富血小板血浆在软骨损伤微骨折治疗的荟萃分析

Microfracture combined with platelet rich plasma for cartilage injury:A meta analysis

[目的]系统评价关节镜下微骨折联合富血小板血浆(platelet-rich plasma, PRP)与单纯微骨折治疗关节软骨损伤的临床疗效。[方法]计算机检索2021年12月26日以前PubMed、Embase、Cochrane、知网、万方、维普以及中国生物文献数据库中微骨折联合富含血小板血浆与单纯微骨折术治疗软骨损伤的临床对照研究。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软件对术后疼痛评分及关节功能评分进行分析。[结果]最终纳入9篇文献,共307例软骨损伤患者,其中PRP组158例,非PRP组149例。荟萃分析结果显示:PRP组术后6、12、24个月VAS评分均显著低于非PRP组(P<0.05);PRP组术后12、24个月膝关节IKDC评分均显著高于非PRP组(P<0.05)。末次随访时(平均21.4个月) PRP组踝关节AOFAS评分显著高于非PRP组(P<0.05)。[结论]联合PRP治疗可以在微骨折术的基础上进一步缓解关节疼痛,改善关节功能,起到增强微骨折术治疗效果的作用。

[Objective]To compare the clinical outcomes of microfracture combined with platelet-rich plasma(PRP)versus microfrac⁃ture only for treatment of cartilage lesions.[Method]The data bases,such as Cochrane Library,PubMed,Web of science,EMBASE,CNKI,Wanfang Data and CBM Data were searched for papers comparing clinical outcomes of microfracture combined with PRP versus microfrac⁃ture only for cartilage lesions from the setting up to December 2021.After literature screening,quality assessment,and data extraction were conducted to meet the inclusion and exclusion criteria,Rev-Man 5.3 was used to perform the meta-analysis of the parameters related to clinical consequences.[Results]A total of 9 articles were enrolled in this study,involving 307 patients with cartilage lesions,including 158 cases in the PRP group and 149 cases in the non-PRP group.As results of the meta-analysis,the PRP group proved significantly superior to the non-PRP group in term of VAS scores at 6,12 and 24 months after surgery(P<0.001;P<0.001;P=0.11).The PRP group proved sig⁃nificantly superior to the non-PRP group in term of IKDC scores at 12 and 24 months after surgery(P<0.001;P<0.001).The PRP group proved significantly superior to the non-PRP group in AOFAS scores at the final follow-up lasted for 21.4 months on a mean(P<0.001).[Conclusion]Microfracture combined with PRP does further relieve joint pain and improve joint function,which plays a role in enhancing the therapeutic effect of microfracture.