目的:系统评价临床疗效(疼痛,函数,生活质量)和富血小板血浆(PRP)治疗冻结肩的安全性,为PRP治疗冻结肩的有效性提供循证医学证据。
方法:在国际数据库上进行了搜索(Pubmed,WebofScience,Embase)和中文数据库(CNKI,万方,VIP),以搜索从开始到2024年1月发表的有关富血小板血浆治疗冻结肩(粘连性囊炎/肩周炎/50肩)的疗效的临床研究及其相应参考文献。彻底排除不符合预定纳入标准的文献,从文献中提取相关数据,并将其输入RevMan5.4进行荟萃分析。
结果:这项研究最终包括14项随机对照试验,共1024名患者。结果表明,与对照组相比,PRP在VAS中具有显着优势(均差(MD)=-0.38,95%置信区间(CI)(-0.73,-0.03),P=0.03),加州大学洛杉矶分校(MD=3.31,95%CI(1.02,5.60),P=0.005),DASH(MD=-4.94,95%CI(-9.34,-0.53),P=0.03),SPADI(SPADI总计:MD=-16.87,95%CI(-22.84,-10.91),P<0.00001;SPADI疼痛:MD=-5.38,95%CI(-7.80,-2.97),P<0.0001;SPADI残疾:MD=-11.00,95%CI(-13.61,-8.39),P<0.00001),以及主动和被动运动范围(主动屈曲:MD=12.70,95%CI(7.44,17.95),P<0.00001;被动屈曲:MD=9.47,95%CI(3.80,15.14),P=0.001;主动延伸:MD=3.45,95%CI(2.39,4.50),P<0.00001;主动外展:MD=13.54,95%CI(8.42,18.67),P<0.00001;被动外展:MD=14.26,95%CI(5.97,22.56),P=0.0008;主动内旋:MD=5.16,95%CI(1.84,8.48),P=0.002;被动内旋:MD=3.65,95%CI(1.15,6.15),P=0.004;主动外旋:MD=10.50,95%CI(5.47,15.53),P<0.0001;被动外旋:MD=6.00,95%CI(1.82,10.19),P=0.005),被动延伸除外(MD=2.25,95%CI(-0.77,5.28),P=0.14)。在安全方面,大多数研究报告没有不良反应,只有一项研究报告了PRP组和对照组的关节穿刺常见并发症,如治疗后肿胀和疼痛。以前的研究表明,由皮质类固醇引起的骨坏死的风险。因此,PRP治疗的安全性更可靠。
结论:结果显示,PRP在治疗肩周炎方面比皮质类固醇和其他对照组更持久,更安全。
方法:系统评价。
背景:PROSPEROCRD42022359444,注册日期:22-09-2022。
OBJECTIVE: To systematically review the clinical efficacy (pain, function, quality of life) and safety of platelet-rich plasma (PRP) in the treatment of frozen shoulder through meta-analysis, and provide evidence-based medical evidence for the effectiveness of PRP in the treatment of frozen shoulder.
METHODS: A search was conducted on international databases (Pubmed, Web of science, Embase) and Chinese databases (CNKI, Wanfang, VIP) to search the clinical studies on the efficacy of platelet-rich plasma in treating frozen shoulder (adhesive capsulitis/periarthritis/50 shoulder) and their corresponding references published from inception until January 2024. Thoroughly excluded literature not meeting the predetermined inclusion criteria, extracted relevant data from the literature, and input it into RevMan5.4 for meta-analysis.
RESULTS: This study ultimately included 14 RCTs, with a total of 1024 patients. The results showed that PRP has significant advantages compared with control groups in VAS (mean difference (MD) =-0.38, 95% confidence interval(CI)(-0.73, -0.03), P = 0.03), UCLA (MD = 3.31, 95% CI (1.02,5.60),P = 0.005), DASH (MD = -4.94,95% CI (-9.34, -0.53),P = 0.03), SPADI (SPADI Total: MD =-16.87, 95% CI (-22.84, -10.91), P < 0.00001; SPADI Pain: MD =-5.38, 95% CI (-7.80, -2.97), P < 0.0001; SPADI Disability: MD =-11.00, 95% CI (-13.61,-8.39), P < 0.00001), and the active and passive Range of Motion (active flexion: MD = 12.70, 95% CI (7.44, 17.95), P < 0.00001; passive flexion: MD = 9.47, 95% CI(3.80, 15.14), P = 0.001; active extension: MD = 3.45, 95% CI(2.39, 4.50), P < 0.00001; active abduction: MD = 13.54, 95% CI(8.42, 18.67), P < 0.00001; passive abduction: MD = 14.26, 95% CI (5.97, 22.56), P = 0.0008; active internal rotation: MD = 5.16, 95% CI (1.84, 8.48), P = 0.002; passive internal rotation: MD = 3.65, 95% CI(1.15, 6.15), P = 0.004; active external rotation: MD = 10.50, 95% CI(5.47, 15.53), P < 0.0001; passive external rotation: MD = 6.00, 95% CI (1.82, 10.19), P = 0.005) except passive extension (MD = 2.25, 95% CI (-0.77, 5.28), P = 0.14). In terms of safety, most studies reported no adverse effects, and only one study reported common complications of joint puncture such as swelling and pain after treatment in both PRP and control groups. Previous studies have shown a risk of osteonecrosis caused by corticosteroids. Therefore, the safety of PRP treatment is more reliable.
CONCLUSIONS: The results showed that PRP was more durable and safer than corticosteroids and other control groups in the treatment of frozen shoulder.
METHODS: Systematic review.
BACKGROUND: PROSPERO CRD42022359444, date of registration: 22-09-2022.