Shen Zhe, Ye Xiaoang, He Yawen, Shen Gaobo, Xu Kuangying, Zhang Bingbing, Wu Lianguo
The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China.
Hangzhou Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China.
Medicine (Baltimore). 2024 May 3;103(18):e38069. doi: 10.1097/MD.0000000000038069.
Although several studies on the potential benefits of protein-rich plasma (PRP) therapy for rotator cuff injuries have been published, the results have been conflicting. Therefore, this study aimed to determine whether PRP is beneficial for the prevention of retears after arthroscopic rotator cuff repair (ARCR).
Two reviewers conducted independent literature searches based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) comparing a PRP treatment group with a control group were included. The quality of evidence was assessed using the Cochrane Collaboration Risk of Bias Tool. Clinical outcomes were compared using the risk ratio (RR) for dichotomous variables and weighted mean difference (WMD) for continuous variables. Statistical significance was set at P < .05.
This review included 21 RCTs (1359 patients). Significant results were noted in favor of PRP treatment compared with controls based on retearing rates (16.5% vs 23.6%, respectively; P = .002) and the Constant score in the short term (WMD: 1.98; 95% confidence interval [CI], 0.27-3.70; I2 = 0%; P = .02), medium term and long term (WMD: 2.56 [95% CI: 1.57-3.55]; I2 = 2%; P < .001); the University of California, Los Angeles score in the short term (WMD: 1.14 [95% CI: 0.43-1.85]; I2 = 25%; P = .002) but not in the medium and long term (WMD: 0.66 [95% CI: -0.16 to 1.48]; I2 = 57%; P = .11); and the visual analog scale score in the short term (WMD: -0.63 [95% CI: -0.83 to-0.43]; I2 = 41%; P < .001), medium and long term (WMD: -0.12 [95% CI: -0.19 to-0.05]; I2 = 0%; P = .008). There was no significant difference in American Shoulder and Elbow Surgeons scores between the treatment and control groups in the short term (WMD: -0.48 [95% CI: -2.80 to 1.85]; I2 = 22%; P = .69) or medium and long term (WMD: 0.92 [95% CI: -1.56 to 3.39]; I2 = 40%; P = .47).
Intraoperative use of PRP reduces the risk of rotator cuff repair failure, improves clinical outcomes, and reduces recurrence rates.
尽管已经发表了几项关于富含蛋白质血浆（PRP）疗法对肩袖损伤潜在益处的研究，但其结果相互矛盾。因此，本研究旨在确定PRP是否有助于预防关节镜下肩袖修复术（ARCR）后的再撕裂。
两名综述作者根据系统评价和Meta分析的首选报告项目指南进行独立文献检索。纳入比较PRP治疗组和对照组的随机对照试验（RCT）。使用Cochrane协作偏倚风险工具评估证据质量。使用二分变量的风险比（RR）和连续变量的加权平均差（WMD）比较临床结局。设定统计学显著性为P < 0.05。
本综述纳入了21项RCT（1359例患者）。基于再撕裂率（分别为16.5%和23.6%；P = 0.002）以及短期（WMD：1.98；95%置信区间[CI]，0.27 - 3.70；I² = 0%；P = 0.02）、中期和长期（WMD：2.56[95% CI：1.57 - 3.55]；I² = 2%；P < 0.001）的Constant评分，与对照组相比，PRP治疗有显著效果；短期的加州大学洛杉矶分校评分（WMD：1.14[95% CI：0.43 - 1.85]；I² = 25%；P = 0.002），但中期和长期无显著差异（WMD：0.66[95% CI： - 0.16至1.48]；I² = 57%；P = 0.11）；以及短期（WMD： - 0.63[95% CI： - 0.83至 - 0.43]；I² = 41%；P < 0.001）、中期和长期（WMD： - 0.12[95% CI： - 0.佃至 - 0.05]；I² = 0%；P = 0.008）的视觉模拟量表评分。治疗组和对照组在短期（WMD： - 0.48[95% CI： - 2.80至1.8钐；I² = 22%；P = 0.69）或中期和长期（WMD：0.92[95% CI： - 1.56至3.39]；I² = 40%；P = 0.47）的美国肩肘外科医师评分无显著差异。
术中使用PRP可降低肩袖修复失败风险，改善临床结局，并降低复发率。
