富血小板血浆注射治疗踝关节骨关节炎：系统评价和荟萃分析。
Platelet-rich plasma injection for the treatment of ankle osteoarthritis: a systematic review and meta-analysis.
机构信息
Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
出版信息
J Orthop Surg Res. 2023 May 19;18(1):373. doi: 10.1186/s13018-023-03828-z.
BACKGROUND
Platelet-rich plasma (PRP) injection for ankle osteoarthritis (OA) treatment showed contradictory results. This review was aimed to pool individual studies which assessed the efficacy of PRP for ankle OA treatment.
METHODS
This study was conducted following the preferred report items of systematic review and meta-analysis guideline. PubMed and Scopus were searched up to January 2023. Meta-analysis, or individual randomised controlled trial (RCT), or observational studies were included if they involved ankle OA with aged ≥ 18 years, compared before-after receiving PRP, or PRP with other treatments, and reported visual analog scale (VAS) or functional outcomes. Selection of eligible studies and data extraction were independently performed by two authors. Heterogeneity test using Cochrane Q test and the I-statistic were assessed. Standardised (SMD) or unstandardised mean difference (USMD) and 95% confidence interval (CI) were estimated and pooled across studies.
RESULTS
Three studies from meta-analysis and two individual studies were included, which consisted of one RCT and four before-after studies with 184 ankle OAs and 132 PRP. The average age was 50.8-59.3 years, and 25-60% of PRP injected cases were male. The number of primary ankle OA was accounted to 0-100%. When compared to before treatment, PRP significantly reduced VAS and functional score at 12 weeks with pooled USMD of - 2.80, 95% CI - 3.91, - 2.68; p < 0.001 (Q = 82.91, p < 0.001; I 96.38%), and pooled SMD of 1.73, 95% CI 1.37, 2.09; p < 0.001 (Q = 4.87, p = 0.18; I 38.44%), respectively.
CONCLUSION
PRP may beneficially improve pain and functional scores for ankle OA in a short-term period. Its magnitude of improvement seems to be similar to placebo effects from the previous RCT. A large-scale RCT with proper whole blood and PRP preparation processes is required to prove treatment effects. Trial registration PROSPERO number CRD42022297503.
背景
富血小板血浆（PRP）注射治疗踝骨关节炎（OA）的效果存在争议。本综述旨在汇总评估 PRP 治疗踝 OA 疗效的研究。
方法
本研究遵循系统评价和荟萃分析报告规范。检索 PubMed 和 Scopus 数据库，检索时限截至 2023 年 1 月。如果研究涉及年龄≥18 岁的踝 OA 患者，比较接受 PRP 治疗前后或 PRP 与其他治疗方法的疗效，并报告视觉模拟评分（VAS）或功能结局，可纳入随机对照试验（RCT）、观察性研究。由两名作者独立筛选合格研究和提取数据。使用 Cochrane Q 检验和 I ² 统计量评估异质性。使用标准化均数差（SMD）或未标准化均数差（USMD）和 95%置信区间（CI）估计并汇总研究间结果。
结果
纳入 3 项荟萃分析研究和 2 项个体研究，共包含 1 项 RCT 和 4 项前后对照研究，共纳入 184 例踝 OA 和 132 例 PRP 患者。平均年龄为 50.8-59.3 岁，25%-60%的 PRP 注射患者为男性。原发性踝 OA 数量为 0-100%。与治疗前相比，PRP 在 12 周时显著降低 VAS 和功能评分，USMD 为-2.80，95%CI-3.91，-2.68；p<0.001（Q=82.91，p<0.001；I 96.38%），SMD 为 1.73，95%CI 1.37，2.09；p<0.001（Q=4.87，p=0.18；I 38.44%）。
结论
PRP 可能在短期内有益于改善踝 OA 的疼痛和功能评分。其改善幅度似乎与之前 RCT 中的安慰剂效应相似。需要进行大规模 RCT，并采用适当的全血和 PRP 制备工艺来证明治疗效果。试验注册号：PROSPERO 编号 CRD42022297503。
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