联合注射富血小板血浆与透明质酸治疗膝骨关节炎效果评价

Efficacy of intra-articular injection of platelet rich plasma and hyaluronic acid in the treatment of knee osteoarthritis

目的比较关节腔内富血小板血浆与透明质酸联合注射与单独注射富血小板血浆治疗膝骨关节炎的临床疗效与安全性差异。方法检索2010年1月至2021年12月间发表的有关于关节腔内联合注射富血小板血浆与透明质酸和单独注射富血小板血浆治疗膝骨关节炎随机对照研究的相关文献,采用Revman 5.3软件对所有纳入研究文献的文献进行偏倚风险评估,采用Stata 16.0软件对数据进行处理与分析。疗效指标差异计算标准化均数差(SMD),差异比较行t检验;安全性指标差异计算比值比(OR),差异比较行t检验。结果①共计纳入相关研究文献7篇,全部为英文文献。②共计纳入研究患者总量为675例,其中330例患者采用关节腔内联合注射富血小板血浆与透明质酸进行治疗,345例患者采用关节腔内单独注射富血小板血浆进行治疗。③富血小板血浆与注射透明质酸联合注射与单独注射富血小板血浆患者的VAS评分结果比较,注射治疗1、3个月后,联合注射富血小板血浆与透明质酸患者的VAS评分与单独注射富血小板血浆患者的VAS评分相比,差异无统计学意义[SMD(95%CI)=-0.02(-0.30,0.27),t=-0.12,P=0.902;SMD(95%CI)=-0.40(-0.80,0.00),t=-1.97,P=0.051];注射治疗6个月后,联合注射富血小板血浆与透明质酸患者的VAS评分均明显低于单独注射富血小板血浆患者相应的VAS评分,差异具有统计学意义[SMD(95%CI)=-0.33(-0.55,-0.11),t=-2.98,P=0.012]。④联合注射富血小板血浆与透明质酸和单独注射富血小板血浆患者的WOMAC评分对比,注射治疗12个月后,联合注射富血小板血浆与透明质酸患者的WOMAC评分明显低于单独注射富血小板血浆患者相应的WOMAC评分,差异具有统计学意义[SMD(95%CI)=-0.30(-0.58,-0.03),t=-2.14,P=0.033]。⑤联合注射富血小板血浆与透明质酸的不良反应事件发生率明显低于单独注射富血小板血浆患者的发生率[OR(95%CI)=0.55(0.33,0.93),P=0.021]。结论相比于关节腔内单独注射富血小板血浆进行治疗,联合注射富血小板血浆与透明质酸的短期临床疗效与单独注射富血小板血浆的短期临床疗效相当,但长期的临床疗效明显更好,而且联合注射富血小板血浆与透明质酸的安全性明显更好。

Objective To compare the clinical efficacy and safety of intra-articular platelet rich plasma combined with hyaluronic acid and platelet rich plasma alone in the treatment of knee osteoarthritis.Methods The relevant literatures published between January 2010 and December 2021 on the randomized control study of intra-articular injection of platelet rich plasma and hyaluronic acid and injection of platelet rich plasma only in the treatment of knee osteoarthritis were searched.The bias risk of all the literatures included in the study was evaluated by Revman 5.3 software,and the data were processed and analyzed by Stata 16.0 software.The standardized mean difference(SMD)was calculated for the difference of efficacy indexes,and the difference was compared by t-test.The odds ratio(OR)was calculated for the difference of safety in-dex,and the difference was compared by t-test.Results ①A total of 7 relevant research literatures were in-cluded,all of which were in English.②A total of 675 patients were included in the study,of which 330 patients were treated with intra-articular injection of platelet rich plasma and hyaluronic acid,and 345 patients were treated with intra-articular injection of platelet rich plasma only.③The VAS scores of patients with platelet rich plasma and hyaluronic acid injection combined with injection and platelet rich plasma injection alone were compared.After 1 and 3 months of injection,the VAS scores of patients with platelet rich plasma combined with hyaluronic acid injection were compared with those of patients with platelet rich plasma injection only.There was no significant difference[SMD(95%CI)=-0.02(-0.30,0.27),t=-0.12,P=0.902;SMD(95%CI)=-0.40(-0.80,0.00),t=-1.97,P=0.051].After 6 months of injection,the VAS scores of patients with combined injection of platelet rich plasma and hyaluronic acid were significantly lower than those of patients with injection of platelet rich plasma only,and the difference was statistically significant[SMD(95%CI)=-0.33(-0.55,-0.11),t=-2.98,P=0.012].④The WOMAC scores of patients with combined injection of platelet rich plasma,hyaluronic acid and platelet rich plasma only were compared.After 12 months of treatment,the WOMAC scores of patients with combined injection of platelet rich plasma and hyaluronic acid were significantly higher than those of patients with PRP only,and the difference was statistically significant[SMD(95%CI)=-0.30(-0.58,-0.03),t=-2.14,P=0.033].⑤The incidence of adverse events of platelet rich plasma combined with hyaluronic acid was lower than that of platelet rich plasma only[OR(95%CI)=0.55(0.33,0.93),P=0.021].Conclusion Compared with intra-articular injection of platelet rich plasma only,the short-term clinical efficacy of combined injection of platelet rich plasma and hyaluronic acid is equivalent to that of injection of platelet rich plasma only,but the long-term clinical efficacy is significantly better,and the safety of combined injection of platelet rich plasma and hyaluronic acid is significantly better.