全膝关节置换术中应用富血小板血浆的临床效果

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。

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

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