I-Platelet rich plasma (PRP) isetyenziswa ngokubanzi kwi-orthopedics, kodwa kusekho ingxoxo enzima.Ngoko ke, iJamani "iQela eliSebenzayo lokuvuselela i-Clinical Tissue" ye-German Orthopedics kunye ne-Trauma Society yenza uphando ukuze lufikelele kwimvumelwano malunga nonyango lwangoku lwe-PRP.
Izicelo ze-PRP zonyango zibhekwa njengencedo (89%) kwaye zingabaluleka ngakumbi kwixesha elizayo (90%).Iimpawu eziqhelekileyo zesifo se-tendon (77%), i-osteoarthritis (OA) (68%), ukulimala kwemisipha (57%), kunye nokulimala kwe-cartilage (51%).Ukuvumelana kwafikelelwa kwingxelo ye-16/31.Ukusetyenziswa kwe-PRP kwi-knee osteoarthritis yokuqala (i-Kellgren Lawrence II) ithathwa njengento enokuba luncedo, kunye nezifo ze-tendon ezibukhali kunye ezingapheliyo.Kwizilonda ezingapheliyo (i-cartilage, i-tendon), ii-injection ezininzi (i-2-4) zicetyiswa ngakumbi kune-injection eyodwa.Nangona kunjalo, akukho datha yaneleyo ngexesha lokuphumla phakathi kweenaliti.Kucetyiswa ngamandla ukulungelelanisa ukulungiswa, ukusetyenziswa, ukuphindaphinda, kunye nokuzimisela kwezibonakaliso ze-PRP.
I-Platelet rich plasma (PRP) isetyenziswa ngokubanzi kwiyeza lokuvuselela, ngakumbi kwiyeza zemidlalo yamathambo.Uphando olusisiseko lwezenzululwazi lubonise ukuba i-PRP ineempembelelo ezininzi ezintle kwiiseli ezininzi ze-musculoskeletal system, ezifana ne-chondrocytes, iiseli ze-tendon, okanye iiseli ze-muscle, zombini kwi-vitro kunye ne-vivo.Nangona kunjalo, umgangatho woncwadi olukhoyo usenomda, kubandakanywa isayensi esisiseko kunye nophando lweklinikhi.Ke ngoko, kuphando lweklinikhi, isiphumo asilunganga njengophando olusisiseko lwesayensi.
Zininzi izizathu ezinokwenzeka.Okokuqala, iindlela ezininzi zokulungiselela (okwangoku ngaphezulu kwe-25 yeenkqubo ezahlukeneyo ezikhoyo ngokurhweba) zikhona ukuze kufumaneke izinto ezikhula kwiplatelet, kodwa imveliso yokugqibela ye-PRP iqulunqwe ziintlobo zazo ezingafaniyo kunye nemigudu yazo ebuhlungu.Ngokomzekelo, iindlela ezahlukeneyo zokulungiselela i-PRP zibonisa imiphumo eyahlukeneyo kwi-chondrocytes edibeneyo.Ukongezelela, ngenxa yokuba iiparamitha ezisisiseko ezifana nokwakheka kwegazi (iiseli ezibomvu zegazi, iiseli ezimhlophe zegazi kunye neeplatelets) azikachazwa kulo lonke uphando, ingxelo esemgangathweni yezi zinto ifuneka ngokukhawuleza.Imveliso yokugqibela ye-PRP nayo inomahluko omkhulu womntu ngamnye.Yintoni enzima ingxaki kukuba i-dosage, ixesha, kunye nobuninzi bezicelo ze-PRP azizange zilinganiswe, kwaye azizange zifundwe ngokupheleleyo kuphando olusisiseko lwesayensi.Kulo mba, imfuno yokuqulunqwa okusemgangathweni kwe-platelet derived factor factor iyabonakala, eya kuvumela uvavanyo olusemgangathweni olusisiseko lwesayensi yemiphumo yeeparamitha ezahlukeneyo ezifana nokwakhiwa kwe-PRP, umthamo we-injection ye-PRP, kunye nexesha lokutofa.Ukongeza, ukusebenzisa ukuhlelwa ukuchaza ngcono iimveliso ze-PRP ezisetyenzisiweyo kufuneka kube yinyanzelo.Abanye ababhali bacebise iinkqubo zokuhlela ezahlukeneyo, kubandakanya iMishra (ukubalwa kweeplatelet, ubukho beeseli ezimhlophe zegazi, ukusebenza) kunye neDohan Ellenfest (isibalo seplatelet, ukubala kweeseli ezimhlophe zegazi, ubukho befibrinogen), iDelong (P latelet count, i-nail activation, w ^ Ukubalwa kweeseli zegazi ze-Haide; Ukuhlelwa kwe-PAW) kunye ne-Mautner (i-Platelet count, ubukho be-eukocyte enkulu, ubukho be-R ebhalwe ngamaseli egazi, kunye nokusetyenziswa kwe-nail activation; ukuhlelwa kwe-PLRA) 。 UMagalon et al.Ulwahlulo olucetywayo lwe-DEPA lubandakanya inaliti yeplatelet OSE, ukusebenza kakuhle kwemveliso, ukhuseleko lwe-PRP, kunye nokusebenza kwayo.UHarrison et al.Enye inkqubo yokuhlela ebanzi yapapashwa, kubandakanywa iindlela zokuvula ezisetyenzisiweyo, umthamo opheleleyo osetyenzisiweyo, ubuninzi bolawulo kunye nezicandelwana ezisebenzayo, ugxininiso lweplatelet kunye neendlela zokulungiselela, kunye nokubala komndilili ngokubanzi kunye noluhlu (oluphantsi oluphezulu) ukubalwa kweeseli ezimhlophe zegazi (i-neutrophils, i-lymphocytes, kunye monocytes) yeeplatelet, iiseli ezibomvu zegazi, kunye nokuhlelwa.Ulwahlulo lwamva nje luvela kwi-Kon et al.Ngokusekelwe kwimvumelwano yeengcali, ezona zinto zibalulekileyo zichazwa njengokubunjwa kweplatelet (concentration yeplatelet and concentration ratio), ubunyulu (ubukho beeseli ezibomvu zegazi / iiseli ezimhlophe zegazi), kunye nokusebenza (endogenous / exogenous, calcium supplement).
Ukusetyenziswa kwezalathi ezininzi ze-PRP kuye kwaxoxwa ngokubanzi, njengokuthi unyango lwesifo se-tendon luchazwe kwizifundo zeklinikhi malunga neendawo ezahlukeneyo [kunye nemiphumo emihle kunye nemiphumo emibi].Ngoko ke, ngokufuthi akunakwenzeka ukufumana ubungqina obubambekayo kuncwadi.Oku kwenza kube nzima ukuba unyango lwe-PRP lufakwe kwizikhokelo ezahlukeneyo.Ngenxa yemicimbi emininzi engasonjululwanga ejikeleze ukusetyenziswa kwe-PRP, umgaqo osisiseko weli nqaku kukubonisa iimbono zeengcali ezivela kwiJamani "iQela eliSebenzayo lokuvuselela iTissue yeClinical" ye-German Orthopedics and Trauma Society (DGOU) malunga nokusetyenziswa kunye nekamva. yePRP.
Indlela
Iqela laseJamani elithi "Iqela leClinical Tissue Regeneration Working Working" liqulunqwe ngamalungu angama-95, ngalinye lijongene notyando lwamathambo kunye nokuvuselelwa kwezicubu (bonke oogqirha bezonyango okanye oogqirha, akukho nyango lomzimba okanye izazinzulu zokuzivocavoca).Iqela elisebenzayo elenziwe ngabantu aba-5 (uphononongo olungaboniyo) linoxanduva lokukhuthaza uphando.Emva kokuphonononga uncwadi olusele lukhona, iqela elisebenzayo lalungisa izinto ezinokuthi zibe khona zolwazi ezinokubandakanywa kumjikelo wokuqala wophando.Uphando lokuqala lwenziwe ngo-Ephreli 2018, lubandakanya imibuzo ye-13 kunye nemiba eqhelekileyo yesicelo se-PRP, kubandakanywa imibuzo evaliweyo nevulekileyo, kunye nokukhuthaza iingcali ukuba ziphakamise iiprojekthi ezingaphezulu okanye ukuguqulwa.Ngokusekelwe kwezi mpendulo, umjikelo wesibini wophando waphuhliswa kwaye waqhutywa ngoNovemba 2018, kunye ne-31 yonke imibuzo evaliweyo evaliweyo kwiindidi ezi-5 ezahlukeneyo: izibonakaliso zokulimala kwe-cartilage kunye ne-osteoarthritis (OA), izibonakaliso ze-tendon pathology, izibonakaliso zokulimala kwemisipha. , ukusetyenziswa kwe-PRP, kunye nemimandla yophando yexesha elizayo.
Ngophando lwe-intanethi (i-Survey Monkey, e-USA), kwafikelelwa kwisivumelwano sokuvumela abaphenduli ukuba bareyithe ukuba ngaba iprojekthi kufuneka ibandakanywe kwezona mfuno zisezantsi zokunika ingxelo, kunye nokubonelela ngezikali zokuphendula ezinokuba zintlanu kwi-Likert: 'Ndivuma kakhulu';Vuma;ningavumelani, ningachasi;Andivumi okanye andivumi kakhulu.Uvavanyo luye lwalingwa ziingcali ezintathu malunga nokuthembeka kobuso, ukuqonda kunye nokwamkeleka, kwaye iziphumo zalungiswa kancinci.Kumjikelo wokuqala, iingcali ezingama-65 zizonke zithathe inxaxheba, ngelixa kumjikelo wesibini, iingcali ezingama-40 zizonke ezithathe inxaxheba.Ngomjikelezo wesibini wokuvumelana, inkcazo ye-priori ichaza ukuba ukuba ngaphezu kwe-75% yabaphenduli bayavumelana, iprojekthi iya kufakwa kuxwebhu lokugqibela lokuvumelana, kwaye ngaphantsi kwe-20% yabaphenduli abavumelani.I-75% yabathathi-nxaxheba bayavuma ukuba sesona sigqibo semvumelwano esichazwe ngokuqhelekileyo, esasetyenziswa kwisifundo sethu.
Isiphumo
Kwinqanaba lokuqala, i-89% yabantu baphendule ukuba isicelo se-PRP siluncedo, kwaye i-90% yabantu bakholelwa ukuba i-PRP iya kubaluleka ngakumbi kwixesha elizayo.Uninzi lwamalungu luqhelene nesayensi esisiseko kunye nophando lweklinikhi, kodwa kuphela i-58% yamalungu asebenzisa i-PRP kwimisebenzi yabo yemihla ngemihla.Izizathu eziqhelekileyo zokungasebenzisi i-PRP kukungabikho kwendawo efanelekileyo, njengezibhedlele zaseyunivesithi (41%), ezibizayo (19%), ukuchitha ixesha (19%), okanye ubungqina obunganelanga besayensi (33%).Iimpawu eziqhelekileyo zokusetyenziswa kwe-PRP zisifo se-tendon (77%), i-OA (68%), ukulimala kwemisipha (57%), kunye nokulimala kwe-cartilage (51%), eyona siseko sesibini sophando.Isalathisi sokusetyenziswa kwe-PRP ye-intraoperative ibonakala ngokubambisana ne-18% yokulungiswa kwe-cartilage kunye ne-32% yokulungiswa kwe-tendon.Ezinye izibonakaliso zibonwa kwi-14%.Kuphela i-9% yabantu ichaze ukuba i-PRP ayinalo ukusetyenziswa kweklinikhi.I-injection ye-PRP ngamanye amaxesha isetyenziswa ngokudibanisa ne-hyaluronic acid (11%).Ukongeza kwi-PRP, iingcali nazo zafaka i-anesthetics yendawo (65%), i-cortisone (72%), i-hyaluronic acid (84%), kunye ne-Traumel / Zeel (28%).Ukongezelela, iingcali zichaze ngokugqithiseleyo imfuno yophando lwezonyango ngakumbi malunga nokusetyenziswa kwe-PRP (76%) kunye nesidingo somgangatho ongcono (ukwenziwa kwe-70%, izibonakaliso ze-56%, ixesha le-53%, i-injection frequency 53%).Ngolwazi oluneenkcukacha kumjikelo wokuqala, nceda ujonge kwisihlomelo.Iingcali zithe ngokugqithisileyo uphando lwezonyango luyafuneka ekusetyenzisweni kwe-PRP (76%), kwaye umgangatho ongcono kufuneka ufezekiswe (ukwenziwa kwe-70%, izibonakaliso ze-56%, ixesha le-53%, i-injection frequency 53%).Ngolwazi oluneenkcukacha kumjikelo wokuqala, nceda ujonge kwisihlomelo.Iingcali zithe ngokugqithisileyo uphando lwezonyango luyafuneka ekusetyenzisweni kwe-PRP (76%), kwaye umgangatho ongcono kufuneka ufezekiswe (ukwenziwa kwe-70%, izibonakaliso ze-56%, ixesha le-53%, i-injection frequency 53%).
Ngokusekelwe kwezi mpendulo, umjikelo wesibini ugxininisa ngakumbi kwisihloko esinomdla kakhulu.Ukuvumelana kwafikelelwa kwingxelo ye-16/31.Ikwabonisa iindawo apho kukho ukuvumelana okuncinci, ngakumbi kwinkalo yezibonakaliso.Abantu ngokubanzi bayavuma (92%) ukuba kukho ukungafani okuphawulekayo kwizibonakaliso ezahlukeneyo zesicelo se-PRP (njenge-OA, isifo se-tendon, ukulimala kwemisipha, njl.).
[Itshathi yebha ye-oblique epakishweyo imele ukwahlulwa kwenqanaba ekuvunyelwene ngalo kumjikelo wesibini wophando (imibuzo engama-31 (Q1 - Q31)), ebonisa kakuhle iindawo zokungavisisani.
Ibar kwicala lasekhohlo le-Y-axis ibonisa ukungavumelani, ngelixa ibha kwicala lasekunene libonisa isivumelwano.Uninzi lokungavisisani luvela kwindawo yezalathisi.]
Iimpawu zokulimala kwe-cartilage kunye ne-OA
Kukho isivumelwano esiqhelekileyo (77.5%) sokuba i-PRP ingasetyenziselwa i-knee osteoarthritis yokuqala [uKellgren Lawrence (KL) iNqanaba II].Ngokulimala okuncinci kwe-cartilage (i-KL Level I) kunye nezigaba ezinzima kakhulu (i-KL Level III kunye ne-IV), akukho mvumelwano okwangoku malunga nokusetyenziswa kwe-PRP ngexesha okanye emva kokuhlinzwa kokuvuselelwa kwe-cartilage, nangona i-67.5% yeengcali zikholelwa ukuba le yintsimi ethembisayo. .
Izibonakaliso zezilonda ze-tendon
Kuphando, iingcali zimele ininzi (82.5% kunye ne-80%) ukuba ukusetyenziswa kwe-PRP luncedo kwizifo ze-tendon ezibukhali kunye ezingapheliyo.Kwimeko yokulungiswa kwe-rotator cuff, i-50% yeengcali zikholelwa ukuba ukusetyenziswa kwe-intraoperative ye-PRP kunokuba luncedo, kodwa i-17.5% yeengcali zibamba uluvo oluchaseneyo.Inani elifanayo leengcali (57.5%) likholelwa ukuba i-PRP inendima efanelekileyo kunyango emva kokulungiswa kwe-tendon.
Isibonakaliso sokulimala kwemisipha
Kodwa akukho mvumelwano efunyenweyo ekusebenziseni i-PRP yonyango lwe-acute okanye engapheliyo yokulimala kwemisipha (njenge-75% yokuvumelana).
Imiba eSebenzayo yeSicelo se-PRP
Kukho iingxelo ezintathu ekunokuvunyelwana ngazo:
(1) Izilonda ezingapheliyo zifuna i-injection engaphezu kweyodwa ye-PRP
(2) Ulwazi olunganelanga malunga nexesha elifanelekileyo lexesha phakathi kweenaliti (akukho mvumelwano efunyenweyo ngamaxesha eveki)
(3) Ukuhlukahluka kweendlela ezahlukeneyo ze-PRP kunokudlala indima ebalulekileyo kwimiphumo yazo yezinto eziphilayo
Imimandla yoPhando lwexesha elizayo
Imveliso ye-PRP kufuneka ibe ngcono ngokusemgangathweni (i-95% ukuhambelana) kunye nesicelo sayo seklinikhi (njenge-injection frequency, ixesha lokufaka isicelo, izibonakaliso zekliniki).Nakwiindawo ezinje ngonyango lwe-OA apho kuxelwa ukuba kukho idata elungileyo yezonyango, amalungu azingcaphephe akholelwa ekubeni kusekho imfuneko enkulu yophando olusisiseko lwenzululwazi nolwezonyango.Oku kusebenza nakwezinye izibonakaliso.
Xoxa
Iziphumo zophando zibonisa ukuba kusekho ingxoxo ebanzi malunga nokusetyenziswa kwe-PRP kwi-orthopedics, nakumaqela eengcali zelizwe.Kwiintetho ze-31, kuphela i-16 eyafikelela kwimvumelwano efanayo.Kukho ukuvumelana okukhulu kwinkalo yophando lwexesha elizayo, ebonisa isidingo esinamandla sokuvelisa ubungqina obandisiweyo ngokuqhuba izifundo ezininzi ezahlukeneyo zexesha elizayo.Kulo mba, uvavanyo olubalulekileyo lobungqina obukhoyo ngamaqela asebenzayo eengcali yindlela yokuphucula ulwazi lwezonyango.
Iimpawu ze-OA kunye nokulimala kwe-cartilage
Ngokoncwadi lwangoku, i-PRP inokufaneleka kwi-OA yangethuba nephakathi.Ubungqina obutsha bubonisa ukuba i-injection ye-intra-articular ye-PRP inokuphucula iimpawu zesigulane kungakhathaliseki ukuba iqondo lomonakalo we-cartilage, kodwa ngokuqhelekileyo kukho ukungabikho kohlalutyo olulungileyo lweqela elisekelwe kwi-Kellgren kunye no-Lawrence classification.Kule nkalo, ngenxa yokungabikho kwedatha ekhoyo, iingcali okwangoku azicebisi ukusebenzisa i-PRP ye-KL yezinga le-4. I-PRP nayo inamandla okuphucula umsebenzi odibeneyo wamadolo, mhlawumbi ngokunciphisa ukusabela okuvuthayo kunye nokunciphisa inkqubo yokuguqulwa kwe-degenerative ye-cartilage edibeneyo.I-PRP ngokuqhelekileyo ifezekisa iziphumo ezingcono kwindoda, encinci, izigulane ezinamazinga aphantsi omonakalo we-cartilage kunye ne-index mass body (BMI).
Xa utolika idatha yeklinikhi epapashiweyo, ukubunjwa kwe-PRP kubonakala kuyipharamitha ephambili.Ngenxa yesiphumo esibonakalisiweyo se-cytotoxic seplasma etyebileyo kwiiseli zegazi ezimhlophe kwiiseli ze-synovial in vitro, i-LP-PRP inconywa kakhulu kwi-intra articular application.Kuphononongo olusisiseko lwamva nje lwenzululwazi, iziphumo zeseli emhlophe yegazi (LP) kunye ne-white blood cell ecebileyo (LR) PRP ekuphuhliseni i-OA yafaniswa kwimodeli yemouse emva kwe-meniscectomy.I-LP-PRP ibonise ukusebenza okuphezulu ekugcineni umthamo we-cartilage xa kuthelekiswa ne-LR-PRP.Uhlalutyo lwe-meta lwamva nje lwezilingo ezilawulwa ngokungahleliwe lufumene ukuba i-PRP ineziphumo ezingcono xa kuthelekiswa ne-hyaluronic acid (HA), kwaye uhlalutyo lwama-subgroup lubonise ukuba i-LP-PRP ineziphumo ezingcono kune-LR-PRP.Nangona kunjalo, akuzange kubekho uthelekiso oluthe ngqo phakathi kwe-LR - kunye ne-LP-PRP, ukwenza uphando olongezelelweyo luyimfuneko.Enyanisweni, uphando olukhulu oluthelekisa i-LR-PRP kunye ne-HA lubonisa ukuba i-LR-PRP ayinayo imiphumo emibi.Ukongezelela, uphando lweklinikhi oluthelekisa i-LR-PRP kunye ne-LP-PRP lubonisa ngokuthe ngqo ukuba akukho ntlukwano yekliniki kwiziphumo emva kweenyanga ze-12.I-LR-PRP iqulethe iamolekyu ezininzi ezinokuvuvukala kunye noxinzelelo oluphezulu lwezinto ezikhulayo, kodwa iqulethe imilinganiselo ephezulu ye-cytokines echasayo, njenge-interleukin-1 receptor antagonists (IL1-Ra).Izifundo zamva nje ziye zachaza inkqubo "yokuvuselela ukuvuvukala" kweeseli ezimhlophe zegazi ezifihla i-cytokines e-pro-inflammatory kunye ne-anti-inflammatory, ebonisa impembelelo enhle ekuhlaziyweni kwezicubu.Izifundo ezongezelelweyo zeklinikhi kunye noyilo olulindelekileyo lwe-randomized luyimfuneko ukumisela imveliso efanelekileyo okanye ukubunjwa kwe-PRP yokwakheka kunye neprotocol yesicelo esifanelekileyo kwi-OA.
Ngoko ke, abanye bacebisa ukuba i-HA kunye ne-PRP inokuba ziindlela zonyango eziphezulu kwizigulane ezine-OA ethambileyo kunye ne-BMI ephantsi.Uvavanyo olucwangcisiweyo lwakutsha nje lubonise ukuba i-PRP inesiphumo esingcono sonyango xa kuthelekiswa ne-HA.Nangona kunjalo, iindawo ezivulekileyo ezicetywayo ngamxhelo-mnye zibandakanya imfuno yokulungiswa kwe-PRP esemgangathweni, amazinga okufaka isicelo, kunye nesidingo solunye ulingo lwezonyango olungenamkhethe kunye nomgangatho wamanzi aphezulu.Ngoko ke, ngoku iingcebiso ezisemthethweni kunye nezikhokelo zihlala zingabandakanyi ekuxhaseni okanye ekuchaseni ukusetyenziswa kwe-knee osteoarthritis.Isishwankathelo, ngokusekelwe kubungqina bangoku, izicwangciso ezahlukeneyo zokulungiselela zinciphisa ukuhluka kweendlela eziphezulu, kwaye i-PRP inokukhokelela ekuphuculeni intlungu kwi-OA encinci ukuya kwimodareyitha.Iqela leengcali alicebisi ukusebenzisa i-PRP kwiimeko ezinzima ze-OA.Uphononongo olutshanje luye lwabonisa ukuba i-PRP inegalelo kwimpembelelo ye-placebo, ngakumbi kunyango lwe-OA okanye i-Epicondylitis esecaleni.Inaliti ye-PRP inokuba yinxalenye yesicwangciso sonyango ngokubanzi ukujongana nemiba yebhayoloji ye-OA.Ukongeza kwezinye izinto ezibalulekileyo ezifana nokunciphisa umzimba, ukulungisa ukuchithwa, ukuqeqeshwa kwemisipha, kunye namadolo, kunokunceda ukunciphisa intlungu kunye nokuzisa iziphumo ezingcono kwizigulane.
Indima ye-PRP kwi-regenerative cartilage operation enye indawo exoxwa ngayo ngokubanzi.Nangona uphando olusisiseko lwezenzululwazi lubonise impembelelo efanelekileyo kwi-chondrocytes, ubungqina bekliniki bokusetyenziswa kwe-PRP ngexesha lotyando, utyando lokuvuselela i-cartilage, okanye izigaba zokuvuselela akwanelanga, zibonakalisa iziphumo zethu.Ukongezelela, ixesha elifanelekileyo lonyango lwe-PRP emva kokuhlinzwa ayikaqinisekanga.Kodwa ezininzi iingcali ziyavuma ukuba i-PRP inokunceda ukukhuthaza ukuvuselelwa kwe-cartilage ye-biological.Isishwankathelo, iziphumo zangoku zesigwebo esibalulekileyo zibonisa ukuba ukuvavanywa okuqhubekayo kwendima enokubakho ye-PRP kwi-regenerative cartilage utyando luyimfuneko.
Izibonakaliso zezilonda ze-tendon
Ukusetyenziswa kwe-PRP yonyango lwe-tendinosis yisihloko esiphikisanayo kwiincwadi.Uphononongo lophando olusisiseko lwesayensi lubonisa ukuba i-PRP inemiphumo emihle kwi-vitro (njengokwandisa i-tendon cell proliferation, ukukhuthaza imiphumo ye-anabolic, njengokwandisa ukuveliswa kwe-collagen) kunye ne-vivo (ukwandisa ukuphulukiswa kwe-tendon).Kwinkqubo yeklinikhi, uphando oluninzi lubonise ukuba unyango lwe-PRP lunemiphumo emihle kwaye akukho miphumo kwizifo ezahlukeneyo ze-tendon ezibukhali kunye nezingapheliyo.Ngokomzekelo, uphononongo olucwangcisiweyo lwamva nje lugxininise iziphumo eziphikisanayo zesicelo se-PRP kwizilonda ze-tendon ezahlukeneyo, ngokukodwa zinefuthe elihle kwizilonda ze-tendon ze-elbow kunye nezilonda ze-tendon patellar, kodwa kungekhona kwi-tendon ye-Achilles okanye i-rotator cuff lesions.Uninzi lweerekhodi ze-RCT zotyando azikho imiphumo enenzuzo, kwaye akukabikho ubungqina obucacileyo bokusetyenziswa kwayo ngokukhuselekileyo kwizifo ze-rotator cuff.Kwi-Epicondylitis yangaphandle, i-meta-analysis yangoku ibonisa ukuba i-corticosteroids inefuthe elihle lexesha elifutshane, kodwa umphumo wexesha elide we-PRP uphezulu.Ngokusekelwe kubungqina bangoku, i-patellar kunye ne-lateral elbow tendinosis ibonise ukuphuculwa emva kokunyanga kwe-PRP, ngelixa i-tendon ye-Achilles kunye ne-rotator cuff ibonakala ixhamla kwisicelo se-PRP.Ngoko ke, ukuvumelana okutsha nje kweKomiti yeSayensi eyiSiseko ye-ESSKA yagqiba ukuba ngoku akukho mvumelwano malunga nokusetyenziswa kwe-PRP yonyango lwe-tendinosis.Nangona ukuphikisana kwiincwadi, njengoko kuboniswe ngophando lwakutsha nje kunye novavanyo olucwangcisiweyo, i-PRP inendima enhle ekuphatheni izifo ze-tendon ezivela kwiimbono ezisisiseko zesayensi kunye neklinikhi.Ngokukodwa ukuqwalasela imiphumo enokubakho ye-corticosteroids xa usebenzisa izifo ze-tendon.Iziphumo zolu phando zibonisa ukuba imbono yaseJamani yangoku kukuba i-PRP ingasetyenziselwa ukunyanga izifo ze-tendon ezinzima kunye nezingapheliyo.
Isibonakaliso sokulimala kwemisipha
Ukuphikisana okungaphezulu kukusetyenziswa kwe-PRP ukunyanga ukulimala kwemisipha, enye yeyona nto ixhaphakileyo yokulimala kwezemidlalo, okubangelwa malunga ne-30% yeentsuku zemihlaba.I-PRP ibonelela ngamathuba okuphucula ukuphiliswa kwezinto eziphilayo kunye nokukhawuleza izinga lokuzilolonga, elifumene ingqwalasela eyongezelelweyo kwiminyaka embalwa edlulileyo.Nangona i-57% yeempendulo ezinikezelwe kumjikelo wokuqala zidweliswe ukulimala kwemisipha njengeyona ndlela iqhelekileyo yokusetyenziswa kwe-PRP, kusekho ukungabikho kwemvelaphi eqinile yesayensi.Izifundo ezininzi ze-in vitro ziye zabona iinzuzo ezinokuthi zenzeke ze-PRP kukulimala kwemisipha.Ukukhawuleza komsebenzi we-satellite cell, ukwanda kwe-fibril diameter ehlaziyiweyo, ukuvuselela i-myogenesis, kunye nokwanda komsebenzi we-MyoD kunye ne-myostatin zonke ziye zavavanywa kakuhle.Ulwazi oluthe vetshe malunga noMazoka et al.Ukwandiswa kokugxilwa kwezinto zokukhula ezifana ne-HGF, i-FGF, kunye ne-EGF yabonwa kwi-PRP-LP.Tsai et al.yagxininisa ezi ziphumo.Ukongeza ekubonakaliseni iprotheyini eyongeziweyo ye-cyclin A2, i-cyclin B1, i-cdk2 kunye ne-PCNA, kubonakaliswe ukuba i-skeletal muscle ye-cell vitality kunye nokwanda kweeseli zonyuka ngokudlulisa iiseli ukusuka kwisigaba se-G1 ukuya kwi-S1 kunye ne-G2 & M izigaba.Uphononongo olutshanje olucwangcisiweyo lushwankathela imvelaphi yesayensi yangoku ngolu hlobo lulandelayo: (1) Kwizifundo ezininzi, unyango lwe-PRP lwandisa ukwanda kweeseli ze-muscle, i-extra factor expression (efana ne-PDGF-A / B kunye ne-VEGF), ukuqeshwa kweeseli ezimhlophe zegazi, kunye ne-angiogenesis kwimisipha. xa kuthelekiswa nemodeli yeqela lolawulo;(2) I-teknoloji yokulungiselela i-PRP ayihambisani nophando lweencwadi zenzululwazi ezisisiseko;(3) Ubungqina obuvela kuphando olusisiseko lwesayensi kwi-vitro kunye ne-vivo lubonisa ukuba i-PRP inokusebenza njengendlela yonyango esebenzayo enokuthi ikhawuleze inkqubo yokuphulukisa izilonda zemisipha xa kuthelekiswa neqela lokulawula, ngokusekelwe kwimiphumo ebonwayo kumanqanaba eselula kunye nezicubu. iqela lonyango.
Nangona uphando olwenziwayo luchaza ukuphiliswa okupheleleyo kwaye luthathelwe ingqalelo ukuba ixesha elingekho kwindawo lingenalo inzuzo enkulu, uBubnov et al.Kuphononongo lweqela labadlali be-30, kwaphawulwa ukuba intlungu yancitshiswa kwaye isantya sokubuyisela kukhuphiswano sasikhawuleza kakhulu.UHamid et al.Kulingo olulawulwa ngokungahleliwe (RCT) oluthelekisa ukungena kwe-PRP kunye neenkqubo zonyango ezilondolozayo, ngokukhawuleza ukubuyisela ngokukhawuleza kukhuphiswano kuchazwe.I-RCT ye-multicenter eyimfama ephindwe kabini kuphela ibandakanya ukulimala kwe-hamstring kubadlali (n = 80), kwaye akukho nto ibalulekileyo yokungena kwi-placebo yabonwa xa kuthelekiswa ne-PRP.Imigaqo yebhayoloji ethembisayo, iziphumo ezilungileyo zangaphambi kweklinikhi, kunye namava onyango aphumeleleyo kwangoko kunye nenaliti ye-PRP ekhankanywe ngasentla ayikaqinisekiswanga yi-RCT ephezulu yamva nje.Imvumelwano yangoku phakathi kwamalungu e-GOTS iye yavavanya unyango olulondolozayo lokulimala kwemisipha kwaye yagqiba ukuba okwangoku akukho bungqina obucacileyo bokuthi i-injection ye-intramuscular ingasetyenziselwa ukuphatha ukulimala kwemisipha.Oku kuhambelana neziphumo zethu, kwaye akukho mvumelwano malunga nokusetyenziswa kwe-PRP kunyango lokulimala kwemisipha.Uphando olongezelelweyo lufuneka ngokukhawuleza kwidosi, ixesha, kunye nokuphindaphinda kwe-PRP kukulimala kwemisipha.Xa kuthelekiswa nokulimala kwe-cartilage, kwi-muscle ukulimala, ukusetyenziswa kwe-algorithms yonyango, ngakumbi i-PRP, inokuhambelana nenqanaba kunye nobude bexesha lokulimala, ukwahlula phakathi kokubandakanyeka kokulimala kwemisipha kunye nokulimala kwe-tendon okanye ukulimala kwe-avulsion.
Intsimi yesicelo se-PRP yenye yezona ndawo zixutyushwa rhoqo, kwaye ukungabikho komgangatho okwangoku kungomnye wemiba ephambili kwizilingo zeklinikhi.Uninzi lweengcali azizange zibone ukwanda kokusetyenziswa kwe-PRP, nangona kunjalo, ezinye izifundo zibonise ukuba ukusetyenziswa okongeziweyo kwe-hyaluronic acid kunokuthelekiswa nokusetyenziswa kwe-PRP enye ye-OA.Imvumelwano kukuba iinaliti ezininzi kufuneka zinikezelwe kwizifo ezingapheliyo, kwaye intsimi ye-OA iyayixhasa le ngcebiso, apho iinaliti ezininzi zisebenza ngakumbi kunenaliti enye.Uphando olusisiseko lwezenzululwazi luphonononga ubudlelwane bedosi-nesiphumo se-PRP, kodwa ezi ziphumo zisafuna ukudluliselwa kuphando lwezonyango.Ugxininiso olufanelekileyo lwe-PRP alukamiselwa okwangoku, kwaye uphando lubonise ukuba ukugxila okuphezulu kunokuba nemiphumo emibi.Ngokufanayo, impembelelo yeeseli ezimhlophe zegazi ixhomekeke kwisalathisi, kwaye ezinye izibonakaliso zifuna i-PRP kunye neeseli zegazi ezimhlophe.Ukuhluka kokwakheka kwe-PRP nganye kudlala indima ebalulekileyo kwimpembelelo ye-PRP.
Imimandla yoPhando lwexesha elizayo
Kuvunywa ngamxhelo mnye ukuba ngokweempapasho zakutsha nje, uphando olongezelelweyo kwi-PRP luyimfuneko kwixesha elizayo.Omnye wemiba ephambili kukuba iifomyula ze-PRP mazibe kumgangatho ongcono (kunye ne-95% consistency).Enye inkalo enokwenzeka yokuphumeza le njongo inokuba kukudityaniswa kweeplatelet ukuphumeza imiqulu emikhulu, ekumgangatho ophezulu.Ukongeza, iiparamitha ezahlukeneyo zesicelo seklinikhi azaziwa, ezinje ngokuba zingaphi na iinaliti ekufuneka zisetyenziswe, ixesha eliphakathi kweenaliti, kunye nedosi ye-PRP.Kuphela ngale ndlela kunokwenzeka ukuba kuqhutywe uphando oluphezulu kunye nokuvavanya ukuba zeziphi izibonakaliso ezifanelekileyo kakhulu ekusebenziseni i-PRP, ukwenza uphando olusisiseko lwesayensi kunye neklinikhi, ngokukodwa izifundo ezilawulwa ngokungahleliwe, eziyimfuneko.Nangona imvumelwano ifikeleleke ukuba i-PRP inokudlala indima ebalulekileyo kwixesha elizayo, kubonakala ngathi uphando oluninzi kunye nophando lweklinikhi luyadingeka ngoku.
Umda
Omnye umda onokubakho welinge lovavanyo lokujongana nesihloko ekuphikiswana ngaso ngokubanzi malunga nesicelo se-PRP ziimpawu zalo zobuhlanga.Ukufumaneka kwe-PRP kunye nokungafani kwelizwe ekubuyiselweni kwembuyekezo kunokuchaphazela iziphumo kunye nemiba yokulawula.Ngapha koko, ukuvumelana akunazinto ezininzi kwaye kubandakanya kuphela izimvo zoogqirha bamathambo.Nangona kunjalo, oku kunokubonwa njengenzuzo njengoko ikuphela kweqela eliphumeza ngokusebenzayo kwaye libeke iliso kunyango lwenaliti ye-PRP.Ukongeza, uphando olwenziweyo lunomgangatho wemethodological eyahlukileyo xa kuthelekiswa nenkqubo yeDelphi eyenziwe ngokungqongqo.I-advanteji yimvumelwano eyenziwe liqela loogqirha bamathambo abaqeqeshiweyo abanolwazi olubanzi lobuchwephesha kwiinkalo zabo ngokweembono zenzululwazi esisiseko kunye nokusebenza kweklinikhi.
Ingcebiso
Ngokusekwe kwimvumelwano yobuncinci be-75% yeengcali ezithatha inxaxheba, ukufikelela kwimvumelwano kwezi ngongoma zilandelayo:
I-OA kunye nokulimala kwe-cartilage: Ukusetyenziswa kwe-knee osteoarthritis (ibakala le-KL II) kunokuba luncedo.
I-tendon pathology: Ukusetyenziswa kwezifo ze-tendon ezibukhali kunye nezingapheliyo kunokuba luncedo
Isiphakamiso esisebenzayo: Kwizilonda ezingapheliyo (i-cartilage, i-tendon), ii-injection ezininzi (i-2-4) ngamaxesha athile zicetyiswa ngakumbi kune-injection eyodwa.
Nangona kunjalo, akukho datha yaneleyo ngexesha lexesha phakathi kwenaliti enye.
Uphando lwexesha elizayo: Kucetyiswa ngamandla ukulinganisa ukuveliswa, ukulungiswa, ukusetyenziswa, ukuphindaphinda, kunye noluhlu lwe-PRP.Uphando olongezelelweyo olusisiseko kunye nolweklinikhi luyimfuneko.
Ukuqukumbela
Imvumelwano ngokubanzi kukuba kukho ukungafani kwizibonakaliso ezahlukeneyo zesicelo se-PRP, kwaye kusekho ukungaqiniseki okubonakalayo ekumiseni umgangatho weprogram ye-PRP ngokwayo, ngakumbi kwizibonakaliso ezahlukeneyo.Ukusetyenziswa kwe-PRP kwi-knee osteoarthritis yokuqala (i-KL grade II) kunye nezifo ezinzima kunye nezingapheliyo ze-tendon zinokuba luncedo.Kwizilonda ezingapheliyo (i-cartilage kunye ne-tendon), ii-injection ezininzi ze-interval (2-4) zicetyiswa ngakumbi kune-injection enye, kodwa akukho datha eyaneleyo kwixesha lexesha phakathi kwenaliti enye.Umba omkhulu kukuhluka kokwakheka kwe-PRP yomntu, edlala indima ebalulekileyo kwindima ye-PRP.Ke ngoko, imveliso ye-PRP kufuneka ikumgangatho ongcono, kunye neeparamitha zeklinikhi ezifana ne-injection frequency, kunye nexesha phakathi kwenaliti kunye nezalathisi ezichanekileyo.Nokuba i-OA, okwangoku imele eyona ndawo ibalaseleyo yophando kwisicelo se-PRP, uphando olusisiseko lwenzululwazi nolwezonyango luyafuneka, kunye nezinye izikhombisi ezicetywayo.
(Imixholo yeli nqaku ishicilelwe, kwaye asiboneleli nasiphi na isiqinisekiso esicacileyo okanye esichaziweyo sokuchaneka, ukuthembeka okanye ukugqibelela kokuqulathwe kweli nqaku, kwaye abanaxanduva ngezimvo zeli nqaku, nceda uqonde.)
Ixesha lokuposa: May-24-2023