Wang Xinan, Zhang Ying
Orthopedics and Trauma Surgery Department, Bazhou People's Hospital, Bazhou, Xinjiang, China.
Department of Orthopedics, The 920th Hospital of Chinese People's Liberation Army Joint Logistics Support Force, Kunming, 650032, Yunnan Province, China.
J Orthop Surg Res. 2025 Mar 25;20(1):306. doi: 10.1186/s13018-025-05725-z.
Although epidural corticosteroid injections (ESIs) provide short-term relief for lumbar radicular pain caused by disc herniation, concerns remain regarding their long-term efficacy and complications. Platelet-rich plasma (PRP), with its dual anti-inflammatory and regenerative properties, is a promising alternative, but the comparative evidence between the two treatments remains inconclusive.
A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library, with a cutoff date of January 10, 2025. The primary outcomes were the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. The risk of bias in the included studies was assessed using Cochrane ROB and ROBINS-I. The primary outcome measures were analyzed by evaluating standardized mean differences (SMDs).
A total of seven studies (four randomized controlled trials and three prospective studies) were included in the meta-analysis, comprising 416 patients. The results indicated that corticosteroids significantly reduced ODI scores at the initial follow-up (4 weeks) (SMD = 0.48, 95% CI: 0.20 to 0.75, p = 0.0008, I² = 15%), with no significant differences observed in VAS and ODI scores between the two groups at other time points. The complication rates for the PRP and corticosteroid groups were reported, with no severe adverse events reported.
Compared to PRP, corticosteroid injections showed significant early functional improvements in patients. Although no significant differences in pain and functional improvements were observed between the PRP and corticosteroid groups at other follow-up time points, future studies are needed to assess the efficacy and safety of PRP versus corticosteroid injections in treating lumbar radicular pain by standardizing PRP preparation, extending follow-up durations, and increasing sample sizes.
尽管硬膜外皮质类固醇注射（ESI）可为椎间盘突出引起的腰椎神经根性疼痛提供短期缓解，但人们仍对其长期疗效和并发症存在担忧。富含血小板血浆（PRP）具有抗炎和再生的双重特性，是一种有前景的替代疗法，但两种治疗方法之间的比较证据仍不明确。
在PubMed、Embase、Web of Science和Cochrane图书馆进行了系统检索，截止日期为2025年1月10日。主要结局指标为视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）评分。使用Cochrane ROB和ROBINS-I评估纳入研究的偏倚风险。通过评估标准化均数差（SMD）对主要结局指标进行分析。
荟萃分析共纳入7项研究（4项随机对照试验和3项前瞻性研究），包括416例患者。结果表明，在初始随访（4周）时，皮质类固醇显著降低了ODI评分（SMD = 0.48，95%CI：0.20至0.75，p = 0.0008，I² = 15%），在其他时间点两组之间的VAS和ODI评分无显著差异。报告了PRP组和皮质类固醇组的并发症发生率，未报告严重不良事件。
与PRP相比，皮质类固醇注射在患者早期功能改善方面表现显著。尽管在其他随访时间点PRP组和皮质类固醇组在疼痛和功能改善方面未观察到显著差异，但未来需要通过标准化PRP制备、延长随访时间和增加样本量来评估PRP与皮质类固醇注射治疗腰椎神经根性疼痛的疗效和安全性。
