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首页> 外文期刊>Arthroscopy: the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association >Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses
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Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses

机译：与其他疗法相比，关节内富含血小板的血浆注射剂在治疗膝骨关节炎方面是否提供临床上更好的结果？重叠荟萃分析的系统评价

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Purpose: The aims of this study were (1) to perform a systematic review of meta-analyses evaluating platelet-rich plasma (PRP) injection in the treatment of knee joint cartilage degenerative pathology, (2) to provide a framework for analysis and interpretation of the best available evidence to provide recommendations for use (or lack thereof) of PRP in the setting of knee osteoarthritis (OA), and (3) to identify literature gaps where continued investigation would be suggested. Methods: Literature searches were performed for meta-analyses examining use of PRP versus corticosteroids, hyaluronic acid, oral nonsteroidal anti-inflammatory drugs, or placebo. Clinical data were extracted, and meta-analysis quality was assessed. The Jadad algorithm was applied to determine meta-analyses that provided the highest level of evidence. Results: Three meta-analyses met the eligibility criteria and ranged in quality from Level II to Level IV evidence. All studies compared outcomes of treatment with intra-articular platelet-rich plasma (IA-PRP) versus control (intra-articular hyaluronic acid or intra-articular placebo). Use of PRP led to significant improvements in patient outcomes at 6 months after injection, and these improvements were seen starting at 2 months and were maintained for up to 12 months. It is unclear if the use of multiple PRP injections, the double-spinning technique, or activating agents leads to better outcomes. Patients with less radiographic evidence of arthritis benefit more from PRP treatment. The use of multiple PRP injections may increase the risk of self-limited local adverse reactions. After application of the Jadad algorithm, 3 concordant high-quality meta-analyses were selected and all showed that IA-PRP provided clinically relevant improvements in pain and function compared with the control treatment. Conclusions: IA-PRP is a viable treatment for knee OA and has the potential to lead to symptomatic relief for up to 12 months. There appears to be an increased risk of local adverse reactions after multiple PRP injections. IA-PRP offers better symptomatic relief to patients with early knee degenerative changes, and its use should be considered in patients with knee OA.
机译：目的：本研究的目的是（1）对评价富含血小板血浆（PRP）注射治疗膝关节软骨退变病理的荟萃分析进行系统评价，（2）提供分析和解释的框架最好的现有证据，为在膝骨关节炎（OA）中使用（或缺乏PRP）提供建议，以及（3）找出建议继续研究的文献空白。方法：文献检索进行荟萃分析，以检查PRP与皮质类固醇，透明质酸，口服非甾体抗炎药或安慰剂的使用。提取临床数据，并评估荟萃分析质量。 Jadad算法用于确定提供最高水平证据的荟萃分析。结果：三项荟萃分析均符合资格标准，其质量从II级到IV级证据不等。所有研究均比较了关节内富含血小板血浆（IA-PRP）与对照（关节内透明质酸或关节内安慰剂）的治疗结果。在注射后6个月，使用PRP可以显着改善患者的预后，并且从2个月开始观察到这些改善，并且可以维持长达12个月。尚不清楚使用多次PRP注射，双重纺丝技术或活化剂是否会产生更好的结果。放射影像学较少的关节炎患者可从PRP治疗中受益更多。使用多次PRP注射可能会增加自我限制的局部不良反应的风险。应用Jadad算法后，选择了3项一致的高质量荟萃分析，所有结果均表明IA-PRP与对照治疗相比在疼痛和功能上提供了临床上相关的改善。结论：IA-PRP是一种可行的膝OA治疗方法，有可能导致症状缓解长达12个月。多次注射PRP后，出现局部不良反应的风险增加。 IA-PRP可为膝关节退行性变早期患者提供更好的症状缓解，并且在膝OA患者中应考虑使用它。

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