富血小板血浆治疗冻结肩的临床疗效的系统评价与Meta分析

Clinical efficacy of platelet-rich plasma on frozen shoulder:a systematic review and Meta-analysis of randomized controlled trials

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摘要目的系统性评价富血小板血浆(platelet-rich plasma,PRP)治疗冻结肩的临床疗效及安全性,为其治疗冻结肩的有效性提供循证医学证据.方法检索自建库起至 2022 年 9 月国内外各数据库有关肩关节注射 PRP 治疗冻结肩的相关研究.严格筛选出符合纳入标准的文献,提取数据信息并录入 RevMan5.4进行 Meta 分析.结果最终纳入随机对照研究(randomized controlled trial,RCT)10 篇,患者 717 例.分析结果表明,PRP 治疗后肩关节的疼痛视觉模拟评分(visual analogue scale,VAS)[MD =-0.51,95%CI(-0.88,-0.14),P = 0.007]、美国加州大学肩关节评分(UCLA)[MD = 3.31,95%CI(1.02,5.60),P = 0.005]、肩关节疼痛残疾指数(SPADI)[SPADI Total:MD =-17.33,95%CI(-29.80,-4.85),P = 0.006;SPADI Pain:MD =-5.09,95%CI(-10.17,-0.01),P = 0.05;SPADI Disability:MD =-9.59,95%CI(-15.39,-3.79),P = 0.001]、除被动后伸[MD = 2.25,95%CI(-0.77,5.28),P = 0.14]外的各方向的主被动活动度[主动屈曲:MD = 12.70,95%CI(7.44,17.95),P＜0.000 01;被动屈曲:MD = 9.47,95%CI(3.80,15.14),P = 0.001;主动后伸:MD = 3.45,95%CI(2.39,4.50),P＜0.000 01;主动外展:MD = 13.54,95%CI(8.42,18.66),P＜0.000 01;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]相比于对照组均存在显著优势;治疗后两组的前臂肩手残疾问卷(DASH)比较差异无统计学意义[MD =-3.86,95%CI(-7.79,0.07),P = 0.05].结论治疗冻结肩,PRP 的疗效优于皮质类固醇及其它对照组,且作用更持久.