关节内注射富血小板血浆治疗膝骨关节炎的Meta分析

发布时间：2018-06-11 17:41

本文选题：富血小板血浆 + 骨关节炎　；参考：《中华关节外科杂志(电子版)》2016年06期

【摘要】：目的评估关节内注射富血小板血浆(PRP)治疗膝骨关节炎的疗效和安全性。方法以"血小板"、"膝"、"骨关节炎"和"随机对照试验"为任意词进行系统检索,英文数据库包括Pubmed、Ovid、Science Direct和Cochrane library,中文数据库包括相关期刊论文、万方数据库和维普数据库。制定文献纳入和排除标准,并由2名研究员独立对文献进行数据摘录和质量评价。根据Cochrane系统评价员手册,对纳入文献进行分组,并做定性描述和定量Meta分析。采用逆方差方统计学方法,比较膝关节评分在PRP治疗前、后的变化和在PRP与其它保守治疗方法之间的差异。针对PRP与其它保守治疗方法之间发生不良反应的风险比的比较则采用Mantel-Haenszel统计学方法。结果共纳入10项研究,959例患者,随访时间从治疗后1~12个月。PRP治疗后1、2、3、4、6和12个月的膝关节评分均显著低于治疗前,差异有统计学意义(1个月:SMD=0.85,P0.05;2个月:SMD=0.97,P0.05;3个月:SMD=1.54,P0.01;4个月:SMD=1.21,P0.01;6个月:SMD=1.46,P0.01;12个月:SMD=1.47,P0.01)。仅有2项研究以生理盐水为安慰剂对照,在治疗后6个月,PRP组的膝关节评分均优于安慰剂组(SMD=1.59),差异有统计学意义(P=0.01),而PRP组的不良反应风险比与安慰剂组的差异无统计学意义(RR=2.99,P0.05)。7项研究比较了PRP与透明质酸治疗膝骨关节炎的疗效,在治疗后6个月PRP组的膝关节评分优于透明质酸,差异具有统计学意义(SMD=0.85,P0.05)。除1项研究认为PRP组不良反应高于透明质酸组外,其他4项研究合并分析的结果是两组的不良反应风险比的差异不具有统计学意义(RR=1.07,P0.05)。结论关节内注射PRP治疗膝骨关节炎是一种安全、有效的治疗方法。
[Abstract]:Objective to evaluate the efficacy and safety of intra-articular injection of platelet-rich plasma (PRP) in the treatment of knee osteoarthritis. Methods\? Criteria for inclusion and exclusion of literature were established, and data extraction and quality evaluation were conducted independently by two researchers. According to the Cochrane systematic reviewers' manual, the literature was grouped, and qualitative description and quantitative meta-analysis were made. Reverse variance square method was used to compare the changes of knee joint score before and after PRP treatment and the difference between PRP and other conservative treatment methods. Mantel-Haenszel statistical method was used to compare the risk ratio of adverse reactions between PRP and other conservative treatment methods. Results A total of 959 patients were included in 10 studies. The knee joint scores of 1 ~ 12 months after PRP treatment and 12 months after PRP treatment were significantly lower than those before treatment. The difference was statistically significant (1 month: 0. 85% SMD 0. 05 P 0. 05; 2 months: 1: SMD0. 97 P0. 05; 3 months: 1. 54% SMD1; 4 months: 1. 21% P0.01; 6 months: SMD1. 46; 12 months: SMD1. 07 P0.01. There were only two studies in which saline was used as a placebo control. At 6 months after treatment, the knee joint score of PRP group was better than that of placebo group (P < 0.01). There was no significant difference between PRP group and placebo group in adverse reaction risk ratio. There was no significant difference between PRP group and placebo group in terms of PRP and hyaluronic acid. Treatment of knee osteoarthritis, The knee joint score in PRP group was better than that in hyaluronic acid group at 6 months after treatment, and the difference was statistically significant. In addition to one study that the adverse reactions in PRP group were higher than those in hyaluronic acid group, the combined analysis of the other four studies showed that there was no significant difference in the adverse reaction risk ratio between the two groups. Conclusion Intraarticular injection of PRP is a safe and effective treatment for knee osteoarthritis.
【作者单位】：上海交通大学附属第六人民医院骨科;上海交通大学创伤骨科研究所流行病学研究室;
【基金】：国家自然科学基金(81401799) 上海市青年科技英才扬帆计划(14YF1412100)
【分类号】：R684.3

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