PDF(Pubmed)
Abstract：
There is a cohort of patients in whom hip preservation surgery is not indicated, because they have developed signs of early osteoarthritis (OA), and nor can they have a hip replacement, as they are too early in the disease process. Management of this cohort of patients is not standardised and both pharmacological and nonpharmacological measures are utilised to reduce pain. Interventions available for early OA include intra-articular injections of steroids, viscosupplementation and more recently platelet-rich plasma (PRP). However, the use of PRP in hip OA has not yet been studied systematically.
To assess intra-articular PRP as a therapeutic intervention for hip OA, including the duration of efficacy, influence of dose and composition of PRP, and the incidence of adverse effects.
A systematic review and meta-analysis; Level of evidence, 4.
We performed literature searches on the MEDLINE, EMBASE, CINAHL, WEB OF SCIENCE, COCHRANE, and SCOPUS databases, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Data were pooled using random-effects meta-analysis. We assessed the quality of the included studies using the methodological index for non-randomized studies instrument, with an additional assessment for randomized controlled trials with the revised Cochrane risk of bias tool for randomized trials. This is the first study to concisely collate the available data on the use of PRP in hip OA.
Eight studies were included in the analysis, with data from a total of 331 patients. PRP significantly reduced pain compared with the baseline at multiple time points, with the greatest effect at the 1- to 2-month follow-up, but PRP significantly improved function only at the 1- to 2-month follow-up. A significantly larger reduction in pain was achieved with a single injection of PRP compared with multiple injections, a total injected dose of PRP <15 mL compared with ≥15 mL, and use of a leukocyte-poor PRP preparation compared with leukocyte-rich PRP. There were no lasting adverse effects.
Low- and moderate-quality evidence suggests that PRP reduces pain and improves function at the end-point follow-up of studies compared with the baseline. Moderate-quality evidence suggests that a larger reduction in pain is achieved with a single injection of PRP compared with multiple injections, and low-quality evidence attributes a larger reduction of pain with a total injected dose of PRP <15 mL compared with ≥15 mL and using leukocyte-poor PRP compared with leukocyte-rich PRP.
To assess intra-articular PRP as a therapeutic intervention for hip OA, including the duration of efficacy, influence of dose and composition of PRP, and the incidence of adverse effects.
A systematic review and meta-analysis; Level of evidence, 4.
We performed literature searches on the MEDLINE, EMBASE, CINAHL, WEB OF SCIENCE, COCHRANE, and SCOPUS databases, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Data were pooled using random-effects meta-analysis. We assessed the quality of the included studies using the methodological index for non-randomized studies instrument, with an additional assessment for randomized controlled trials with the revised Cochrane risk of bias tool for randomized trials. This is the first study to concisely collate the available data on the use of PRP in hip OA.
Eight studies were included in the analysis, with data from a total of 331 patients. PRP significantly reduced pain compared with the baseline at multiple time points, with the greatest effect at the 1- to 2-month follow-up, but PRP significantly improved function only at the 1- to 2-month follow-up. A significantly larger reduction in pain was achieved with a single injection of PRP compared with multiple injections, a total injected dose of PRP <15 mL compared with ≥15 mL, and use of a leukocyte-poor PRP preparation compared with leukocyte-rich PRP. There were no lasting adverse effects.
Low- and moderate-quality evidence suggests that PRP reduces pain and improves function at the end-point follow-up of studies compared with the baseline. Moderate-quality evidence suggests that a larger reduction in pain is achieved with a single injection of PRP compared with multiple injections, and low-quality evidence attributes a larger reduction of pain with a total injected dose of PRP <15 mL compared with ≥15 mL and using leukocyte-poor PRP compared with leukocyte-rich PRP.
摘要：
■有一组患者没有进行髋关节保留手术，因为他们已经出现了早期骨关节炎（OA）的迹象，他们也不能做髋关节置换手术,因为它们在疾病过程中还为时过早。该患者队列的管理未标准化，并且使用药理学和非药理学措施来减轻疼痛。早期OA的干预措施包括关节内注射类固醇，粘性补充和最近富含血小板的血浆（PRP）。然而,PRP在髋关节OA中的应用尚未得到系统研究。
■为了评估关节内PRP作为髋关节OA的治疗干预措施，包括疗效的持续时间，PRP的剂量和成分的影响，以及不良反应的发生率。
■系统评价和荟萃分析；证据水平，4.
■我们在MEDLINE上进行了文献检索，EMBASE,CINAHL,WEB的科学,Cochrane,和SCOPUS数据库，并遵循PRISMA（系统审查和荟萃分析的首选报告项目）指南。使用随机效应荟萃分析汇总数据。我们使用非随机研究工具的方法学指数评估纳入研究的质量，使用修订后的Cochrane偏倚风险工具对随机对照试验进行额外评估。这是第一项简要整理有关PRP在髋关节OA中使用的可用数据的研究。
■分析中包括了8项研究，数据来自总共331名患者。与基线相比，PRP在多个时间点显著减轻疼痛，在1至2个月的随访中效果最大，但PRP仅在1至2个月的随访中显着改善了功能。与多次注射相比，单次注射PRP可明显减轻疼痛。PRP的总注射剂量<15mL，与≥15mL相比，与富含白细胞的PRP相比，使用缺乏白细胞的PRP制剂。没有持久的不良反应。
■低质量和中等质量的证据表明，与基线相比，PRP在研究的终点随访中减轻了疼痛并改善了功能。中等质量的证据表明，与多次注射相比，单次注射PRP可实现更大的疼痛减轻。和低质量证据归因于与≥15mL相比,注射总剂量PRP<15mL时,与使用富含白细胞的PRP相比,使用缺乏白细胞的PRP时,疼痛减轻更大.
■为了评估关节内PRP作为髋关节OA的治疗干预措施，包括疗效的持续时间，PRP的剂量和成分的影响，以及不良反应的发生率。
■系统评价和荟萃分析；证据水平，4.
■我们在MEDLINE上进行了文献检索，EMBASE,CINAHL,WEB的科学,Cochrane,和SCOPUS数据库，并遵循PRISMA（系统审查和荟萃分析的首选报告项目）指南。使用随机效应荟萃分析汇总数据。我们使用非随机研究工具的方法学指数评估纳入研究的质量，使用修订后的Cochrane偏倚风险工具对随机对照试验进行额外评估。这是第一项简要整理有关PRP在髋关节OA中使用的可用数据的研究。
■分析中包括了8项研究，数据来自总共331名患者。与基线相比，PRP在多个时间点显著减轻疼痛，在1至2个月的随访中效果最大，但PRP仅在1至2个月的随访中显着改善了功能。与多次注射相比，单次注射PRP可明显减轻疼痛。PRP的总注射剂量<15mL，与≥15mL相比，与富含白细胞的PRP相比，使用缺乏白细胞的PRP制剂。没有持久的不良反应。
■低质量和中等质量的证据表明，与基线相比，PRP在研究的终点随访中减轻了疼痛并改善了功能。中等质量的证据表明，与多次注射相比，单次注射PRP可实现更大的疼痛减轻。和低质量证据归因于与≥15mL相比,注射总剂量PRP<15mL时,与使用富含白细胞的PRP相比,使用缺乏白细胞的PRP时,疼痛减轻更大.
