富血小板血浆较玻璃酸钠可提供更优的膝关节骨关节炎疼痛缓解与功能改善：随机对照试验的系统综述与Meta分析
简介
纳入28项随机对照试验、2685例膝骨关节炎患者的Meta分析显示，关节腔内注射富血小板血浆（PRP）在WOMAC总分与疼痛VAS上均优于玻璃酸钠（HA），证据等级分别为中等与低。亚组提示白细胞贫乏型PRP、多次注射及Kellgren-Lawrence I–II级患者获益更大。轻中度膝骨关节炎的门诊注射可优先考虑PRP多次方案，但制备与报告尚需标准化。
英文摘要
IMPORTANCE: Knee osteoarthritis is among the leading causes of pain-related disability in adults, and intra-articular injection occupies an established niche between conservative management and arthroplasty. Platelet-rich plasma (PRP) and hyaluronic acid (HA) are both in widespread clinical use, yet which agent should be preferred, and for which patients, remains unsettled. AIM OR OBJECTIVE: The efficacy and safety of intra-articular PRP were compared with those of intra-articular HA for pain and physical function in adults with symptomatic knee osteoarthritis, and study-level modifiers of the treatment effect were identified. EVIDENCE REVIEW: PubMed/MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched from inception to 14 April 2026 without language or date restriction, supplemented by reference-list searching. Randomized controlled trials comparing intra-articular PRP with intra-articular HA in adults with knee osteoarthritis and reporting the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score or the pain visual analogue scale (VAS) at 4 weeks or later were eligible. Two reviewers independently screened, extracted data and appraised each trial with the Cochrane Risk of Bias 2.0 tool. Mean differences (MDs) were pooled using random-effects models; heterogeneity was explored through pre-specified subgroup analyses (PRP leukocyte content, injection number, osteoarthritis severity, follow-up duration), sensitivity analyses and meta-regression; and certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. FINDINGS: Twenty-eight randomized controlled trials comprising 2,685 participants were included. PRP was associated with greater improvement than HA in WOMAC total score (MD -8.14, 95% confidence interval [CI] -10.79 to -5.48; P < 0.00001; I2 = 96%) and in pain VAS score (MD -7.89, 95% CI -12.90 to -2.89; P = 0.002; I2 = 97%). Treatment effects were larger with leukocyte-poor PRP (P-interaction = 0.04), with multiple-injection protocols (P-interaction = 0.04) and in Kellgren-Lawrence grade I-II disease (P-interaction = 0.03). Meta-regression confirmed osteoarthritis severity (P = 0.03) and injection number (P = 0.04) as statistically significant effect modifiers, together explaining approximately 24% of the between-study variance. Restricting the analysis to trials at low risk of bias, and re-estimating the between-study variance with the restricted maximum likelihood estimator, attenuated but did not nullify the advantage of PRP. Egger's test showed no statistically significant funnel-plot asymmetry (WOMAC P = 0.21; VAS P = 0.24). Certainty of evidence was moderate for WOMAC and low for VAS. CONCLUSION: and Relevance: Intra-articular PRP produced greater functional improvement than HA with moderate certainty and greater pain relief with low certainty. The largest benefit is to be expected in mild-to-moderate disease treated with leukocyte-poor PRP in a multiple-injection protocol, and this profile should inform patient selection. HA remains a reasonable alternative, and standardized PRP preparation and reporting are required before firmer recommendations can be made. LEVEL OF EVIDENCE: Level I, systematic review and meta-analysis of randomized controlled trials.