Ling Jeremiah F, Wininger Austin E, Hirase Takashi
Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA.
Cureus. 2021 Mar 23;13(3):e14062. doi: 10.7759/cureus.14062.
This systematic review compares clinical outcomes between platelet-rich plasma (PRP) and corticosteroid injections for the treatment of lumbar spondylosis and sacroiliac arthropathy. A systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Pubmed, SCOPUS, and Ovid MEDLINE databases. All level I-III evidence comparative studies published in the English language investigating the clinical outcomes between PRP and corticosteroid injections for the treatment of lumbar spondylosis and sacroiliac arthropathy were included. Five studies (242 patients, 114 PRP, 128 corticosteroid) were analyzed. One randomized study was level I evidence, two randomized studies were level II, and two non-randomized studies were level III. Final follow-up ranged from six weeks to six months. Four studies found that both PRP and corticosteroid treatment led to a statistically significant reduction in the visual analog scale (VAS). One found that only the PRP group led to a statistically significant reduction in VAS. Three studies found more significant improvements in one or more clinical outcome scores among PRP patients as compared with corticosteroid patients at the three- to six-month follow-up. Two studies found no difference in outcome score improvements between the two groups at six- to 12-week follow-up. There were no reports of major complications. There were no significant differences in minor complication rates between the two groups. In conclusion, both PRP and corticosteroid injections are safe and effective options for the treatment of lumbar spondylosis and sacroiliac arthropathy. There is some evidence that PRP injection is a more effective option at long-term follow-up compared with corticosteroid injection. Further randomized controlled trials with longer-term follow-up are necessary to compare its long-term efficacy.
本系统评价比较了富血小板血浆（PRP）和皮质类固醇注射治疗腰椎病和骶髂关节炎的临床疗效。一项系统评价已在国际前瞻性系统评价注册库（PROSPERO）登记，并根据系统评价和Meta分析的首选报告项目（PRISMA）指南，使用PubMed、SCOPUS和Ovid MEDLINE数据库进行。纳入所有以英文发表的、研究PRP和皮质类固醇注射治疗腰椎病和骶髂关节炎临床疗效的I-III级证据比较研究。分析了五项研究（242例患者，114例PRP，128例皮质类固醇）。一项随机研究为I级证据，两项随机研究为II级，两项非随机研究为III级。最终随访时间为六周至六个月。四项研究发现，PRP和皮质类固醇治疗均使视觉模拟量表（VAS）评分在统计学上显著降低。一项研究发现只有PRP组的VAS评分在统计学上显著降低。三项研究发现，在三至六个月的随访中，与皮质类固醇治疗的患者相比，PRP治疗的患者在一项或多项临床结局评分上有更显著的改善。两项研究发现在六至十二周的随访中，两组的结局评分改善无差异。没有重大并发症的报告。两组的轻微并发症发生率无显著差异。总之，PRP和皮质类固醇注射都是治疗腰椎病和骶髂关节炎的安全有效选择。有一些证据表明，与皮质类固醇注射相比，PRP注射在长期随访中是一种更有效的选择。需要进一步进行长期随访的随机对照试验来比较其长期疗效。
