Pang Long, Xu Yang, Li Tao, Li Yinghao, Zhu Jing, Tang Xin
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China; West China Medical School, Sichuan University, Chengdu, China.
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Arthroscopy. 2023 Feb;39(2):402-421.e1. doi: 10.1016/j.arthro.2022.06.022. Epub 2022 Jul 8.
To explore whether platelet-rich plasma (PRP) injection can be a viable alternative to corticosteroid (CS) injection for conservative treatment of rotator cuff disease.
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, EMBASE, The Cochrane Library, and Web of Science were searched from January 1, 1990, to March 20, 2022, for English-language randomized controlled trials that compared PRP and CS injections for patients with rotator cuff disease. Two evaluators independently screened the literature, extracted data, and assessed the level of evidence and methodologic quality of the enrolled studies. The meta-analysis was conducted using RevMan software (version 5.3.3).
Thirteen nonsurgical randomized controlled trials with 725 patients were included. Compared with CS, PRP provided statistically worse short-term (<2 months) changes in American Shoulder and Elbow Surgeons (ASES) assessment scores, Simple Shoulder Test scores, and Disabilities of the Arm, Shoulder and Hand questionnaire scores but provided better medium-term (2-6 months) changes in Disabilities of the Arm, Shoulder and Hand scores, as well as long-term (≥6 months) changes in Constant-Murley scores, ASES scores, and Simple Shoulder Test scores. No statistically significant differences regarding pain reduction were found between the 2 groups. PRP injections led to worse short-term changes in forward flexion and internal rotation but better medium-term changes in forward flexion and external rotation. PRP showed significantly lower rates of post-injection failure (requests for subsequent injections or surgical intervention prior to 12 months) than CS. No outcome reached the minimal clinically important difference. After sensitivity analyses excluding studies with substantial clinical and/or methodologic heterogeneity, PRP showed better medium-term changes in ASES scores and visual analog scale scores and long-term changes in visual analog scale scores that reached the minimal clinically important difference.
Without the drawbacks of CS injection, PRP injection is not worse than CS injection in terms of pain relief and function recovery at any time point during follow-up. PRP injection may reduce rates of subsequent injection or surgery, and it might provide better improvements in pain and function in the medium to long term. PRP injection can be a viable alternative to CS injection for conservative treatment of rotator cuff disease.
Meta-analysis of Level I and II studies.
探讨富血小板血浆（PRP）注射能否作为皮质类固醇（CS）注射的可行替代方法，用于保守治疗肩袖疾病。
本研究按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。检索了1990年1月1日至2022年3月20日期间的PubMed、EMBASE、Cochrane图书馆和Web of Science，以查找比较PRP和CS注射治疗肩袖疾病患者的英文随机对照试验。两名评估者独立筛选文献、提取数据，并评估纳入研究的证据水平和方法学质量。使用RevMan软件（5.3.3版）进行Meta分析。
纳入了13项非手术随机对照试验，共725例患者。与CS相比，PRP在短期（<2个月）美国肩肘外科医师协会（ASES）评估评分、简易肩关节测试评分和上肢、肩部和手部功能障碍问卷评分方面的变化在统计学上更差，但在中期（2 - 6个月）上肢、肩部和手部功能障碍评分方面变化更好，以及在长期（≥6个月）Constant-Murley评分、ASES评分和简易肩关节测试评分方面变化更好。两组在疼痛减轻方面未发现统计学上的显著差异。PRP注射导致前屈和内旋的短期变化更差，但前屈和外旋的中期变化更好。PRP注射后的失败率（在12个月前要求后续注射或手术干预）显著低于CS。没有结果达到最小临床重要差异。在排除具有实质性临床和/或方法学异质性的研究进行敏感性分析后，PRP在ASES评分和视觉模拟量表评分的中期变化以及视觉模拟量表评分的长期变化方面表现更好，达到了最小临床重要差异。
PRP注射没有CS注射的缺点，在随访期间的任何时间点，PRP注射在缓解疼痛和功能恢复方面都不比CS注射差。PRP注射可能会降低后续注射或手术的发生率，并且在中长期可能会在疼痛和功能方面提供更好的改善。PRP注射可以作为CS注射的可行替代方法，用于保守治疗肩袖疾病。
I级和II级研究的Meta分析。
