经皮内镜下腰椎间盘切除术联合富血小板血浆注射治疗腰椎间盘突出症的临床疗效：一项系统评价与Meta分析
The clinical efficacy of percutaneous endoscopic lumbar discectomy combined with platelet-rich plasma injection for lumbar disc herniation: a systematic review and meta-analysis.
作者信息
Song Hua, Zhang Ying
机构信息
Department of Orthopaedics, Tengzhou Central People's Hospital, Tengzhou, Shandong, China.
Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, Yunnan, China.
出版信息
Front Surg. 2025 May 27;12:1601772. doi: 10.3389/fsurg.2025.1601772. eCollection 2025.
OBJECTIVE
Although percutaneous endoscopic lumbar discectomy (PELD) has shown favorable outcomes in the treatment of LDH patients, the issue of recurrence caused by potential disc degeneration remains unresolved. Regenerative therapy with platelet-rich plasma (PRP) injection offers the potential to reduce recurrence rates and improve clinical outcomes. This systematic review and meta-analysis evaluated the clinical efficacy of combining PELD with PRP injection as a novel therapeutic approach for LDH.
METHODS
A comprehensive literature search was conducted in the PubMed, Embase, Web of Science, and Cochrane databases, with the search period ending on October 30, 2024. Data were extracted and analyzed to evaluate recurrence rates, pain relief, functional outcomes, and intervertebral disc health status.
RESULTS
A total of 4 eligible studies were identified in this research, comprising 421 patients, of whom 212 received the combined treatment of PRP and PELD, while 209 underwent PELD alone. The results demonstrated that the combined PELD and PRP therapy significantly reduced recurrence rates (OR: 0.21, 95% CI: 0.07 to 0.64, = 0.006) and improved VAS pain scores for both back and leg pain at specific follow-up time. Additionally, intervertebral disc height at the final follow-up was significantly greater in the combined PELD and PRP group (MD: 0.88, 95% CI: 0.57 to 1.20, < 0.00001), indicating the potential of the combined therapy to restore degenerative discs.
CONCLUSIONS
The study indicates that PELD combined with PRP therapy provides better clinical outcomes compared to PELD alone, particularly in reducing recurrence rates, alleviating pain, and improving functional recovery. However, future studies with larger sample sizes and extended follow-up durations are warranted to validate the long-term efficacy and safety of this innovative therapeutic approach.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024621150, PROSPERO CRD42024621150.
目的
尽管经皮内镜下腰椎间盘切除术（PELD）在治疗腰椎间盘突出症（LDH）患者方面已显示出良好的效果，但由潜在椎间盘退变引起的复发问题仍未得到解决。富血小板血浆（PRP）注射再生疗法有可能降低复发率并改善临床疗效。本系统评价和荟萃分析评估了PELD联合PRP注射作为LDH的一种新型治疗方法的临床疗效。
方法
在PubMed、Embase、Web of Science和Cochrane数据库中进行了全面的文献检索，检索期截至2024年10月30日。提取并分析数据以评估复发率、疼痛缓解情况、功能结局和椎间盘健康状况。
结果
本研究共纳入4项符合条件的研究，包括421例患者，其中212例接受了PRP与PELD的联合治疗，209例仅接受了PELD治疗。结果表明，PELD与PRP联合治疗显著降低了复发率（OR：0.21，95%CI：0.07至0.64，P = 0.006），并在特定随访时间改善了背部和腿部疼痛的视觉模拟评分（VAS）。此外，PELD与PRP联合治疗组在最终随访时的椎间盘高度显著更高（MD：0.88，95%CI：0.57至1.20，P < 0.00001），表明联合治疗具有恢复退变椎间盘的潜力。
结论
该研究表明，与单纯PELD相比，PELD联合PRP治疗提供了更好的临床疗效，特别是在降低复发率、减轻疼痛和改善功能恢复方面。然而，需要未来进行更大样本量和更长随访时间的研究来验证这种创新治疗方法的长期疗效和安全性。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024621150，PROSPERO CRD42024621150。
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