富血小板血浆治疗距骨骨软骨损伤：临床试验的系统评价
Platelet rich plasma for treatment of osteochondral lesions of the talus: A systematic review of clinical trials.
作者信息
Yausep Oliver Emmanuel, Madhi Imad, Trigkilidas Dionysios
机构信息
University of Indonesia, Jakarta, Indonesia.
Orthopedic Division, South Tyneside District Hospital, South Shields, United Kingdom.
出版信息
J Orthop. 2020 Jan 30;18:218-225. doi: 10.1016/j.jor.2020.01.046. eCollection 2020 Mar-Apr.
BACKGROUND
The ankle is the second most frequent site, following the knee, that requires cartilage repair. Osteochondral lesion of the talus (OLT) is common among athletes and is a result of talar cartilage detachment with or without subchondral bone fragmentation after a traumatic event. Treatment strategies for OLT can be classified as reparative or replacement interventions, with the former taking precedence. Recent studies show that the growth factors and bioactive components in platelet rich plasma (PRP) could improve cartilage regeneration. The prospect of using autologous blood to obtain a product that could enhance regeneration in damaged cartilage has been regarded as innovative, as it could circumvent the need for a replacement, and potentially join the ranks of first line reparative interventions against cartilage diseases.
METHODS
Literature searches were performed across seven search engines for randomized controlled trials using PRP to treat patients with OLT. Outcomes extracted included ankle function and pain measures. Level of evidence and methodological quality were evaluated using relevant guidelines.
RESULTS
Four studies met the eligibility criteria and were systematically appraised. Two studies scored Level 1 and 2 scored Level 2 based on the LOE assessment. MQOE evaluation revealed one study with excellent quality, and three with good quality. Overall results showed that PRP, as an adjunct to microfracture surgery, significantly improved function and reduced pain compared to microfracture surgery alone. Intra-articular PRP injection also demonstrated significantly enhanced recovery of function, and decreased pain scores compared to HA.
CONCLUSION
PRP improves joint function, and reduces pain in patients with OLT regardless of the method of implementation. In addition, inter-study comparison demonstrated that patients that received surgery along with PRP injections improved more than those that received PRP only. The studies that corroborate this conclusion have high levels of evidence with satisfactory methodological quality.
LEVEL OF EVIDENCE
Level 2, systematic review of Level 1 and 2 studies.
背景
踝关节是继膝关节之后第二常见的需要进行软骨修复的部位。距骨骨软骨损伤（OLT）在运动员中很常见，是创伤事件后距骨软骨脱离伴或不伴软骨下骨碎片的结果。OLT的治疗策略可分为修复性或置换性干预，前者优先。最近的研究表明，富血小板血浆（PRP）中的生长因子和生物活性成分可以促进软骨再生。利用自体血液获得一种能够增强受损软骨再生的产品的前景被认为是创新性的，因为它可以避免置换的需要，并有可能跻身治疗软骨疾病的一线修复性干预措施之列。
方法
在七个搜索引擎中进行文献检索，以查找使用PRP治疗OLT患者的随机对照试验。提取的结果包括踝关节功能和疼痛测量。使用相关指南评估证据水平和方法学质量。
结果
四项研究符合纳入标准并进行了系统评价。根据证据水平（LOE）评估，两项研究得分为1级，两项得分为2级。方法学质量评估（MQOE）显示，一项研究质量优秀，三项质量良好。总体结果表明，与单纯微骨折手术相比，PRP作为微骨折手术的辅助手段，显著改善了功能并减轻了疼痛。与透明质酸（HA）相比，关节内注射PRP也显著增强了功能恢复，并降低了疼痛评分。
结论
无论采用何种实施方法，PRP均可改善OLT患者的关节功能并减轻疼痛。此外，研究间比较表明，接受手术联合PRP注射的患者比仅接受PRP治疗的患者改善更多。证实这一结论的研究具有较高的证据水平和令人满意的方法学质量。
证据水平
2级，对1级和2级研究的系统评价。
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