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富血小板血浆治疗部分厚度肩袖撕裂和肌腱病的保守治疗:系统评价和荟萃分析。

Conservative treatment of partial-thickness rotator cuff tears and tendinopathy with platelet-rich plasma: A systematic review and meta-analysis.

机构信息

Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China.

School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, P. R. China.

出版信息

Clin Rehabil. 2021 Dec;35(12):1661-1673. doi: 10.1177/02692155211011944. Epub 2021 Apr 26.

Abstract

OBJECTIVE

To assess the effect of platelet-rich plasma as a conservative therapy in individuals with partial-thickness rotator cuff tears or tendinopathy on pain, and function.

DATA SOURCES

Embase, MEDLINE, CENTRAL, Web of Science, CINAHL, PEDro, and the grey literature (to 31 March 2021).

METHODS

Randomized controlled trials in English that reported short-term (6 ± 1 months), or long-term (⩾1 year) outcomes (shoulder pain or function) were conducted. Two independent reviewers screened the literature, completed the assessment of the Cochrane's risk of bias and extracted the data. Mean difference or standardized mean difference was used for continuous data. Heterogeneity was identified with test.

RESULTS

A total of 11 studies were eligible, and nine studies ( = 629) were included in this meta-analysis, that showed statistically significant short-term effects of platelet-rich plasma on pain relief (MD = -1.56; 95% CI -2.82 to -0.30), Constant-Murley score (MD = 16.48; 95% CI 12.57 to 20.40), and Shoulder Pain and Disability Index (MD = -18.78; 95% CI -36.55 to -1.02). Nonetheless, no long-term effect was observed on pain and function, except Constant-Murley score (MD = 24.30; 95% CI 23.27 to 25.33). The results of minimal important difference reached the minimal clinically important difference, except American Shoulder and Elbow Surgeons. For subgroup analysis, differences of pain relief were statistically significant in platelet-rich plasma-treated groups with double centrifugation, single injection, and post-injection rehabilitation.

CONCLUSION

Our results suggested platelet-rich plasma had positive effects on pain relief and functional improvement for partial-thickness rotator cuff tears and rotator cuff tendinopathy, although the effects may not last for a long time.

摘要

目的

评估富血小板血浆作为部分厚度肩袖撕裂或肌腱病患者的保守治疗方法对疼痛和功能的影响。

资料来源

Embase、MEDLINE、CENTRAL、Web of Science、CINAHL、PEDro 和灰色文献(截至 2021 年 3 月 31 日)。

方法

纳入英语发表的短期(6±1 个月)或长期(≥1 年)结局(肩部疼痛或功能)的随机对照试验。两名独立的综述作者筛选文献,评估 Cochrane 偏倚风险,并提取数据。连续数据采用均数差或标准化均数差表示。采用 t 检验识别异质性。

结果

共纳入 11 项研究,其中 9 项研究(n=629)纳入本 meta 分析。结果显示,富血小板血浆治疗在短期能显著减轻疼痛(MD=-1.56;95%CI-2.82 至-0.30)、Constant-Murley 评分(MD=16.48;95%CI 12.57 至 20.40)和肩关节疼痛和功能障碍指数(MD=-18.78;95%CI-36.55 至-1.02)。然而,除 Constant-Murley 评分(MD=24.30;95%CI 23.27 至 25.33)外,富血小板血浆治疗对疼痛和功能无长期影响。除美国肩肘外科医师学会评分外,最小差异重要性的结果达到了最小临床重要差异。对于亚组分析,在接受双离心、单次注射和注射后康复治疗的富血小板血浆治疗组,疼痛缓解的差异具有统计学意义。

结论

我们的研究结果表明,富血小板血浆对部分厚度肩袖撕裂和肩袖肌腱病患者的疼痛缓解和功能改善有积极作用,尽管效果可能不会持续很长时间。

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