中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (29): 4737-4743.doi: 10.3969/j.issn.2095-4344.2820

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    下一篇

关节镜下前交叉韧带重建应用富血小板血浆与对照组的比较

黄俊翰,陈  平,刘  军,陈海云,潘建科,吕  阳,何祥忠   

  1. 广州中医药大学第二附属医院/广东省中医院,广东省广州市  510006

  • 收稿日期:2019-11-15 修回日期:2019-11-19 接受日期:2019-12-26 出版日期:2020-10-18 发布日期:2020-09-15
  • 通讯作者: 陈海云,硕士,主任医师,广州中医药大学第二附属医院/广东省中医院 510006
  • 作者简介:Chen Haiyun, Master, Chief physician, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine/ Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510006, Guangdong Province, China
  • 基金资助:

    广东省财政厅项目(粤财社[2014]157)

Efficacy of platelet-rich plasma in arthroscopic anterior cruciate ligament reconstruction: a meta-analysis

Huang Junhan, Chen Ping, Liu Jun, Chen Haiyun, Pan Jianke, Lü Yang, He Xiangzhong   

  1. The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510006, Guangdong Province, China

  • Received:2019-11-15 Revised:2019-11-19 Accepted:2019-12-26 Online:2020-10-18 Published:2020-09-15
  • Contact: 黄俊翰,男,1994年生,广东省陆丰市人,广州中医药大学在读硕士,医师,主要从事创伤骨科及运动医学的研究。
  • About author:Huang Junhan, Master candidate, Plysician, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine/ Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510006, Guangdong Province, China
  • Supported by:

    a grant from Guangdong Provincial Finance Department, No. [2014]157

摘要:

文题释义:

富血小板血浆:是自体全血经过离心得到的血小板浓缩物,其包含多种生长因子,对组织的修复、愈合与再生有促进作用。

KT2000/ KT 1000是一种用以判定膝关节前后向稳定性的关节测量仪,通过测量胫骨股骨间的移动距离,来量化膝关节的松弛程度。

背景:目前富血小板血浆在软骨缺损、骨缺损等骨科领域的治疗中取得良好效果,但其在前交叉韧带重建手术中的临床效果尚未有共识。

目的:以Meta分析的方法评价富血小板血浆应用于关节镜下前交叉韧带重建术的临床疗效。

方法:计算机检索PubMedEMbasethe Cochrane LibraryCNKI、万方、维普和中国生物医学文献服务系统(CBM)中有关富血小板血浆应用于关节镜下前交叉韧带重建的随机对照试验,检索时限从建库至20199月,由2名研究员按照纳入与排除标准独立筛选文献、提取数据并进行文献质量评价。共纳入10篇随机对照试验,共595例患者,2组均进行关节镜下前交叉韧带重建,富血小板血浆组联合富血小板血浆治疗,非富血小板血浆组为空白对照或生理盐水治疗。采用RevMan 5.3软件进行Meta分析。

结果与结论①在Lysholm评分上,术后36个月时富血小板血浆组优于非富血小板血浆组[MD=9.2695%CI(6.5811.94)P < 0.000 01MD=5.1495%CI(3.047.23)P < 0.000 01],在术后12个月时2组差异无显著性意义[MD=2.1795%CI(-0.094.42)P=0.06];②在IKDC评分上,术后36个月时富血小板血浆组均优于非富血小板血浆组[MD=6.2995%CI(3.748.85)P < 0.000 01MD=1.8695%CI(0.253.47)P=0.02];③在KT-1000/2000关节测量上,富血小板血浆组优于非富血小板血浆组[MD=-1.0895%CI(-2.020.15)P=0.02];④在IKDC正常级别、接近正常级别、异常级别所占比例上,2组差异均无显著性意义[OR=1.1195%CI(0.592.08)P=0.75OR=1.0695%CI(0.552.05)P=0.87OR=0.4395%CI(0.092.02)P=0.28];⑤在目测类比评分上,2组术后312个月时的差异均无显著性意义[MD=-0.9995%CI(-2.060.07)P=0.07MD=-0.0895%CI(-0.990.84)P=0.87];④各研究间测量骨隧道增宽程度的方法不同,故进行描述性分析,在有限的证据下得出:2组在骨隧道增宽程度上结果相似;⑤结果说明,在关节镜下前交叉韧带重建的治疗中,富血小板血浆能改善术后中短期的膝关节功能,同样能加强膝关节的稳定性,但在短期或长期的疼痛缓解、减少骨隧道增宽上,2组没有明显差异。限于目前文献质量和样本量,上述结论尚需要更多高质量的研究进行验证。

关键词: 富血小板血浆, 关节镜, 前交叉韧带重建, Meta分析

Abstract:

BACKGROUND: Platelet-rich plasma has a favorable effect in the treatment of articular cartilage defects and bone defects. But there is still no consensus in its use for arthroscopic anterior cruciate ligament reconstruction.

OBJECTIVE: To evaluate the clinical efficacy of platelet-rich plasma in arthroscopic anterior cruciate ligament reconstruction by a meta-analysis.

METHODS: The randomized controlled trials concerning arthroscopic anterior cruciate ligament reconstruction with or without the use of platelet-rich plasma were retrieved in PubMed, EMbase, the Cochrane Library, CNKI, WanFang, VIP and CBM from inception to September 2019. According to inclusion and exclusion criteria, two searchers screened the literature, extracted the data and evaluated the quality independently, using RevMan 5.3 software for the meta-analysis. A total of 595 patients were enrolled in 10 randomized controlled trials. Both groups received arthroscopic anterior cruciate ligament reconstruction. The trial group was treated with platelet-rich plasma, while the control group was blank control or treated with normal saline.

RESULTS AND CONCLUSION: Meta-analysis results showed that in the Lysholm score, the trial group was superior to the control group at 3 and 6 months after surgery [mean difference (MD)=9.26, 95% confidence interval (CI) (6.58, 11.94), P < 0.000 01; MD=5.14, 95%CI (3.04, 7.23), P < 0.000 01]. There was no significant difference between the two groups at 12 months after surgery [MD=2.17, 95%CI (-0.09, 4.42), P=0.06]. In the International Knee Documentation Committee (IKDC) score, the trial group was superior to the control group at 3 and 6 months after surgery [MD=6.29, 95%CI (3.74, 8.85), P < 0.000 01; MD=1.86, 95%CI (0.25, 3.47), P=0.02]. There was no significant difference in the proportion of normal, nearly normal and abnormal IKDC scores between the two groups [odds ratio (OR)=1.11, 95%CI (0.59, 2.08), P=0.75; OR=1.06, 95%CI (0.55, 2.05), P=0.87; OR=0.43, 95%CI (0.09, 2.02), P=0.28]. In the KT-1000/2000 arthrometer measurement, the trial group was better than the control group [MD=-1.08, 95%CI (-2.02, 0.15), P=0.02]. In the Visual Analogue Scale score, there was no significant difference between the two groups at 3 and 12 months after surgery [MD=-0.99, 95%CI (-2.06, 0.07), P=0.07; MD=-0.08, 95%CI (-0.99, 0.84), P=0.87]. The methods used to measure the width of bone tunnel were different among the studies. Therefore, descriptive analysis was carried out and it was concluded from limited evidence that the two groups had similar results. To conclude, in the arthroscopic anterior cruciate ligament reconstruction, platelet-rich plasma could improve the function of the knee joint in the short and medium term after surgery, as well as the stability of the knee joint. However, there was no significant difference in short-term or long-term pain relief and prevention of bone tunnel widening between the two groups. Due to the limitation of current literature quality and sample size, more high-quality studies are needed to verify the above conclusions.

Key words: platelet-rich plasma, arthroscopy, anterior cruciate ligament reconstruction, meta-analysis

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