富血小板血浆在口腔外科中的应用：系统评价和荟萃分析。
The use of platelet-rich plasma in oral surgery: a systematic review and meta-analysis.
机构信息
Italian National Blood Centre, National Institute of Health, Rome, Italy.
Department of Haematology and Transfusion Medicine, "Carlo Poma" Hospital, Mantua, Italy.
出版信息
Blood Transfus. 2019 Sep;17(5):357-367. doi: 10.2450/2019.0177-19.
BACKGROUND
The aim of this systematic review and meta-analysis was to evaluate the benefit of platelet rich plasma (PRP) in oral surgery.
MATERIALS AND METHODS
We performed a systematic search of the literature. The GRADE system was used to assess the certainty of the body of evidence.
RESULTS
We found 21 randomised controlled trials that met our inclusion criteria: 12 studies included patients with periodontal defects, five studies focused on healing of extraction sockets, three studies on sinus lift augmentation, and one study on periapical osseous defects. However, for the quantitative synthesis (meta-analysis), we evaluated "periodontal defects" studies only, since for other clinical contexts the number of studies were too low and the procedural heterogeneity was too high to allow pooling of data. PRP-containing regimens were compared to non-PRP-containing regimens. Primary outcomes for the evaluation of periodontal defects were probing depths, clinical attachment level, gingival recession, and radiographic bone defect. It is not usually clear whether or not the use of PRP compared to controls affects "probing depth" at long-term follow up; the between group differences were small and unlikely to be of clinical importance (i.e., very low quality of evidence). For the other outcomes analysed ("clinical attachment levels", "gingival recession", "bony defect"), we observed a very slight marginal clinical benefit of PRP compared to controls. The available evidence for these comparisons was rated as low quality as most of the studies selected showed inconsistency, imprecision, and risk of bias.
DISCUSSION
Evidence from a comparison between the use in oral surgery of PRP-containing regimens compared to other regimens not-containing PRP was of low quality. The results of the meta-analysis, limited to studies in patients with periodontal defects, document that PRP was slightly more effective compared to controls not-containing PRP.
背景
本系统评价和荟萃分析的目的是评估富含血小板的血浆（PRP）在口腔手术中的益处。
材料和方法
我们进行了系统的文献检索。使用 GRADE 系统评估证据体的确定性。
结果
我们发现了 21 项符合纳入标准的随机对照试验：12 项研究包括牙周缺损患者，5 项研究专注于拔牙窝愈合，3 项研究用于鼻窦提升增强，1 项研究用于根尖周骨缺损。然而，对于定量综合（荟萃分析），我们仅评估了“牙周缺损”研究，因为对于其他临床情况，研究数量太少，程序异质性太高，无法对数据进行汇总。含 PRP 的方案与不含 PRP 的方案进行比较。评估牙周缺损的主要结局是探诊深度、临床附着水平、牙龈退缩和影像学骨缺损。通常不清楚与对照组相比，使用 PRP 是否会影响长期随访的“探诊深度”；组间差异较小，不太可能具有临床意义（即证据质量极低）。对于分析的其他结局（“临床附着水平”、“牙龈退缩”、“骨缺损”），我们观察到 PRP 与对照组相比具有非常轻微的边际临床优势。由于大多数选定的研究显示不一致性、不准确性和偏倚风险，因此对这些比较的证据质量评价为低质量。
讨论
将口腔手术中使用的含 PRP 方案与不含 PRP 的其他方案进行比较的证据质量较低。限于牙周缺损患者的研究的荟萃分析结果表明，PRP 与不含 PRP 的对照组相比，效果略好。
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