富血小板血浆治疗肩袖损伤术后的疗效:随机对照试验Meta分析

Platelet rich plasma combined with arthroscopic rotator cuff repair:a meta analysis of randomized controlled trials

目的比较单纯使用关节镜治疗与联合使用富血小板血浆(PRP)的疗效,为肩袖损伤的治疗方法提供循证依据。方法检索CENTRAL、Medline、PubMed、EMbase、CNKI、万方、维普、CBM数据库和手工检索会议文献等。通过制定纳入标准及排除标准纳入记录相关的随机对照试验的文献。检索时间均从该库建库始至2019年12月,检索词包括“platelet-rich plasma”、“rotator cuff”、“randomized controlled tria”、“富血小板血浆”、“肩袖损伤”等,纳入文献均为Ⅰ、Ⅱ级证据水平。收集每篇文献的样本量、患者年龄、性别、病程等数据,运用Cochrane Review Manager software 5.3评估文献方法学质量、偏倚评价、异质性评价、敏感性分析及数据统计。根据治疗方法不同分为关节镜组和PRP组,关节镜组单纯使用关节镜治疗,PRP组联合使用关节镜及富血小板血浆(PRP)。结果共检索出224篇文献,通过筛选共有14篇文献纳入研究,共纳入866例患者,最长随访时间60个月。统计结果显示,固定效应模型分析显示两组间Constant评分结果为MD=3.03,95%CI(1.56,4.51),P<0.001,结果差异有统计学意义;洛杉矶加州大学关节功能评分(UCLA)MD=1.62,95%CI(0.94,2.30),P<0.001;短期视觉模拟评分(VAS)(随访时间为3个月内)结果,差异有统计学意义MD=-1.45,95%CI(-2.13,-0.77),P<0.001;远期VAS(随访时间>3个月)MD=-0.11,95%CI(-0.18,-0.04),P=0.02。运用固定效应模型分析术中采用单排缝合技术的再撕裂率得出PRP组发生率更低OR=0.35,95%CI(0.16,0.78),P=0.01,双排缝合中OR=0.37,95%CI(0.21,0.65),P<0.001,提示PRP组再撕裂率更低,两者差异均有统计学意义;但在美国肩肘外科(ASES)评分中MD=1.67,95%CI(-0.19,3.52),P=0.08,差异无统计学意义。结论相较于单纯使用关节镜治疗肩袖损伤,PRP的联合使用可有效改善术后患者的活动功能及疼痛。对于再撕裂率而言,无论是术中采用单排缝合抑或是双排缝合,PRP的运用均可有效降低肩袖再撕裂的发生,提高临床疗效。

Objective To compare the efficacy of arthroscopic therapy alone and combined use of platelet-rich plasma so as to provide evidence basis for the treatment of rotator cuff injury.Methods Databases such as CENTRAL,Medline,PubMed,EMbase databases and manual conference proceedings were searched.Literatures containing relevant randomized controlled trials was established by setting inclusion and exclusion criteria.The retrieval time was from the construction of the library to Dec.2019.The Mesh words included"Platelet-Rich Plasma","Rotator Cuff","randomized controlled tria",etc.The included literatures were allⅠandⅡlevel of evidence.Sample size,patient age,gender,disease course and other data of each literature were collected.Cochrane Review Manager software 5.3 was used to evaluate the quality of literature methodology,bias evaluation,heterogeneity evaluation,sensitivity analysis and data statistics.According to different treatment methods,the patients were divided into the arthroscopic group treated by arthroscopy alone and the PRP group treated by arthroscopy combined with platelet rich plasma.Results A total of 224 literatures were retrieved,14 literatures were included in the study after screening and 866 patients were included.The maximum follow-up time was 60 months.According to the statistical results,there were statistical differences in Constant-Murley score[MD=3.03,95%CI(1.56,4.51),P<0.001],UCLA score[MD=1.62,95%CI(0.94,2.30),P<0.001],short-term VAS score(follow-up within 3 months)[MD=-1.45,95%CI(-2.13,-0.77),P<0.001],and long-term VAS score(follow-up time greater than 3 months)[MD=-0.11,95%CI(-0.18,-0.04),P=0.02].The fixed effects model was used to analyze the intraoperative re-tear rate of the single-row suture technique,and the incidence of PRP group was lower(OR=0.35,95%CI(0.16,0.78),P=0.01)in comparison to the double-row suture technique[OR=0.37,95%CI(0.21,0.65),P<0.001],indicating that the re-tear rate in the PRP group was lower,and both were statistically significant.However,there was no statistical difference in the American shoulder&elbow surgeons'score(ASES)[MD=1.67,95%CI(-0.19,3.52),P=0.08].Conclusions The combined use of PRP can effectively improve the mobility and pain of patients after surgery compared to the use of arthroscopy to treat rotator cuff injuries.For the retear rate,whether it is single row or double row suture during the operation,the use of PRP can effectively reduce the occurrence of rotator cuff retear,have a significant positive impact on the affected shoulder,and improve clinical efficacy.