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中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 181 -189. doi: 10.3877/cma.j.issn.1674-134X.2022.02.007

荟萃分析

全膝关节置换术中应用富血小板血浆的临床效果
李印鹏1, 焦月震1, 王建朝1, 邵德成1, 陈百成1, 张晓阳1,†()   
  1. 1. 050000　石家庄，河北医科大学第三医院运动医学科
  • 收稿日期:2021-03-02 出版日期:2022-04-01
  • 通信作者: 张晓阳

Clinical efficacy on intraoperative application of autologous platelet rich plasma in total knee arthroplasty

Yinpeng Li1, Yuezhen Jiao1, Jianzhao Wang1, Decheng Shao1, Baicheng Chen1, Xiaoyang Zhang1,†()   

  1. 1. The Third Hospital of Hebei Medical University, Shijiazhuang 050000, China
  • Received:2021-03-02 Published:2022-04-01
  • Corresponding author: Xiaoyang Zhang
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引用本文：

李印鹏, 焦月震, 王建朝, 邵德成, 陈百成, 张晓阳. 全膝关节置换术中应用富血小板血浆的临床效果[J/OL]. 中华关节外科杂志(电子版), 2022, 16(02): 181-189.

Yinpeng Li, Yuezhen Jiao, Jianzhao Wang, Decheng Shao, Baicheng Chen, Xiaoyang Zhang. Clinical efficacy on intraoperative application of autologous platelet rich plasma in total knee arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(02): 181-189.

目的

评价全膝关节置换术中局部应用富血小板血浆的临床效果。

方法

检索中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据知识服务平台(WANFANG)、维普资讯中文期刊服务平台(VIP)4个中文数据库和PubMed、Web of Science、荷兰医学文摘数据库(Embase)、循证医学数据库(Cochrane Library)4个外文数据库中公开发表的关于全膝关节置换术中应用富血小板血浆临床疗效的相关文献，按照只纳入随机对照临床试验不纳入综述、非随机试验及动物实验等标准筛选文献，根据文献质量评估标准评价文献，采用标准格式收集数据，运用RevMan 5.3软件对4个结局指标即估计总失血量、膝关节活动度(ROM)、住院时间、术后并发症进行荟萃分析。

结果

共纳入7篇随机对照试验，分析结果显示：富血小板血浆(PRP)组估计总失血量比对照组少[均数差(MD)＝-132.32，95%置信区间(CI)(-231.24，-33.40)，P＝0.009]；PRP组住院时间比对照组短[MD ＝-2.12，95% CI(-3.47，-0.76)，P＝0.002]；PRP组术后并发症发生率比对照组低[比值比(OR)＝0.45，95% CI(0.22，0.91)，P＝0.03]; PRP组膝关节ROM与对照组差异不大[术后2 d：MD ＝0.80，95% CI(-2.87，4.46)，P＝0.67；术后3 d：MD ＝1.23，95% CI (-4.12，6.58)，P＝0.65；术后5 d：MD ＝2.93，95% CI(-0.60，6.46)，P＝0.10；术后7 d：MD ＝2.09，95% CI(-4.63，8.82), P＝0.54；术后2周：MD ＝-0.88, 95% CI(-3.70，1.94)，P＝0.54；术后6周：MD ＝3.93，95% CI(-5.17，13.02)，P＝0.40；术后3个月：MD ＝1.00, 95% CI(-4.15，6.15)，P＝0.70]。

结论

全膝关节置换术中应用富血小板血浆时，估计总失血量减少、住院时间缩短、术后并发症发生率降低，但膝关节活动度无明显提高。

关键词: 关节成形术，置换，膝, 富血小板血浆, Meta分析
Objective

The aim of this meta-analysis of randomized controlled trials is to evaluate the clinical outcome of intraoperative application of autologous platelet rich plasma (PRP) in total knee arthroplasty.

Methods

The electronic databases of PubMed, Web of Science, Cochrane Library, Excerpta Medica Database (Embase), China Biology Medicine (CBM) disc, China National Knowledge Infrastructure (CNKI), WANFANG Database and China Science and Technology Journal Database(VIP) were searched from inception to September, 2020. All the randomized controlled trials involving efficacy of clinical outcome of application of PRP in total knee arthroplasty were selected. The literature was screened according to the criteria of only randomized controlled clinical trials (RCTs) but not review, non-randomized trials and animal experiments. Data of estimated blood loss, knee joint range of motion (ROM), hospital stay duration and complications were assessed with meta analysis by RevMan 5.3 software.

Results

Seven RCTs were enrolled. The estimated total blood loss of the PRP group was less than that of the control group [mean difference (MD)=-132.32, 95% confidence interval (CI) (-231.24, -33.40), P=0.009]. The length of hospital stay in the PRP group was shorter than that in the control group [MD=-2.12, 95% CI (-3.47, -0.76), P=0.002]. The incidence of postoperative complications in the PRP group was lower than that in the control group [odds ratio (OR)=0.45, 95% CI (0.22, 0.91), P=0.03]. ROM in the PRP group was not greater than that in the control group [two days after operation: MD =0.80, 95% CI(-2.87, 4.46), P =0.67; three days after operation: MD =1.23, 95% CI (-4.12, 6.58), P =0.65; five days after operation: [MD =2.93, 95% CI(-0.60, 6.46), P =0.10; seven days after operation: MD =2.09, 95% CI(-4.63, 8.82), P =0.54; two weeks after operation: MD =-0.88, 95% CI(-3.70, 1.94), P =0.54; six weeks after operation: MD =3.93, 95% CI(-5.17, 13.02), P =0.40; three months after operation: MD =1.00, 95% CI(-4.15, 6.15), P =0.70].

Conclusion

PRP application in TKA would significantly reduce total blood loss, length of hospital stay and surgical complications, while the knee joint ROM may not improve.

Key words: Arthroplasty, replacement, knee, Platelet rich plasma, Meta-analysis
图1 文献筛选流程图
表1 纳入文献的基本特征
作者年份 国家 样本量(例，PRP/C) 平均年龄(岁，PRP/C) 女性比例(%，PRP/C) 身体质量指数(kg/m2，PRP/C) PRP剂量 假体类型 结局指标
Aggarwal[10] 2014 印度 7/14 56.43±7.59/53.79±9.75 未提及 27.47±2.15/26.52±2.99 8 ml 水泥型 ②③
Guerreiro[12] 2015 巴西 20/20 66.4/71.6 70/60 未提及 5 ml 未提及 ②④
Horstmann[16] 2011 荷兰 20/20 67/66 70/65 未提及 10 ml 水泥型 ②③④
Mochizuki[17] 2016 日本 109/206 73.0±7.8/73.4±8.2 84.4/79.1 25.7±4.1/26.0±5.7 未提及 水泥型 ①②
Morishita[18] 2014 日本 20/20 72±4.1/74.7±5.7 90/100 26.5±3.5/25.4±4.4 5 ml 水泥型 ①②④
Peerbooms[19] 2009 荷兰 32/41 77±4.4/78±5.1 74/79 未提及 6 ml 水泥型 ②④
周智[11] 2015 中国 30/30 69.4±8.4/68.5±8.0 80/83.3 30.2±2.4/29.3±2.2 12 ml 水泥型 ①②④
图2 纳入研究的偏倚风险评估图
表2 纳入研究的改良Jadad评分量表得分
作者年份 改良JADAD评分量表
随机序列产生 分配隐藏 盲法 撤出与退出 总分
Aggarwal[10] 2014 1 2 2 1 6
Guerreiro[12] 2015 1 1 1 1 4
Horstmann[16] 2011 1 2 2 1 6
Mochizuki[17] 2016 1 1 1 1 4
Morishita[18] 2014 2 1 1 1 5
Peerbooms[19] 2009 1 2 2 1 6
周智[11] 2015 1 1 1 1 4
图3 TKA(全膝关节置换)术后估计总失血量森林图
图4 TKA(全膝关节置换)术后膝关节活动度森林图
图5 TKA(全膝关节置换)术后住院时间森林图
图6 TKA(全膝关节置换)术后并发症森林图
图7 不同结局变量的漏斗图分析，显示基本不对称。图A为估计总失血量；图B为膝关节活动度；图C为住院时间；图D为术后并发症
[1]
Gidwani S, Fairbank A. The orthopaedic approach to managing osteoarthritis of the knee[J]. BMJ, 2004, 329(7476): 1220-1224.
[2]
刘宏，汤睿，喻亮．全膝关节置换联合自体富血小板血浆凝胶治疗膝骨关节炎患者疗效分析[J]．中华骨与关节外科杂志，2016，9(6)：504-507.
[3]
Arthur JR, Spangehl MJ. Tourniquet use in total knee arthroplasty[J]. J Knee Surg, 2019, 32(8): 719-729.
[4]
Fillingham YA, Ramkumar DB, Jevsevar DS, et al. The efficacy of tranexamic acid in total knee arthroplasty: a network Meta-Analysis[J]. J Arthroplasty, 2018, 33(10): 3090-3098.e1.
[5]
Horstmann W, Kuipers B, Ohanis D, et al. Autologous re-transfusion drain compared with no drain in total knee arthroplasty: a randomised controlled trial[J]. Blood Transfus, 2014, 12 Suppl 1(Suppl 1): s176-s181.
[6]
Jahic D, Omerovic D, Tanovic AT, et al. The effect of prehabilitation on postoperative outcome in patients following primary total knee arthroplasty[J]. Med Arch, 2018, 72(6): 439-443.
[7]
Levine BR, Haughom B, Strong B, et al. Blood management strategies for total knee arthroplasty[J]. J Am Acad Orthop Surg, 2014, 22(6): 361-371.
[8]
Ma J, Sun J, Guo W, et al. The effect of platelet-rich plasma on reducing blood loss after total knee arthroplasty: a systematic review and meta-analysis[J/OL]. Medicine, 2017, 96(26): e7262. DOI: 10.1097/MD.0000000000007262.
[9]
Wu P, Diaz R, Borg-Stein J. Platelet-rich plasma[J]. Phys Med Rehabil Clin N Am, 2016, 27(4): 825-853.
[10]
Aggarwal AK, Shashikanth VS, Marwaha N. Platelet-rich plasma prevents blood loss and pain and enhances early functional outcome after total knee arthroplasty: a prospective randomised controlled study[J]. Int Orthop, 2014, 38(2): 387-395.
[11]
周智，袁东堂，谢跃，等．膝关节置换术中改良止血法结合富血小板血浆的临床研究[J/CD]．中华关节外科杂志(电子版)，2015，9(3)：314-318.
[12]
Guerreiro JP, Danieli MV, Queiroz A, et al. Platelet-rich plasma (PRP) applied during total knee arthroplasty[J]. Rev Bras Ortop, 2015, 50(2): 186-194.
[13]
Higgins JP, Altman DG, Gøtzsche PC, et al. The cochrane collaboration′s tool for assessing risk of bias in randomised trials[J/OL]. BMJ, 2011, 18, 343: d5928. DOI: 10.1136/bmj.d5928.
[14]
Palys KE, Berger VW. A note on the jadad score as an efficient tool for measuring trial quality[J]. J Gastrointest Surg, 2013, 17(6): 1170-1171.
[15]
Higgins J P T, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions[M]. New Jersey: John Wiley & Sons Inc, 2019：130-136.
[16]
Horstmann WG, Slappendel R, Van HG, et al. Autologous platelet gel in total knee arthroplasty: a prospective randomized study[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(1): 115-121.
[17]
Mochizuki T, Yano K, Ikari K, et al. Platelet-rich plasma for the reduction of blood loss after total knee arthroplasty: a clinical trial[J]. Eur J Orthop Surg Traumatol, 2016, 26(8): 901-905.
[18]
Morishita M, Ishida K, Matsumoto T, et al. Intraoperative platelet-rich plasma does not improve outcomes of total knee arthroplasty [J]. J arthroplasty, 2014, 29(12): 2337-2341.
[19]
Peerbooms JC, de Wolf GS, Colaris JW, et al. No positive effect of autologous platelet gel after total knee arthroplasty: a double-blind randomized controlled trial: 102 patients with a 3-month follow-up [J]. Acta orthopaedica, 2009, 80(5): 557-562.
[20]
Tingstad EM, Bratt SN, Hildenbrand KJ, et al. Platelet-rich plasma does not decrease blood loss in total knee arthroplasty[J]. Orthopedics, 2015, 38(5): e434-e436.
[21]
Marx RE. Platelet-rich plasma: evidence to support its use[J]. J Oral Maxillofac Surg, 2004, 62(4): 489-496.
[22]
Wang Z, Wei M, Zhang Q, et al. Comparison of High-Flexion and conventional implants in total knee arthroplasty: a meta-analysis[J]. Med Sci Monit, 2015, 21: 1679-1686.
[23]
Osinski T, Bekka S, Regnaux JP, et al. Functional recovery after knee arthroplasty with regional analgesia: a systematic review and meta-analysis of randomised controlled trials[J]. Eur J Anaesthesiol, 2019, 36(6): 418-426.
[24]
Bade MJ, Struessel T, Dayton M, et al. Early High-Intensity versus Low-Intensity rehabilitation after total knee arthroplasty: a randomized controlled trial[J]. Arthritis Care Res (Hoboken), 2017, 69(9): 1360-1368.
[25]
Berghoff WJ, Pietrzak WS, Rhodes RD. Platelet-rich plasma application during closure following total knee arthroplasty[J]. Orthopedics, 2006, 29(7): 590-598.
[26]
Everts PA, Devilee RJ, Oosterbos CJ, et al. Autologous platelet gel and fibrin sealant enhance the efficacy of total knee arthroplasty: improved range of motion, decreased length of stay and a reduced incidence of arthrofibrosis[J]. Knee Surg Sports Traumatol Arthrosc, 2007, 15(7): 888-894.
[27]
Gardner MJ, Demetrakopoulos D, Klepchick PR, et al. The efficacy of autologous platelet gel in pain control and blood loss in total knee arthroplasty. An analysis of the haemoglobin, narcotic requirement and range of motion[J]. Int Orthop, 2007, 31(3): 309-313.
[28]
Bierbaum BE, Callaghan JJ, Galante JO, et al. An analysis of blood management in patients having a total hip or knee arthroplasty[J]. J Bone Joint Surg Am, 1999, 81(1): 2-10.
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