and Ankle Society score between platelet-rich plasma and corticosteroids injections at any time point. In the subgroup analyses, pain was significantly reduced at 6 mos by self-prepared platelet-rich plasma, one-step separation platelet-rich plasma, platelet-rich plasma of more than 3 ml, and platelet-rich plasma without local analgesics.
The results of this meta-analysis suggest that platelet-rich plasma may provide a long-term effect in relieving pain in plantar fasciopathy patients.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Compare the efficacy of whole blood (WB), platelet-rich plasma (PRP), and corticosteroid (CS) in short-term pain reduction in patients with plantar fasciopathy (PF); (2) Compare the efficacy of WB, PRP, and CS in long-term pain reduction in patients with PF; (3) Identify the potential complication of corticosteroid injection for plantar fasciopathy; and (4) Identify the components of whole blood that might influence the growth factors in healing process.
Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
本文通过系统评价，评估包括全血和富含血小板血浆在内的自体血源性产品相较于皮质类固醇治疗足底筋膜炎患者在减轻疼痛和改善功能方面的疗效。
本文比较了自体血源性产品与皮质类固醇治疗足底筋膜炎的相关文献，纳入了 12 项随机对照试验和 4 项准实验研究。在 1.5、3 和 6 个月的随访中，评估视觉模拟评分和美国矫形足踝协会后足评分。还进行了亚组分析，包括富含血小板血浆的制备技术、注射方案和研究设计。
在 1.5 和 3 个月时，皮质类固醇比全血更有效地减轻疼痛，但在 6 个月时效果消失。在注射后 6 个月时，富含血小板血浆比皮质类固醇更有效地减轻疼痛。然而，在任何时间点，富含血小板血浆和皮质类固醇注射之间的美国矫形足踝协会评分均无显著差异。在亚组分析中，自我制备的富含血小板血浆、一步分离的富含血小板血浆、超过 3ml 的富含血小板血浆和不含局部镇痛药的富含血小板血浆在 6 个月时均能显著减轻疼痛。
这项荟萃分析的结果表明，富含血小板血浆可能为足底筋膜炎患者缓解疼痛提供长期效果。
索取 CME 学分：在线完成自我评估活动和评估，网址为 http://www.physiatry.org/JournalCME。CME 目标：完成本文后，读者应能够：（1）比较全血（WB）、富含血小板血浆（PRP）和皮质类固醇（CS）在减轻足底筋膜炎（PF）患者短期疼痛方面的疗效；（2）比较 WB、PRP 和 CS 在减轻 PF 患者长期疼痛方面的疗效；（3）确定皮质类固醇注射治疗足底筋膜炎的潜在并发症；（4）确定影响愈合过程中生长因子的全血成分。
高级
学术物理治疗协会（Association of Academic Physiatrists）经继续医学教育认证委员会（Accreditation Council for Continuing Medical Education）认证，可为医生提供继续医学教育。学术物理治疗协会将这项基于期刊的 CME 活动最多指定为 1.0 项 AMA PRA 类别 1 学分。医生应仅声明与其参与活动程度相符的学分。
