Jiang Jiabao, Xing Fei, Luo Rong, Liu Ming
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Front Pharmacol. 2022 Apr 27;13:834213. doi: 10.3389/fphar.2022.834213. eCollection 2022.
Recently, there was a series of clinical studies focusing on local injection of platelet-rich plasma (PRP) for treatment of patients with carpal tunnel syndrome (CTS). However, the safety and efficacy of PRP in these CTS patients remains controversial. Therefore, we performed a systematic review to compare PRP with other conservative treatments in treatment of CTS patients. We systematically searched from electronic databases (Cochrane, PubMed, Web of Science, and EMBASE) up to 10 December 2021. The data of clinical results were extracted and analyzed by RevMan Manager 5.4. Finally, eight randomized controlled studies, involving 220 CTS patients undergoing local injection of PRP were enrolled in this systematic review. All enrolled trials were considered to be of high quality. In the short-term efficacy, the PRP group was significantly lower in symptom severity scale (SSS) compared with the control group (MD = -2.00; 95% CI, -3.15 to -0.85; = 0.0007; I = 0%). In the mid-term efficacy, the PRP group was significantly effective than the control group in the visual analogue scale (MD = -0.63; 95% CI, -1.22 to -0.04; = 0.04; I = 61%), SSS (MD = -3.56; 95% CI, -4.93 to -2.18; < 0.00001; I = 0%), functional status scale (MD = -2.29; 95% CI, -3.03 to -1.56; < 0.00001; I = 45%), sensory peak latency (MD = -0.39; 95% CI, -0.58 to -0.19; = 0.0001; I = 0%) and cross-sectional area of median nerve (MD = -0.20; 95% CI, -0.31 to -0.10; = 0.0002; I = 0%). In the mid-long-term efficacy, the PRP group was only significantly lower in SSS compared with the control group (MD = -2.71; 95% CI, -4.33 to -1.10; = 0.001; I = 38%). Local PRP injection is more effective than other conservative treatments in terms of mid-term efficacy in relieving pain, improving wrist function and symptoms, reducing MN swelling, and partially improving electrophysiological indicators. However, the long-term adverse side and consensus on standardization of PRP in CTS patients still need further large-scale trials.
最近，有一系列临床研究聚焦于局部注射富血小板血浆（PRP）治疗腕管综合征（CTS）患者。然而，PRP在这些CTS患者中的安全性和有效性仍存在争议。因此，我们进行了一项系统评价，以比较PRP与其他保守治疗方法在CTS患者治疗中的效果。我们系统检索了截至2021年12月10日的电子数据库（Cochrane、PubMed、Web of Science和EMBASE）。临床结果数据由RevMan Manager 5.4提取和分析。最后，八项随机对照研究纳入了本系统评价，涉及220例接受局部注射PRP的CTS患者。所有纳入的试验均被认为质量较高。在短期疗效方面，与对照组相比，PRP组的症状严重程度量表（SSS）显著更低（MD = -2.00；95%CI，-3.15至-0.85；P = 0.0007；I² = 0%）。在中期疗效方面，PRP组在视觉模拟量表（MD = -0.63；95%CI，-1.22至-0.04；P = 0.04；I² = 61%）、SSS（MD = -3.56；95%CI，-4.93至-2.18；P < 0.00001；I² = 0%）、功能状态量表（MD = -2.29；95%CI，-3.03至-1.56；P < 0.00001；I² = 45%）、感觉峰值潜伏期（MD = -0.39；95%CI，-0.58至-0.19；P = 0.0001；I² = 0%）和正中神经横截面积（MD = -0.20；95%CI，-0.31至-0.10；P = 0.0002；I² = 0%）方面均显著优于对照组。在中长期疗效方面，与对照组相比，PRP组仅在SSS方面显著更低（MD = -2.71；95%CI，-4.33至-1.10；P = 0.001；I² = 38%）。局部注射PRP在中期疗效方面，在缓解疼痛、改善腕部功能和症状、减轻正中神经肿胀以及部分改善电生理指标方面比其他保守治疗更有效。然而，CTS患者中PRP的长期不良副作用以及标准化共识仍需要进一步的大规模试验。
