METHODS: A systematic review was performed with searches in the MEDLINE (PubMed), Scopus, Web of Science, and Cochrane (Central) databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Metanalytic procedures were performed for randomized controlled trials (RCTs), and a subgroup analysis was used for studies with target (approximately 10 6 cells·μL -1 ) or below-target PRP cellular concentrations (app. 5 × 10 5 cells·μL -1 ) regarding the primary outcome of tendon healing.
RESULTS: This review included 10 studies (8 RCTs) with 342 patients in the aRCR + PRP group and 344 patients with isolated aRCR. The risk of bias was low to intermediate (6/4, respectively). Meta-analysis of the RCT revealed that the aRCR + high-concentration PRP group had an approximately 3.9-fold higher chance of healing than the non-PRP group (odds ratio, 3.89; 95% confidence interval, 1.78-8.44; P = 0.0007). No significant difference in healing was found between the aRCR + low-concentration PRP and non-PRP groups (odds ratio, 2.21; 95% confidence interval, 0.66-7.45; P = 0.2). The Constant-Murley score and University of California Los Angeles scores were significantly improved in the aRCR + PRP groups with more than 12 months of follow-up, and no significant differences were found consistently for the American Shoulder and Elbow Society and visual analog scale scores.
CONCLUSIONS: This study highlights that a PRP cell concentration close to the target (10 6 cells·μL -1 ) of patients with aRCR may improve their healing and functional outcomes and that dosing may be potentially useful in therapy.
方法:在MEDLINE(PubMed)中进行了系统评价,Scopus,WebofScience,和Cochrane(中央)数据库根据系统评价和荟萃分析指南的首选报告项目。对随机对照试验(RCT)进行元分析程序,亚组分析用于目标(约106个细胞·μL-1)或低于目标的PRP细胞浓度的研究(app。5×105细胞·μL-1)关于肌腱愈合的主要结果。
结果:本综述纳入了10项研究(8项RCT),其中aRCR+PRP组342例患者和孤立aRCR组344例患者。偏倚风险低至中等(分别为6/4)。RCT的Meta分析显示,aRCR+高浓度PRP组比非PRP组有约3.9倍的愈合机会(优势比,3.89;95%置信区间,1.78-8.44;P=0.0007)。aRCR+低浓度PRP组和非PRP组之间愈合无显著差异(比值比,2.21;95%置信区间,0.66-7.45;P=0.2)。在超过12个月的随访中,aRCR+PRP组的Constant-Murley评分和加州大学洛杉矶分校评分显著提高,在美国肩肘协会和视觉模拟量表评分中,没有发现显着差异。
结论:本研究强调,PRP细胞浓度接近aRCR患者的目标(106个细胞·μL-1)可能会改善其愈合和功能结果,并且剂量可能对治疗有用。