Zhu Jinqiang, Han Dunhu, Sun Yuanyuan, Zhao Chunzeng
Department of Orthopaedics, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital), No.4 Renmin Road, Shibei District, Qingdao 266033, Shandong Province, China.
Department of Vascular Surgery, Qingdao Haici Medical North Hospital (Qingdao Hongdao People's Hospital) No.330 Haiao Road, Chengyang District, Qingdao 266112, Shandong Province, China.
J Orthop Sci. 2024 Nov 20. doi: 10.1016/j.jos.2024.10.015.
Long bone fractures may exhibit nonunion/delayed union and the precise mechanism underlying this devastating condition remain unknown. More recently, a series of meta-analyses have examined the effect of local administration of platelet-rich plasma (PRP) in patients suffering from nonunion/delayed union fractures; however, the conclusions of available meta-analyses have remained debatable. This umbrella meta-analysis was performed to synthesize and recalculate available evidence to assess the certainty of the effect of PRP on nonunion/delayed union fractures.
Relevant meta-analyses and individual studies investigating the effect of PRP therapy on nonunion/delayed union fractures were obtained through a systematic search in PubMed, Web of Knowledge, and Scopus up to November 2023. Meta-analyses were re-conducted for healing rate and healing time using a random effects model. The methodology quality of the included meta-analyses and the quality of evidence was assessed using the AMSTAR2 and GRADE criteria, respectively.
A total of 5 meta-analyses with 13 individual studies, comprising 1362 patients, were included. The analysis revealed a significant improvement in both healing rate (relative risk (RR) = 1.30, 95%CI: 1.06 to 1.60) and healing time (mean difference (MD): -1.25, 95 % CI: -2.09 to -0.42) of nonunion/delayed union fractures. However, when individual studies were pooled, PRP was not effective in increasing the healing rate, while it was effective in reducing healing time (MD = -2.15, 95 % CI = -3.17 to -1.13). PRP therapy had no significant effect on pain improvement and the Excellent/Good Posttreatment Limb Function. The risk of the adverse side effects was not significant.
This umbrella meta-analysis revealed that PRP may reduce healing time in patients with nonunion/delayed union fractures, with no potential side effects. This finding is needed to be confirmed by further studies.
长骨骨折可能会出现骨不连/延迟愈合，而这种破坏性情况的确切机制仍不清楚。最近，一系列荟萃分析研究了局部应用富血小板血浆（PRP）对骨不连/延迟愈合骨折患者的影响；然而，现有荟萃分析的结论仍存在争议。本伞形荟萃分析旨在综合并重新计算现有证据，以评估PRP对骨不连/延迟愈合骨折影响的确定性。
通过在PubMed、Web of Knowledge和Scopus上进行系统检索，获取截至2023年11月研究PRP治疗对骨不连/延迟愈合骨折影响的相关荟萃分析和个体研究。使用随机效应模型对愈合率和愈合时间重新进行荟萃分析。分别使用AMSTAR2和GRADE标准评估纳入荟萃分析的方法学质量和证据质量。
共纳入5项荟萃分析，包含13项个体研究，涉及1362例患者。分析显示，骨不连/延迟愈合骨折的愈合率（相对危险度（RR）=1.30，95%置信区间：1.06至1.60）和愈合时间（平均差（MD）：-1.25，95%置信区间：-2.09至-0.42）均有显著改善。然而，当汇总个体研究时，PRP在提高愈合率方面无效，而在缩短愈合时间方面有效（MD=-2.15，95%置信区间=-3.17至-1.13）。PRP治疗对疼痛改善和治疗后肢体功能优/良无显著影响。不良副作用风险不显著。
本伞形荟萃分析表明，PRP可能会缩短骨不连/延迟愈合骨折患者的愈合时间，且无潜在副作用。这一发现需要进一步研究予以证实。
