Hirase Takashi, Jack Ii Robert A, Sochacki Kyle R, Harris Joshua D, Weiner Bradley K
Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA.
Cureus. 2020 Jun 25;12(6):e8831. doi: 10.7759/cureus.8831.
Current studies evaluating the outcomes of intradiscal platelet-rich plasma (PRP) injections in degenerative disc disease (DDD) are limited. The purpose of this review was to determine if an intradiscal injection of PRP for degenerative discs results in a statistically significant improvement in clinical outcomes. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Level I-IV investigations of intradiscal PRP injections in DDD were sought in multiple databases. The Modified Coleman Methodology Score (MCMS) was used to analyze the methodological quality of the study. Only the outcome measurements used by more than 50% of the studies were included in the data analysis. The study heterogeneity and nature of evidence (mostly retrospective, non-comparative) precluded meta-analysis. Pre and post-injection pain visual analog scales (VAS) were compared using two sample Z-tests. Five articles (90 subjects, mean age 43.6 ± 7.7 years, mean follow-up 8.0 ± 3.6 months) were analyzed. Four articles were level IV evidence and one article was level II. Mean MCMS was 56.0 ± 10.3. There were 43 males and 37 females (10 unidentified). Pain VAS significantly improved following lumbar intradiscal PRP injection (69.7 mm to 43.3 mm; p<0.01). Two patients (2.2%) experienced lower extremity paresthesia after treatment. One patient (1.1%) underwent re-injection. No other complications were reported. In conclusion, intradiscal injection of PRP for degenerative discs resulted in statistically significant improvement in VAS with low re-injection and complication rates in this systematic review. It is unclear whether the improvements were clinically significant given the available evidence. The low level of evidence available (level IV) does not allow for valid conclusions regarding efficacy; however, the positive results suggest that further higher-quality studies might be of value.
目前评估椎间盘内注射富血小板血浆（PRP）治疗椎间盘退变疾病（DDD）疗效的研究有限。本综述的目的是确定椎间盘内注射PRP治疗退变椎间盘是否能在临床疗效上产生具有统计学意义的改善。使用系统评价和Meta分析的首选报告项目（PRISMA）指南进行了一项系统评价。在多个数据库中检索了关于DDD患者椎间盘内注射PRP的I-IV级研究。采用改良科尔曼方法学评分（MCMS）分析研究的方法学质量。数据分析仅纳入超过50%的研究使用的结局指标。研究的异质性和证据性质（大多为回顾性、非对照性）排除了Meta分析的可能性。使用两样本Z检验比较注射前后的疼痛视觉模拟量表（VAS）。分析了5篇文章（90名受试者，平均年龄43.6±7.7岁，平均随访8.0±3.6个月）。4篇文章为IV级证据，1篇文章为II级证据。平均MCMS为56.0±10.3。男性43例，女性37例（10例身份不明）。腰椎间盘内注射PRP后疼痛VAS显著改善（从69.7 mm降至43.3 mm；p<0.01）。2例患者（2.2%）治疗后出现下肢感觉异常。1例患者（1.1%）接受了再次注射。未报告其他并发症。总之，在本系统评价中，椎间盘内注射PRP治疗退变椎间盘在VAS上有统计学意义的改善，再次注射率和并发症发生率较低。根据现有证据，尚不清楚这些改善是否具有临床意义。现有证据水平较低（IV级）不允许就疗效得出有效结论；然而，阳性结果表明进一步开展更高质量的研究可能有价值。
