关节镜清理联合富血小板血浆注射治疗膝骨关节炎的Meta分析

Meta-analysis of arthroscopic debridement combined with platelet-rich plasma injection in the treatment of knee osteoarthritis

目的:评价关节镜清理联合富血小板血浆(PRP)注射治疗膝骨关节炎(KOA)的临床疗效。方法:运用计算机在中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方(Wanfang)、维普(VIP)、PubMed、Embase、The Cochrane Library等数据库中检索关节镜清理联合PRP治疗KOA的随机对照试验(RCT)文献,时间范围为从数据库建库开始至2023年8月。运用RevMan 5.3软件和Stata 14软件进行Meta分析。结果:共检索到文献2 064篇,筛选后最终纳入17篇文献进行Meta分析,共1 280例患者,分析结果显示:(1)与单用关节镜清理术相比,关节镜清理联合PRP注射治疗的有着更高的临床有效率(OR=5.37,95%CI 3.21~8.99,P<0.001)。(2)与单用关节镜清理术相比,关节镜清理联合PRP注射治疗的VAS评分(3个月:MD=-1.50,95%CI-2.04~-0.96,P<0.001;6个月:MD=-1.33,95%CI-1.77~-0.89,P<0.001;12个月:MD=-1.30,95%CI-1.98~-0.62,P=0.000 2)、Lysholm评分(3个月:MD=10.26,95%CI 5.49~15.04,P<0.001;6个月:MD=4.95,95%CI 0.59~9.31,P=0.03;12个月:MD=9.76,95%CI 7.89~11.63,P<0.001)以及TNF-α水平(MD=-22.55,95%CI-41.70~-3.40,P=0.02)、IL-1β水平(MD=-24.38,95%CI-30.85~-17.90,P<0.001)均有着更好的结果。(3)关节镜清理联合PRP注射治疗的不良反应发生率与单用关节镜清理术相比并无统计学意义。结论:与单用关节镜清理术相比,关节镜清理联合PRP注射治疗KOA的临床疗效更好,具体表现在提高临床有效率、减轻关节疼痛、改善关节功能和降低炎症因子水平方面,但仍需更多高质量的RCT来进一步验证。

Objective:To evaluate the clinical efficacy of arthroscopic debridement combined with platelet-rich plasma(PRP)injection in the treatment of knee osteoarthritis(KOA).Methods:Randomized controlled trial(RCT)of arthroscopic debridement combined PRP injection in the treatment of knee osteoarthritis were searched and selected from databases including China Biology Medicine(CBM),China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP database,PubMed,Embase and Cochrane Library.With a time frame from library construction to August 2023.RevMan 5.3 and Stata 14 were used to perform Meta-analysis.Results:A total of 2064 papers were retrieved,and 17 papers were finally included in the Meta-analysis after screening,and involving 1280 participants.The results of the analysis showed that:(1)Compared with arthroscopic debridement alone,arthroscopic debridement combined with PRP injection had a higher clinical efficacy rate(OR=5.37,95%CI 3.21-8.99,P<0.001).(2)Arthroscopic debridement combined with PRP injection in the treatment of KOA was superior to arthroscopic debridement alone with regard to VAS score(March:MD=-1.50,95%CI-2.04--0.96,P<0.001;June:MD=-1.33,95%CI-1.77--0.89,P<0.001;Dec:MD=-1.30,95%CI-1.98--0.62,P=0.0002);Dec:MD=-1.33,95%CI(-1.77~-0.89),P<0.00001Lysholm score(March:MD=10.26,95%CI 5.49-15.04,P<0.001;June:MD=4.95,95%CI 0.59-9.31,P=0.03;Dec:MD=9.76,95%CI 7.89-11.63,P<0.001),as well as TNF-αlevel(MD=-22.55,95%CI-41.70--3.40,P=0.02)and IL-1βlevel(MD=-24.38,95%CI-30.85--17.90,P<0.001).(3)The incidence of adverse effects of arthroscopic debridement combined with PRP injection therapy was not statistically significant compared to arthroscopic debridement alone.Conclusion:Compared with arthroscopic debridement alone,arthroscopic debridement combined with PRP injection in the treatment of KOA has better clinical efficacy in terms of increased clinical efficacy,reduced joint pain,improved joint function,and reduced levels of inflammatory factors,but more high-quality RCTs are needed for further validation.