前交叉韧带重建术联合富血小板血浆关节腔注射治疗前交叉韧带损伤临床疗效和安全性的Meta分析

Clinical efficacy and safety of anterior cruciate ligament reconstruction combined with intra-articular injection of platelet-rich plasma for treatment of anterior cruciate ligament injury:a meta-analysis

目的:评价前交叉韧带(anterior cruciate ligament,ACL)重建术联合富血小板血浆(platelet rich plasma,PRP)关节腔注射治疗ACL损伤的临床疗效和安全性。方法:应用计算机检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、维普网和万方数据库中关于ACL重建术联合PRP关节腔注射治疗ACL损伤的随机对照试验文献,检索时限均为建库至2020年12月。试验组采用ACL重建术联合PRP关节腔注射治疗,对照组采用ACL重建术治疗。由2名研究者根据纳入和排除标准独立进行文献筛选和数据提取,意见不一致时讨论解决。采用Cochrane手册中的偏倚风险评估工具对纳入文献的质量进行评估,采用RevMan5.3软件进行数据统计分析。结果:共检索到585篇文献,通过逐层筛选,最终纳入12篇文献,其中中文文献8篇,英文文献4篇,共涉及681例患者。Meta分析结果显示,试验组和对照组患者膝关节疼痛视觉模拟量表评分、Lysholm膝关节评分、国际膝关节文献委员会膝关节评分、胫骨相对前移距离KT1000/2000测量值、韧带重建MRI评分、股骨隧道直径、胫骨隧道直径、骨隧道直径(将股骨隧道直径和胫骨隧道直径合并)的组间差异均无统计学意义[MD=0.22,95%CI(-0.14,0.57),P=0.230;MD=1.61,95%CI(-0.73,3.95),P=0.180;MD=2.32,95%CI(-0.92,5.55),P=0.160;MD=0.08,95%CI(-0.98,1.15),P=0.880;MD=0.24,95%CI(-0.04,0.52),P=0.090;MD=-0.25,95%CI(-1.10,0.61),P=0.57;MD=0.17,95%CI(-0.77,1.10),P=0.730;MD=-0.08,95%CI(-0.85,0.69),P=0.840]。结论:采用ACL重建术联合PRP关节腔注射与采用ACL重建术治疗ACL损伤的临床疗效和安全性相当。

Objective:To evaluate the clinical efficacy and safety of anterior cruciate ligament(ACL)reconstruction(ACLR)combined with intra-articular injection of platelet-rich plasma(PRP)for treatment of ACL injury.Methods:All the randomized controlled trial(RCT)articles about ACLR combined with intra-articular injection of PRP for treatment of ACL injury included from database establishing to December 2020 were retrieved from the PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Internet, Vip Database and Wanfang Database through computer.The patients in experimental group were treated with ACLR combined with intra-articular injection of PRP,while the ones in control group with ACLR alone.The articles were screened and the information was extracted independently by two researchers according to the inclusion and exclusion criteria, and if any disagreement was found between them, discussion was conducted for making a final decision.The methodological quality of research in the articles was evaluated by using bias risk assessment tools recommended by Cochrane handbook, and then a Meta-analysis was conducted by using RevMan5.3 software.Results:Five hundred and eighty-five articles were searched out.After screening, 12 articles(681 patients)were included in the final analysis, including 8 Chinese articles and 4 English articles.The results of Meta-analysis revealed that there was no statistical difference in knee pain visual analogue scale(VAS)score, Lysholm knee score, International Knee Documentation Committee(IKDC)knee score, value of relative forward distance of tibia measured by KT1000/2000,MRI scores of ligament reconstruction, femoral tunnel diameter, tibial tunnel diameter and merged bone tunnel diameter between experimental group and control group(MD=0.22,95%CI(-0.14,0.57),P=0.230;MD=1.61,95%CI(-0.73,3.95),P=0.180;MD=2.32,95%CI(-0.92,5.55),P=0.160;MD=0.08,95%CI(-0.98,1.15),P=0.880;MD= 0. 24,95% CI(-0. 04,0. 52),P = 0. 090;MD =-0. 25,95% CI(-1. 10,0. 61),P = 0. 57;MD = 0. 17,95% CI(-0. 77,1. 10),P =0. 730;MD =-0. 08,95% CI(-0. 85,0. 69),P = 0. 840). Conclusion: ACLR combined with intra-articular injection of PRP is similar to ACLR in clinical efficacy and safety in treatment of ACL injury.