关节镜联合富血小板血浆修复半月板疗效的Meta分析  

Meta-analysis of arthroscope combined with platelet-rich plasma for meniscus repair

作　　者：陈健 吴波文 徐强[1] 王镖[1] 邱尔钺 刘志勤[1] 曾武思 张锡平[1] Chen Jian;Wu Bowen;Xu Qiang;Wang Biao;Qiu Eryue;Liu Zhiqin;Zeng Wusi;Zhang Xiping(The Affiliated Zhuzhou Hospital Xiangya Medical College CSU, Zhuzhou 412007, China)

机构地区：[1]中南大学湘雅医学院附属株洲医院,株洲412007

出　　处：《中华关节外科杂志（电子版）》2020年第6期709-716,共8页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：湖南省自然科学基金(2019JJ60083)。

摘　　要：目的系统评价关节镜联合富血小板血浆(PRP)修复半月板损伤的短期疗效。方法对中国知网,维普,万方数据,PubMed,Web of Science,Cochrance Library及荷兰医学文摘(Embase)等数据库进行检索,选择关节镜联合PRP修复半月板和单纯关节镜修复半月板的随机对照试验(RCT)及临床对照试验。采用RevMan 5.3软件对纳入的研究进行异质性检验和Meta分析,Cochrane系统评价工具评估文献发表偏倚。结果共纳入11篇相关文献。结果显示:PRP组疼痛视觉模拟评分(VAS)改善显著优于对照组,其差异具有统计学意义[均数差(MD)=-0.92,I2=99%,95%置信区间(CI)(-1.54,-0.30),P=0.004];PRP组Lysholm膝关节评分(LKS评分)改善显著优于对照组,其差异具有统计学意义[MD=5.69,I2=86%,95%CI(2.19,9.19),P=0.001];PRP组西安大略和曼彻斯特大学关节炎指数(WOMAC)评分改善显著优于对照组,其差异具有统计学意义[MD=-5.90,I2=74%,95%CI(-9.68,-2.12),P=0.002];PRP组半月板修复失败率明显低于对照组,其差异具有统计学意义[MD=0.44,I2=0%,95%CI(0.21,0.90),P=0.02]。结论关节镜联合富血小板血浆修复半月板损伤可取得较好的临床效果,短期内可改善患者症状,促进膝关节功能的恢复。但纳入文献存在一定的发表偏倚,各研究间存在一定程度的异质性,样本量小,相关评价指标比较分散,试验设计不够严谨,仍需更多设计严谨的大样本量临床试验加以验证。Objective To systematically evaluate the short-term efficacy of arthroscope combined with platelet-rich plasma(PRP)in meniscus repair.Methods The articles about arthroscope combined with platelet-rich plasma for meniscus repair and arthroscopic meniscus repair were searched in China National Knowledge Infrastructure(CNKI),Viper,Wanfang data,PubMed,Web of Science,cochrance Library,and Excerpta Medica Database(Embase).The databases from a randomized controlled trial(RCTS)and clinical controlled trial of arthroscope combined with PRP for meniscus repair and arthroscopic repair of meniscus alone were selected.The meta-analysis and heterogeneity test were performed with RevMan 5.3 software and and Cochrane systematic evaluation tools were used to evaluate literature publication bias.Results Eleven relevant literatures were included,the visual analogue scale(VAS)score in PRP group was significantly improved compared with the control group[mean difference(MD)=-0.92,I2=99%,95%confidence interval(CI)(-1.54,-0.30),P=0.004].The Lysholm knee score(LKS score)in PRP group was significantly improved compared with the control group[MD=5.69,I2=86%,95%CI(2.19,9.19),P=0.001].The University of Western Ontario and McMaster arthritis index(WOMAC)in PRP group was significantly improved compared with the control group[MD=-5.90,I2=74%,95%CI(-9.68,-2.12),P=0.002].The failure rate of meniscus repair in PRP group was significantly lower than that of the control group[MD=0.44,I2=0%,95%CI(0.21,0.90),P=0.02].Conclusions Arthroscope combined with PRP to repair meniscus injury can achieve good clinical results,improve the symptoms of patients and promote the recovery of knee function in the short term.However,there is a certain publication bias in the included literature,a certain degree of heterogeneity among studies,small sample size,relatively scattered related evaluation indicators,and insufficient experimental design,which still needs to be verified by more large sample size clinical trials with rigorous design.

关 键 词：半月板 胫骨 创伤和损伤 富血小板血浆 关节镜 META分析 

分 类 号：R687.4[医药卫生—骨科学]