富血小板血浆治疗肱骨外上髁炎的长期功能改善和缓解疼痛的效果更好：一项随机对照试验的系统评价和荟萃分析。

Platelet-Rich Plasma Has Better Results for Long-term Functional Improvement and Pain Relief for Lateral Epicondylitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

机构信息

Sports Medicine Center, West China Hospital, Sichuan University, Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Am J Sports Med. 2024 Aug;52(10):2646-2656. doi: 10.1177/03635465231213087. Epub 2024 Feb 15.

DOI:10.1177/03635465231213087

PMID:38357713

Abstract

BACKGROUND

Corticosteroids (CS) have shown good short-term performance in terms of pain relief and functional improvement. However, the safety and long-term efficacy of this treatment remains controversial. Several studies have reported good results of platelet-rich plasma (PRP) in the treatment of tendinopathies. However, whether its use in the treatment of lateral epicondylitis (LE) is superior to that of CS remains controversial.

PURPOSE

To perform a systematic review and meta-analysis of original studies to determine whether the prognosis of LE patients treated with PRP is better than that of CS.

STUDY DESIGN

Meta-analysis; Level of evidence, 2.

METHODS

Two independent reviewers searched online databases from January 2000 to July 2022 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to evaluate prospective studies of PRP versus CS injection for LE. A third author addressed any discrepancies. Evidence quality was assessed using the Cochrane risk of bias tool. Risk ratios for dichotomous variables and mean differences (MDs) for continuous variables were used to compare clinical outcomes. values <.05 were considered statistically significant.

RESULTS

Eleven randomized controlled trials with 730 patients were included in this review. PRP provided a significantly worse short-term (<2 months) improvement in the visual analog scale (VAS) pain score (MD, 0.93 [95% CI, 0.42 to 1.44]; = 85%; = .0003) and Disabilities of the Arm, Shoulder and Hand (DASH) score (MD, 10.23 [95% CI, 9.08 to 11.39]; = 67%; < .0001) but better long-term (≥6 months) improvement in the VAS score (MD, -2.18 [95% CI, -3.13 to -1.22]; = 89%; < .0001), DASH score (MD, -8.13 [95% CI, -9.87 to -6.39]; = 25%; < .0001), and Mayo Elbow Performance Score (MD, 16.53 [95% CI, 1.52 to 31.53]; = 98%; = .03) than CS. The medium-term (2-6 months) reduction in the VAS score was not significantly different between the 2 groups. After sensitivity analysis, none of the results changed except for the short-term VAS scores (MD, 0.53 [95% CI, -0.13 to 1.19]; = 78%; = .12).

CONCLUSION

Both PRP and CS injections are effective treatments for patients with LE. CS provides better short-term (<2 months) functional improvement and may be more advantageous in terms of short-term pain relief, while PRP provides better long-term (≥6 months) functional improvement and better performance regarding long-term pain relief.

摘要

背景

皮质类固醇（CS）在缓解疼痛和改善功能方面具有良好的短期疗效。然而，这种治疗的安全性和长期疗效仍存在争议。多项研究报告了富血小板血浆（PRP）在治疗腱病方面的良好效果。然而，其在治疗外侧肱骨上髁炎（LE）中的应用是否优于 CS 仍存在争议。

目的

对原始研究进行系统评价和荟萃分析，以确定 LE 患者接受 PRP 治疗的预后是否优于 CS。

研究设计

荟萃分析；证据水平，2 级。

方法

两名独立的审查员根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，从 2000 年 1 月至 2022 年 7 月在线数据库中搜索，以评估 PRP 与 CS 注射治疗 LE 的前瞻性研究。第三位作者解决了任何分歧。使用 Cochrane 偏倚风险工具评估证据质量。二分类变量的风险比和连续变量的均数差值（MD）用于比较临床结局。认为<.05 具有统计学意义。

结果

本综述纳入了 11 项随机对照试验，共 730 例患者。PRP 在短期（<2 个月）疼痛视觉模拟量表（VAS）评分（MD，0.93[95%CI，0.42 至 1.44]； = 85%； =.0003）和上肢功能障碍（DASH）评分（MD，10.23[95%CI，9.08 至 11.39]； = 67%； <.0001）方面的改善明显较差，但在长期（≥6 个月）VAS 评分（MD，-2.18[95%CI，-3.13 至-1.22]； = 89%； <.0001）、DASH 评分（MD，-8.13[95%CI，-9.87 至-6.39]； = 25%； <.0001）和 Mayo 肘功能评分（MD，16.53[95%CI，1.52 至 31.53]； = 98%； =.03）方面的改善明显优于 CS。两组在中期（2-6 个月）VAS 评分的降低方面没有显著差异。经过敏感性分析，除短期 VAS 评分外（MD，0.53[95%CI，-0.13 至 1.19]； = 78%； =.12），其余结果均无变化。