Medina-Porqueres Ivan, Ortega-Castillo Miguel, Muriel-Garcia Alfonso
Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain.
Medical Services, Malaga Football Club, Malaga, Spain.
Clin Rheumatol. 2021 Jan;40(1):53-64. doi: 10.1007/s10067-020-05241-x. Epub 2020 Jun 30.
The effectiveness of platelet-rich plasma (PRP) injections for osteoarthritis (OA) is still controversial. Previous research supports the use of intra-articular PRP injections to promote a favorable environment for joint tissue healing and to delay the progression of OA. The purpose of this review is to investigate the effectiveness of PRP in the management of hip osteoarthritis (HOA). Five electronic databases were searched from inception to May 2019: Medline (via PubMed), SportDiscus via EBSCO, ProQuest Health & Medical Complete, CINAHL, and Cochrane. Risk of bias was assessed with the Cochrane risk of bias tool. The GRADE method was used to assess the level of evidence for the studies included in this review. Clinical trials evaluate PRP injections among adult patients diagnosed with HOA according to the American College of Rheumatology criteria. At least one outcome measure for pain or function must have been reported. A total of 4 trials (334 participants, 340 hips) were included, all marked as "moderate risk of bias". Pain and function were assessed throughout the studies with visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Harris Hip Score (HHS) tools. Intra-articular PRP injections were more effective at stages earlier than 3 months for both treatment groups with the exception of WOMAC score in one study. The superiority of PRP against comparative treatments was only reported in one study; longer-term evaluations from 4 to 12 months showed diverse results, with only one study reporting significantly better results for PRP. PRP may be beneficial and safe for patients with HOA at mid-term follow-up. However, its superiority over other procedures such as hyaluronic acid remains unclear. Further researches with high-quality designs and larger samples become imperative.
富血小板血浆（PRP）注射治疗骨关节炎（OA）的有效性仍存在争议。先前的研究支持关节内注射PRP以促进关节组织愈合的有利环境并延缓OA的进展。本综述的目的是研究PRP在治疗髋骨关节炎（HOA）中的有效性。从创刊到2019年5月检索了五个电子数据库：Medline（通过PubMed）、通过EBSCO的SportDiscus、ProQuest健康与医学完整版、CINAHL和Cochrane。使用Cochrane偏倚风险工具评估偏倚风险。采用GRADE方法评估本综述中纳入研究的证据水平。临床试验根据美国风湿病学会标准评估诊断为HOA的成年患者中的PRP注射情况。必须报告至少一项疼痛或功能的结局指标。总共纳入了4项试验（334名参与者，340个髋关节），所有试验均标记为“中度偏倚风险”。在整个研究过程中，使用视觉模拟量表（VAS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及Harris髋关节评分（HHS）工具评估疼痛和功能。除一项研究中的WOMAC评分外，两个治疗组在早于3个月的阶段关节内注射PRP均更有效。只有一项研究报告了PRP相对于对照治疗的优越性；4至12个月的长期评估结果各异，只有一项研究报告PRP的结果明显更好。在中期随访中，PRP可能对HOA患者有益且安全。然而，其相对于其他程序（如透明质酸）的优越性仍不清楚。开展高质量设计和大样本量的进一步研究势在必行。
