富血小板血浆联合透明质酸治疗膝骨关节炎在缓解疼痛和改善功能方面优于单纯透明质酸：系统评价和荟萃分析。
Platelet-Rich Plasma Combined With Hyaluronic Acid Improves Pain and Function Compared With Hyaluronic Acid Alone in Knee Osteoarthritis: A Systematic Review and Meta-analysis.
机构信息
School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Thessaloniki Minimally Invasive (The-MIS) Orthopaedic Center, St. Luke's Hospital, Thessaloniki, Greece.
出版信息
Arthroscopy. 2021 Apr;37(4):1277-1287.e1. doi: 10.1016/j.arthro.2020.11.052. Epub 2020 Dec 3.
PURPOSE
To evaluate the efficacy of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) injections versus HA injections alone for the management of knee osteoarthritis (OA).
METHODS
This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible randomized-controlled trials and observational studies directly comparing combined PRP-HA injections with HA injections alone were identified through a search of PubMed, Scopus, and Cochrane Central databases from inception to May 2020. A random effects model meta-analysis was conducted and the I statistic was used to assess for heterogeneity.
RESULTS
Four studies comprising 377 patients (PRP-HA: 193, HA: 184) with knee OA ranging from I-IV Kellgren-Lawrence grading scale were included. The final follow-up was 12 months in 3 studies and 6 months in 1 study. Patients who received PRP combined with HA had significantly greater improvements compared with those injected with HA alone in terms of visual analog scale scores at 3-month (standardized mean difference [SMD] 1.13; 95% confidence interval [CI] 0.56-1.70; I = 56.7%; P < .001), 6-month (SMD 1.08; 95% CI 0.54-1.62; I = 67.9%; P < .001), and 12-month (SMD 1.13; 95% CI 0.74-1.52; I = 0.0%; P < .001) and 12-month Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical functioning (SMD 0.91; 95% CI 0.65-1.17; I = 0.0%; P < .001) and 12-month WOMAC stiffness (SMD 1.09; 95% CI 0.80-1.38; I = 0.0%; P < .001) scores. No difference was identified in terms of 12-month WOMAC pain score (SMD 0.36; 95% CI -0.19 to 0.91; I = 74.1%; P = .195).
CONCLUSIONS
Symptomatic patients with knee OA who were injected with a combination of PRP and HA demonstrated greater improvement in pain and function compared with patients who received HA injections only, as assessed by 3-, 6-, and 12-month visual analog scale scores and 12-month WOMAC physical function and stiffness scores. This study provides encouraging evidence for the use of the combined PRP-HA injections in the management of symptomatic patients with knee OA.
LEVEL OF EVIDENCE
III (meta-analysis of randomized and non-randomized comparative trials).
目的
评估富血小板血浆（PRP）联合透明质酸（HA）注射与单独 HA 注射治疗膝骨关节炎（OA）的疗效。
方法
本研究按照系统评价和荟萃分析的首选报告项目进行。通过检索 PubMed、Scopus 和 Cochrane 中央数据库，从成立到 2020 年 5 月，确定了直接比较 PRP-HA 联合注射与单独 HA 注射的随机对照试验和观察性研究。采用随机效应模型进行荟萃分析，并使用 I 统计量评估异质性。
结果
共纳入 4 项研究，包括 377 例（PRP-HA：193 例，HA：184 例）I-IV 级 Kellgren-Lawrence 分级的膝骨关节炎患者。3 项研究的最终随访时间为 12 个月，1 项研究为 6 个月。与单独接受 HA 注射的患者相比，接受 PRP 联合 HA 注射的患者在 3 个月（标准化均数差 [SMD] 1.13；95%置信区间 [CI] 0.56-1.70；I = 56.7%；P <.001）、6 个月（SMD 1.08；95% CI 0.54-1.62；I = 67.9%；P <.001）和 12 个月（SMD 1.13；95% CI 0.74-1.52；I = 0.0%；P <.001）时视觉模拟量表评分以及 12 个月的 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）躯体功能（SMD 0.91；95% CI 0.65-1.17；I = 0.0%；P <.001）和 12 个月的 WOMAC 僵硬（SMD 1.09；95% CI 0.80-1.38；I = 0.0%；P <.001）评分方面均有显著改善。12 个月时 WOMAC 疼痛评分（SMD 0.36；95% CI -0.19 至 0.91；I = 74.1%；P =.195）无差异。
结论
与单独接受 HA 注射的患者相比，接受 PRP 和 HA 联合注射的膝骨关节炎症状性患者在 3、6 和 12 个月时的视觉模拟量表评分以及 12 个月时的 WOMAC 躯体功能和僵硬评分方面疼痛和功能均有更大改善。本研究为 PRP-HA 联合注射治疗膝骨关节炎症状性患者提供了令人鼓舞的证据。
证据水平
III（随机和非随机对照试验的荟萃分析）。
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