关节镜手术联合富血小板血浆治疗半月板损伤的Meta分析

Arthroscopic surgery combined with platelet-rich plasma for meniscus injury:a Meta-analysis

目的:探讨关节镜手术联合富血小板血浆(platelet-rich plasma,PRP)治疗半月板损伤的临床疗效。方法:计算机检索PubMed、Science Direct、Cochrane library、中国期刊全文数据库、万方数据库和维普数据库中关节镜手术联合PRP与单纯关节镜手术修复半月板损伤的临床对照研究,检索时间自2015年1月至2019年12月。根据纳入和排除标准,进行文献筛查、数据提取并评价其方法学质量。采用RevMan 5.3软件比较两种治疗方式术后1,6,12个月的膝关节疼痛视觉模拟评分(visual analogue scale,VAS),Lysholm评分和术后3,6,12个月西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster University Osteoarthritis Index,WOMAC)。结果:共纳入9项研究,329例半月板损伤患者,关节镜手术联合PRP组146例,单纯关节镜手术组183例。两组术后1、6、12个月VAS评分比较差异无统计学意义(P>0.05)。两组术后1,6个月Lysholm评分[MD=3.85,95%CI(1.25,6.44),P<0.05],[MD=2.88,95%CI(0.13,5.63),P<0.05]比较差异有统计学意义;术后12个月Lysholm评分比较差异无统计学意义[MD=5.88,95%CI(-8.72,20.48),P=0.43]。两组术后3、6个月WOMAC比较差异有统计学意义[MD=-8.07,95%CI(-11.17,-4.89),P<0.00001],[MD=-7.96,95%CI(-11.44,-4.48),P<0.00001];但术后12个月WOMAC评分比较差异无统计学意义[MD=-6.61,95%CI(-16.64,3.41),P>0.05]。结论:关节镜手术联合PRP修复半月板损伤在改善膝关节功能,延缓关节炎方面短期疗效优于单纯关节镜手术,但两者长期疗效及缓解疼痛方面疗效相当。

Objective:To evaluate clinical efficacy of arthroscopic with platelet-rich plasma(PRP)in treating meniscus injury.Methods:From January 2015 to December 2019,clinical control study on repair meniscus injury by arthroscopic with PRP between arthroscopic were searched by PubMed,Science Direct,Cochrane library,Chinese Journal Full-text Database,Wanfang and VIP database.Literature screening,data extraction and quality evaluation according to inclusion and exclusion criteria.Visual analogue scale(VAS)of knee joint and Lysholm score at 1,6 and 12 months after opertaion between two groups were compared,and Western Ontario and McMaster University Osteoarthritis Index(WOMAC)at 3,6 and 12 months after opertaion between two groups were also compared.Results:Totally 9 literatures and 329 patients with meniscal injuries were screened,include 146 patients treated by arthroscopic with PRP and 183 patients treated by arthroscopic.There were no statistical differences in VAS between two groups at 1,6 and 12 months after opertaion.There were differences in Lysholm score at 1 and 6 months after operation between two groups[MD=3.85,95%CI(1.25,6.44),P<0.05],[MD=2.88,95%CI(0.13,5.63),P<0.05];while there was no difference at 12 months[MD=5.88,95%CI(-8.72,20.48),P=0.43].There were differneces in WOMAC score at 3 and 6 months after operation between two groups[MD=-8.07,95%CI(-11.17,-4.89),P<0.00001],[MD=-7.96,95%CI(-11.44,-4.48),P<0.00001];and no difference at 12 months after operation[MD=-6.61,95%CI(-16.64,3.41),P>0.05].Conclusion:Arthroscopic with PRP for repair meniscus injury has short-term efficacy of knee function and delay arthritis,while has similar effect in long-term clinical efficacy and relieve pain.