Ukusetyenziswa kweI-Platelet Rich Plasma (PRP)Kwiinkalo ezahlukeneyo kunye nendlela yokukhetha i-PRP eSityebi kwiiSeli zeGazi eziMhlophe (L-PRP) kunye ne-PRP ehluphekileyo kwiiseli zegazi eziMhlophe (P-PRP)
Ukufumanisa kutshanje inani elikhulu lobungqina obuphezulu buxhasa ukusetyenziswa kwe-injection ye-LR-PRP yonyango lwe-Epicondylitis esecaleni kunye ne-LP-PRP yonyango lwe-knee Articular bone.Ubungqina obuphakathi bomgangatho ophakathi buxhasa ukusetyenziswa kwe-LR-PRP ye-injection ye-patellar tendinosis kunye ne-PRP ye-PRP ye-Plantar fasciitis kunye nentlungu yendawo yomnikeli kwi-patellar tendon transplantation ye-BTB ACL yokwakhiwa kwakhona.Akukho ubungqina obaneleyo bokucebisa rhoqo i-PRP ye-rotator cuff tendinosis, i-hip Articular bone osteoarthritis okanye i-ankle sprain.Ubungqina bangoku bubonisa ukuba i-PRP ayinayo ukuphumelela ekuphatheni isifo se-tendon ye-Achilles, ukulimala kwemisipha, i-fractures acute okanye i-bone non union, utyando lokulungiswa kwe-rotator, ukulungiswa kwe-tendon ye-Achilles, kunye nokwakhiwa kwakhona kwe-ACL.
I-Platelet rich plasma (PRP) lulungiselelo lweplasma lomntu oluzihambelayo olwandisa ugxininiso lweplatelet ngokubeka i-centrifuging isixa esikhulu segazi lomguli.IiPlatelets kwi-α Particles yayo (TGF- β 1. PDGF, bFGF, VEGF, EGF, IGF-1) iqulethe ubuninzi bezinto zokukhula kunye nabalamli, ezigxininiswe ngenkqubo ye-centrifugation ukukhulula izixa ze-suprabiological zale miba yokukhula kunye ne-cytokines. kwindawo eyenzakeleyo kwaye uphucule inkqubo yendalo yokuphilisa.
Uluhlu oluqhelekileyo lwe-platelet count yi-150000 ukuya kwi-350000 / μ L. Ukuphuculwa kwethambo kunye nokuphulukiswa kwezicubu ezithambileyo kubonakalisiwe, kunye neeplatelet ezigxininisiweyo ezifikelela kwi-1000000 / μ L. Imele ukunyuka okuphindwe kathathu ukuya kahlanu kwizinto zokukhula.Amalungiselelo e-PRP adla ngokuphinda ahlulwe abe yi-PRP ecebileyo kwiiseli zegazi ezimhlophe (LR-PRP), echazwa njenge-concentration ye-neutrophil ngaphezu kwesiseko, kunye ne-PRP ehluphekileyo kwiiseli ezimhlophe zegazi (LP-PRP), echazwe njengengqamuzana legazi elimhlophe (neutrophil) elingaphantsi kwesiseko. .
Unyango lweeNgozi zeTendon
Ukusetyenziswa kwe-PRP yonyango lokulimala kwe-tendon okanye isifo se-tendon kuye kwaba sisihloko sezifundo ezininzi, kwaye ezininzi ii-cytokines ezifunyenwe kwi-PRP zibandakanyeka ekuboniseni iindlela ezenzekayo ngexesha lokuphulukisa ukuvuvukala, ukwanda kweeseli, kunye nokuhlaziywa kwezicubu ezilandelayo.I-PRP inokukhuthaza ukubunjwa kwemithambo yegazi emitsha, enokunyusa ukunikezelwa kwegazi kunye nesondlo esifunekayo ekuhlaziyweni kweeseli zezicubu ezonakalisiweyo, kunye nokuzisa iiseli ezintsha kunye nokususa i-debris kwizicubu ezonakalisiweyo.Ezi ndlela zesenzo zinokuthi zichaneke ngokukodwa kwi-tendinosis engapheliyo, apho iimeko zebhayoloji azihambelani nokuphulukiswa kwezicubu.Uphononongo olutshanje olucwangcisiweyo kunye nohlalutyo lwe-meta lugqibe ekubeni ukutofa i-PRP kunokuphatha ngokufanelekileyo i-tendinosis yeempawu.
I-Epicondylitis yecala
I-PRP iye yavavanywa njengendlela yonyango enokubakho kwizigulane ezine-lateral Epicondylitis ezingasebenziyo kwi-physiotherapy.Kwesona sifundo sikhulu, uMishra et al.Kwisifundo se-Cohort esilindelekileyo, izigulane ze-230 ezingazange ziphendule kwi-Conservative management of lateral Epicondylitis ubuncinane kwiinyanga ze-3 zavavanywa.Isigulana safumana unyango lwe-LR-PRP, kwaye kwiiveki ze-24, i-injection ye-LR-PRP idibaniswe nokuphucula okuphawulekayo kwintlungu xa kuthelekiswa neqela lokulawula (71.5% vs 56.1%, P = 0.019), kunye nokunciphisa okukhulu ipesenti yezigulane ezixela ukuthamba kwengqiniba okushiyekileyo (29.1% vs 54.0%, P=0.009).Kwiiveki ze-24, izigulane eziphathwe nge-LR-PRP zibonise uphuculo olubalulekileyo lweklinikhi kunye nokubaluleka kwezibalo xa kuthelekiswa ne-injection yokulawula esebenzayo ye-anesthetics yendawo.
Uphononongo lwangaphambili lubonise ukuba i-LR-PRP inokubonelela ngesiqabu esihlala ixesha elide kwiimpawu ze-Epicondylitis esecaleni xa kuthelekiswa nenaliti ye-Corticosteroid, ngoko inomphumela wonyango oluzinzileyo.I-PRP ibonakala iyindlela esebenzayo yonyango lwe-Epicondylitis yangaphandle.Ubungqina obuphezulu obuphezulu bubonisa ukusebenza kwexesha elifutshane kunye nexesha elide.Obona bungqina bukhoyo bubonisa ngokucacileyo ukuba i-LR-PRP kufuneka ibe yindlela yokuqala yokonyango.
I-Patellar Tendinosis
Izifundo ezilawulwa ngokungakhethiyo zixhasa ukusetyenziswa kwe-LR-PRP kunyango lwe-refractory patellar tendon engapheliyo.UDraco et al.Izigulane ezingamashumi amabini anesithathu ezine-patellar tendinosis ezingaphumelelanga ulawulo lwe-Conservative zavavanywa.Izigulane zabelwa ngokungenamkhethe ukuba zithole iinaliti ezomileyo ezikhokelwa yi-ultrasound okanye i-injection ye-LR-PRP, kwaye zalandelwa> iiveki ze-26.Ngokusebenzisa umlinganiselo we-VISA-P, iqela lonyango le-PRP libonise ukuphuculwa okuphawulekayo kweempawu kwiiveki ze-12 (P = 0.02), kodwa umehluko wawungabalulekanga kwi> iiveki ze-26 (P = 0.66), ebonisa ukuba inzuzo ye-PRP ye-patellar tendon isifo. inokuba luphuculo kwiimpawu zokuqala.Vitrano et al.Iinzuzo zenaliti ye-PRP ekunyangeni isifo se-tendon ye-patellar engapheliyo xa kuthelekiswa nokugxilwa kwe-extracorporeal shock wave therapy (ECSWT) nayo yaxelwa.Nangona kwakungekho nantlukwano ephawulekayo phakathi kwamaqela ngexesha lokulandelelana kweenyanga ze-2, iqela le-PRP libonise uphuculo oluphawulekayo kwi-6 kunye neenyanga ze-12 zokulandelelana, ukugqithisa i-ECSWT njengoko kulinganiswe yi-VISA-P kunye ne-VAS, kunye nokulinganisa i-Blazina. amanqaku okulinganisa kwiinyanga ze-12 zokulandela (zonke P <0.05).
Olu phononongo luvavanya uncwadi lwangoku lweklinikhi malunga nokusetyenziswa kwe-plasma ecebileyo yeplatelet (PRP), kubandakanywa ne-leukocyte ecebileyo ye-PRP (LR PRP) kunye ne-leukocyte i-PRP ehluphekileyo (LP PRP), ukwenzela ukuba kuphuhliswe iingcebiso ezisekelwe kubungqina bezifo ezahlukeneyo ze-musculoskeletal.
Ukufumanisa kutshanje inani elikhulu lobungqina obuphezulu buxhasa ukusetyenziswa kwe-injection ye-LR-PRP yonyango lwe-Epicondylitis esecaleni kunye ne-LP-PRP yonyango lwe-knee Articular bone.Ubungqina obuphakathi bomgangatho ophakathi buxhasa ukusetyenziswa kwe-LR-PRP ye-injection ye-patellar tendinosis kunye ne-PRP ye-PRP ye-Plantar fasciitis kunye nentlungu yendawo yomnikeli kwi-patellar tendon transplantation ye-BTB ACL yokwakhiwa kwakhona.Akukho ubungqina obaneleyo bokucebisa rhoqo i-PRP ye-rotator cuff tendinosis, i-hip Articular bone osteoarthritis okanye i-ankle sprain.Ubungqina bangoku bubonisa ukuba i-PRP ayinayo ukuphumelela ekuphatheni isifo se-tendon ye-Achilles, ukulimala kwemisipha, i-fractures acute okanye i-bone non union, utyando lokulungiswa kwe-rotator, ukulungiswa kwe-tendon ye-Achilles, kunye nokwakhiwa kwakhona kwe-ACL.
Yazisa
I-Platelet rich plasma (PRP) lulungiselelo lweplasma lomntu oluzihambelayo olwandisa ugxininiso lweplatelet ngokubeka i-centrifuging isixa esikhulu segazi lomguli.IiPlatelets kwi-α Particles yayo (TGF- β 1. PDGF, bFGF, VEGF, EGF, IGF-1) iqulethe ubuninzi bezinto zokukhula kunye nabalamli, ezigxininiswe ngenkqubo ye-centrifugation ukukhulula izixa ze-suprabiological zale miba yokukhula kunye ne-cytokines. kwindawo eyenzakeleyo kwaye uphucule inkqubo yendalo yokuphilisa.Uluhlu oluqhelekileyo lwe-platelet count yi-150000 ukuya kwi-350000 / μ L. Ukuphuculwa kwethambo kunye nokuphulukiswa kwezicubu ezithambileyo kubonakalisiwe, kunye neeplatelet ezigxininisiweyo ezifikelela kwi-1000000 / μ L. Imele ukunyuka okuphindwe kathathu ukuya kahlanu kwizinto zokukhula.
Amalungiselelo e-PRP adla ngokuphinda ahlulwe abe ngamalungiselelo e-PRP atyebileyo kwiiseli ezimhlophe zegazi (LR-PRP), echazwa njenge-neutrophil concentrations ngasentla kwesiseko, kunye namalungiselelo e-PRP ahluphekileyo kwiiseli ezimhlophe zegazi (LP-PRP), ezichazwe njengeengqamuzana zegazi elimhlophe (neutrophil) ngaphantsi kwesiseko.
Ukulungiselela kunye noKwakha
Akukho mvumelwano ngokubanzi malunga nokuqulunqwa kwe-PRP efanelekileyo yoxinaniso lwecandelo legazi, kwaye okwangoku kukho iinkqubo ezininzi ze-PRP zorhwebo kwiimarike.Ngoko ke, ngokweenkqubo ezahlukeneyo zorhwebo, kukho ukungafani kwiiprotokholi zokuqokelela i-PRP kunye neempawu zokulungiselela, ukunika inkqubo nganye ye-PRP iimpawu ezizodwa.Iinkqubo zorhwebo ngokuqhelekileyo zihluke ekusebenzeni kakuhle kweplatelet, indlela yokwahlula (inyathelo elinye okanye inyathelo elibini le-centrifugation), isantya se-centrifugation, kunye nohlobo lwenkqubo yetyhubhu yokuqokelela kunye nokusebenza.Ngokuqhelekileyo, phambi kwe-centrifugation, igazi elipheleleyo liqokelelwa kwaye lixutywe kunye nezinto ezichasene ne-anticoagulant ukuze zahlule iiseli ezibomvu zegazi (RBCs) kwi-platelet-poor plasma (PPP) kunye "ne-erythrocyte sedimentation brown layer" equlethe iiplatelet ezigxininisiweyo kunye neeseli ezimhlophe zegazi.Iindlela ezahlukeneyo zisetyenziselwa ukwahlula iiplatelet, ezinokuthi zifakwe ngokuthe ngqo kumzimba wesigulane okanye "zisebenze" ngokufaka i-calcium chloride okanye i-thrombin, ekhokelela kwi-platelet degranulation kunye nokukhululwa kwezinto zokukhula.Imiba emibini echaphazelekayo yesigulane, kubandakanywa nokulawulwa kweziyobisi kunye neendlela zokulungiselela inkqubo yorhwebo, ichaphazela ukubunjwa okuthe ngqo kwe-PRP, kunye nolu tshintsho ekubunjweni kwe-PRP formulations ekuchazeni ukusebenza kwekliniki ye-PRP.
Ukuqonda kwethu kwangoku kukuba i-PRP kunye nokunyuka kweeseli ezimhlophe zegazi, okuyi-PRP ecebileyo kwiiseli zegazi ezimhlophe (i-neutrophils), ihambelana nemiphumo ye-pro-inflammatory.Ukunyuswa kweeseli ezimhlophe zegazi (i-neutrophils) kwi-LR-PRP iphinda idibaniswe nokunyuka kwee-cytokines ze-catabolic, ezifana ne-interleukin-1 β, i-Tumor Necrosis Factor α kunye ne-metalloproteinases, enokuthi iphikisana ne-anabolic cytokines equlethwe kwiiplatelet.Iziphumo zeklinikhi kunye nemiphumo yeselula yale miqulu eyahlukeneyo ye-PRP, kubandakanywa nomxholo weseli emhlophe yegazi, isacaciswa.Olu phononongo lujolise ekuvavanyeni obona bungqina busemgangathweni obukhoyo kwimiqondiso eyahlukeneyo yeklinikhi yeendlela ezahlukeneyo zePRP.
Izifo ze-Achilles Tendon
Izilingo ezininzi zembali ziye zahluleka ukubonisa ukungafani kwiziphumo zekliniki phakathi kwe-PRP kunye ne-placebo yodwa kunyango lwe-Achilles tendinitis.Ulingo lwakutsha nje oluLawulwayo oluHlaziyiweyo luthelekisa uthotho lweenaliti ezine ze-LP-PRP ezinenaliti ye-placebo edityaniswe nenkqubo yokubuyisela umthwalo we-centrifugal.Xa kuthelekiswa neqela le-placebo, iqela lonyango le-PRP libonise ukuphuculwa okuphawulekayo kwintlungu, umsebenzi, kunye namanqaku omsebenzi kuwo onke amanqaku kwixesha lonke leenyanga ze-6.Uphononongo luphinde lwafumanisa ukuba i-injection eyodwa yevolumu enkulu (i-50 mL) ye-0.5% ye-Bupivacaine (10 mL), i-methylprednisolone (20 mg) kunye ne-saline ye-physiological (40 mL) yayinokuphuculwa okufaniswayo, kodwa xa kuqwalaselwa olu nyango, kufuneka kuthathelwe ingqalelo. umbono wokonyuka komngcipheko wokuqhekeka kwe-tendon emva kwesitofu se-steroid.
I-Rotator Cuff Tendinosis
Kukho izifundo ezimbalwa eziphakamileyo eziphezulu kwi-injection ye-PRP kunyango olungenalo utyando lwe-rotator cuff tendon isifo.Izifundo ezimbalwa ezipapashiweyo ziqhathanise iziphumo zekliniki ze-injection ye-subacromial ye-PRP kunye ne-placebo kunye ne-Corticosteroid, kwaye akukho sifundo siye savavanya i-injection ngqo ye-PRP kwi-tendon ngokwayo.UCasey Buren et al.Kwafunyaniswa ukuba akukho mmahluko kumanqaku eziphumo zeklinikhi xa kuthelekiswa nokutofa i-saline ye-physiological phantsi kwegxalaba.Nangona kunjalo, ulingo olulawulwa ngokungahleliwe lufumanise ukuba iinaliti ezimbini ze-LR-PRP rhoqo emva kweeveki ezine ziphucula iintlungu xa kuthelekiswa neenaliti ze-placebo.Shams et al.Uphuculo oluthelekisayo lwe-PRP ye-subacromial kunye ne-Corticosteroid injection phakathi kwe-Xi'an Ontario RC index (WORI), i-shoulder disability index (SPDI) kunye neentlungu ze-VAS zamagxa kunye novavanyo lwe-Neer lwabikwa.
Ukuza kuthi ga ngoku, uphando lubonise ukuba ukujova i-PRP phantsi kwegxalaba kunokuphucula okuphawulekayo kwiziphumo ezichazwe kwizigulane ezine-rotator cuff tendon disease.Ezinye izifundo ezifuna ukulandelwa ixesha elide, kubandakanywa nokuvavanya i-injection ngqo ye-PRP kwii-tendon.Ezi zijovo ze-PRP zibonakaliswe ukuba zikhuselekile kwaye zinokuba enye i-injection ye-Corticosteroid kwi-rotator cuff tendinosis.
I-Plantar Fasciitis
Ulingo oluninzi olulawulwa ngokungahleliwe luvavanye inaliti ye-PRP ye-Plantar fasciitis engapheliyo.Amandla e-PRP njengonyango lwe-injection yengingqi kunciphisa iinkxalabo ezinxulumene nenaliti ye-Corticosteroid, efana ne-atrophy ye-fashion pads okanye ukuphuka kwe-fascia plantar.Uhlalutyo lwemeta ezimbini zakutsha nje luvavanye uthelekiso phakathi kwesitofu se-PRP kunye nenaliti ye-Corticosteroid, kwaye kwaqukunjelwa ukuba inaliti ye-PRP yenye indlela enokwenzeka kwinaliti ye-Corticosteroid ngokwemigaqo yokusebenza kakuhle.Ezinye izifundo zibonise ukongama kwe-PRP.
Utyando oludityaniswe ne-PRP
Ukulungiswa kwemikhono yamagxa
Izifundo ezininzi zeklinikhi eziphakamileyo zavavanya ukusetyenziswa kweemveliso ze-PRP kwi-Arthroscopy ukulungiswa kweenyembezi ze-rotator cuff.Izifundo ezininzi ziye zafunda ngokukodwa ukusetyenziswa kweplatelet rich fibrin matrix amalungiselelo okuphucula (PRFM), ngelixa ezinye izifundo ziye zafaka i-PRP ngqo kwindawo yokulungisa.Kukho i-heterogeneity ebalulekileyo kwi-PRP okanye kwi-PRFM yokwakheka.Iziphumo ezijoliswe kwisigulana zifunyenwe, ezifana neYunivesithi yaseCalifornia, eLos Angeles (UCLA), i-American Shoulder kunye ne-Elbow Association (ASES), i-Constant Shoulder Score, i-Simple Shoulder Test (SST) amanqaku, kunye namanqaku eentlungu ze-VAS, kunye nenjongo yekliniki. idatha efana namandla e-rotator cuff kunye ne-ROM yegxalaba zaqokelelwa ukulinganisa ukungafani kwiziphumo zokusebenza.Uninzi lwezifundo zomntu ngamnye zibonise umehluko omncinci kwimilinganiselo yezi ziphumo kwi-PRP xa kuthelekiswa nokulungiswa komntu ngamnye [njengeepads ze-Arthroscopy rotator cuff ukulungiswa.Ukongeza, uhlalutyo olukhulu lwe-meta kunye nophononongo oluqatha lwamva nje luye lwabonisa ukuba ukulungiswa kwe-Arthroscopy ye-cuff yamagxa [PRP] ayinayo inzuzo ebalulekileyo ekukhuliseni ibele.Nangona kunjalo, idatha elinganiselweyo ibonisa ukuba inempembelelo ethile ekunciphiseni intlungu ye-perioperative, mhlawumbi ngenxa yeempawu ezichasayo ze-PRP.
Uhlalutyo lweqela elincinci lubonise ukuba phakathi kunye neenyembezi ezincinci ziphathwa nge-Arthroscopy kabini ukulungiswa komqolo, inaliti ye-PRP inokunciphisa izinga lokukrazula kwakhona, ngaloo ndlela ifumana iziphumo ezingcono.Qiao et al.Kwafunyaniswa ukuba i-PRP inenzuzo ekunciphiseni izinga lokukrazulwa kwakhona kweenyembezi eziphakathi kunye nezinkulu ze-rotator xa kuthelekiswa nokuhlinzwa kuphela.
Izilingo zeklinikhi ezingahleliwe kunye nohlalutyo olukhulu lwe-meta lubonisa ukungabikho kobungqina bokusetyenziswa kwe-PRP kunye ne-PRFM njengokuqiniswa kokulungiswa kwe-rotator cuff.Olunye uhlalutyo lweqela elincinci lucebisa ukuba ukulungiswa kwemiqolo emibini kunokuba neenzuzo ezithile zokunyanga iinyembezi ezincinci okanye eziphakathi.I-PRP inokunceda kwakhona ukunciphisa ngokukhawuleza intlungu emva kokuhlinzwa.
Ukulungiswa kwe-Achilles Tendon
Izifundo zangaphambili zibonise ukuba i-PRP inefuthe elithembisayo ekukhuthazeni ukuphulukiswa kwe-Achilles tendon rupture.Nangona kunjalo, ubungqina obuphikisanayo buthintela ukuguqulwa kwe-PRP njengonyango olusebenzayo lwe-adjuvant for acute Achilles tendon rupture kubantu.Ngokomzekelo, kwisifundo esinye, iziphumo zesakhiwo kunye nokusebenza kwezigulane ezine-Achilles tendon rupture eziphathwe kunye nangaphandle kwe-PRP zifana.Ngokwahlukileyo, uZou et al.Kwisifundo esilawulwa ngokungahleliwe, izigulane ze-36 zaye zafumana ukulungiswa kwe-tendon ye-Achilles enzima kunye nangaphandle kwe-injection ye-LR-PRP.Izigulane kwiqela le-PRP zinezihlunu ezingcono ze-isokinetic kwiinyanga ze-3, kwaye zinezinga eliphezulu ze-SF-36 kunye ne-Leppilahti kwi-6 kunye neenyanga ze-12, ngokulandelanayo (yonke i-P <0.05).Ukongezelela, uluhlu oludibeneyo lwe-ankle yokunyakaza kwiqela le-PRP nalo liphuculwe kakhulu kuwo onke amanqaku exesha kwi-6, i-12, kunye neenyanga ze-24 (P <0.001).Nangona izilingo zeklinikhi ezikumgangatho ophezulu zifuneka, ukutofa i-PRP njengophuculo lotyando lokulungiswa kwe-tendon ye-Achilles ebukhali akubonakali kunenzuzo.
Utyando lweLigament lwangaphambili
Ukuphumelela kwe-anterior cruciate ligament (ACL) utyando aluxhomekanga kuphela kwizinto zobuchwepheshe (ezifana nokubekwa kwe-tunnel ye-graft kunye nokulungiswa kwe-graft), kodwa nakwi-biological impiliso ye-ACL grafts.Uphando malunga nokusetyenziswa kwe-PRP kwi-ACL yokuhlinzwa ngokutsha kugxininise kwiinkqubo ezintathu zezinto eziphilayo: (1) ukuhlanganiswa kwamathambo ethambo phakathi kwe-graft kunye ne-tibial kunye ne-femoral tunnels, (2) ukuvuthwa kwecandelo elidibeneyo le-graft, kunye () 3) ukuphilisa kunye nokunciphisa intlungu kwindawo yokuvuna.
Nangona izifundo ezininzi zijolise ekusebenziseni inaliti ye-PRP kwi-ACL yotyando kwiminyaka emihlanu edlulileyo, kukho izifundo ezimbini kuphela eziphezulu.Izifundo zangaphambili zibonise ukuba ubungqina obuxubileyo buxhasa ukuhlanganiswa kokutshintshwa okanye ukuxutywa kweeseli ze-Osteoligamous ezivuthiweyo usebenzisa i-injection ye-PRP, kodwa ubungqina obuthile bubonakaliswe ukuxhasa intlungu kwindawo yomnikeli.Ngokumalunga nokusetyenziswa kophuculo lwe-PRP ekuphuculeni i-graft bone tunnel bonding, idatha yakutshanje ibonisa ukuba i-PRP ayinayo inzuzo yeklinikhi ekwandiseni itonela okanye ukuhlanganiswa kwamathambo okuxutywa.
Izilingo zeklinikhi zakutsha nje zibonise iziphumo ezithembisayo zakwangoko kwintlungu yendawo yabanikeli kunye nokuphilisa usebenzisa i-PRP.Sajas et al.Ukuqwalasela intlungu yangaphambili yamadolo emva kokuvuselelwa kwe-ACL ye-autologous ye-bone patella bone (BTB), kwafunyaniswa ukuba xa kuthelekiswa neqela lokulawula, intlungu yangaphambili yamadolo yancitshiswa ngexesha lokulandelelana kweenyanga ze-2.
Uphando olongezelelweyo luyafuneka ukuphanda imiphumo ye-PRP kwi-ACL yokuhlanganiswa kwe-graft, ukuvuthwa, kunye nentlungu yendawo yomnikeli.Nangona kunjalo, ngeli nqanaba, uphando lubonise ukuba i-PRP ayinayo impembelelo ebalulekileyo yekliniki ekudityanisweni kwe-graft okanye ukuvuthwa, kodwa izifundo ezilinganiselwe zibonise iziphumo ezilungileyo ekunciphiseni intlungu kwindawo yomnikeli we-tendon patellar.
I-Osteoarthritis
Abantu banomdla ngakumbi ekusebenzeni kwe-PRP ye-intra-articular injection kwi-non-operation treatment of knee Articular bone osteoarthritis.Shen et al.I-meta-analysis ye-14 izilingo zeklinikhi ezingahleliwe (RCTs) ezibandakanya izigulane ze-1423 zenziwa ukuthelekisa i-PRP kunye nolawulo oluhlukeneyo (kubandakanywa ne-placebo, i-hyaluronic acid, i-injection ye-Corticosteroid, iyeza lomlomo kunye nonyango lwe-Homeopathy).Uhlalutyo lwe-Meta lubonise ukuba ngexesha lokulandelwa kwe-3, i-6 kunye ne-12 iinyanga, amanqaku e-Osteoarthritis index (WOMAC) yeYunivesithi yaseWestern Ontario kunye neYunivesithi yaseMcMaster iphuculwe kakhulu (= 0.02, 0.04, <0.001, ngokulandelanayo).Uhlalutyo lwe-subgroup ye-PRP esekelwe kubunzima be-knee osteoarthritis lubonise ukuba i-PRP iyasebenza kakhulu kwizigulane ezine-OA encinci ukuya kwimodareyitha.Umbhali ukholelwa ukuba ngokweentlungu zentlungu kunye neziphumo ezichaziweyo zesigulane, i-injection ye-PRP ye-intra articular iyasebenza ngakumbi kunezinye ii-injection zokunyanga i-knee osteoarthritis.
URiboh et al.iqhube i-meta-analysis ukuthelekisa indima ye-LP-PRP kunye ne-LR-PRP kunyango lwe-knee Osteoarthritis, kwaye yafumanisa ukuba xa kuthelekiswa ne-HA okanye i-placebo, i-LP-PRP injection inokuphucula kakhulu amanqaku e-WOMAC.Ferrado et al.wafunda inaliti ye-LR-PRP, okanye wafumanisa ukuba akukho mahluko wezibalo xa kuthelekiswa nenaliti ye-HA, ebonisa ngakumbi ukuba i-LP-PRP ingaba yinto yokuqala yokukhetha unyango lweempawu ze-Osteoarthritis.Isiseko sayo sebhayoloji sinokulala kumanqanaba anxulumene nokuvuvukala kunye nabalamli abachasayo abakhoyo kwi-LR-PRP kunye ne-LP-PRP.Ngaphambi kwe-LR-PRP, umlamli ovuthayo we-TNF- α, IL-6, IFN- ϒ kunye ne-IL-1 β Unyuswe ngokuphawulekayo, ngelixa i-injection ye-LP-PRP ikwandisa i-IL-4 kunye ne-IL-10, echasene nokuvuvukala. abalamli.Kufunyenwe ukuba i-IL-10 iluncedo ngokukhethekileyo kunyango lwe-hip osteoarthritis, kwaye inokuthintela umlamli ovuthayo we-TNF- α, IL-6 kunye ne-IL-1 β Ukukhutshwa kunye nokuthintela indlela yokuvuvukala ngokuphazamisa umsebenzi we-nuclear factor kB.Ukongeza kwimiphumo eyingozi kwi-chondrocytes, i-LR-PRP isenokungakwazi ukunceda ukuphatha iimpawu ze-Osteoarthritis ngenxa yemiphumo yayo kwiiseli ze-synovial.Braun et al.Kwafunyaniswa ukuba ukuphatha iiseli ze-synovial kunye ne-LR-PRP okanye iiseli ezibomvu zegazi kunokukhokelela ekuveliseni umlamli obalulekileyo we-pro-inflammatory kunye nokufa kweeseli.
Inaliti ye-Intra articular ye-LP-PRP yindlela yonyango ekhuselekileyo, kwaye kukho ubungqina beNqanaba loku-1 bokuthi inokunciphisa iimpawu zentlungu kunye nokuphucula umsebenzi wezigulane ezifunyanwe nge-knee Articular bone osteoarthritis.Umlinganiselo omkhulu kunye nezifundo zokulandela ixesha elide ziyafuneka ukumisela ukusebenza kwayo kwexesha elide.
I-Hip Osteoarthritis
Izilingo ezine kuphela zeklinikhi ezifaniswayo kunye nenaliti ye-PRP kunye ne-hyaluronic acid (HA) yokunyangwa kwe-hip osteoarthritis.Iziphumo zeziphumo ziziphumo zentlungu ye-VAS, inqaku le-WOMAC, kunye ne-Harris hip joint score (HHS).
Batalya et al.ufumene ukuphuculwa okuphawulekayo kumanqaku e-VAS kunye ne-HHS kwi-1, i-3, i-6, kunye neenyanga ze-12.Ukuphuculwa kwencopho kwenzeka kwiinyanga ze-3, kwaye umphumo waba buthathaka ngokuthe ngcembe emva koko [72].Amanqaku kwiinyanga ze-12 zisaphuculwe kakhulu xa kuthelekiswa namanqaku asisiseko (P <0.0005);Nangona kunjalo, akukho mahluko abalulekileyo kwiziphumo phakathi kwe-PRP kunye namaqela e-HA.
Di Sante et al.wabona ukuba inqaku le-VAS leqela le-PRP liphuculwe kakhulu kwiiveki ze-4, kodwa libuyiselwe kwisiseko kwiiveki ze-16.Kwakungekho mmahluko obalulekileyo kumanqaku e-VAS phakathi kweqela le-HA kwiiveki ze-4, kodwa kukho ukuphuculwa okuphawulekayo kwiiveki ze-16.UDalari et al.Sivavanye impembelelo ye-PRP kwi-injection ye-HA, kodwa kwakhona sithelekisa ukudibanisa kwe-HA kunye ne-PRP ye-injection kuzo zombini iimeko.Iqela le-PRP lifunyenwe libe nelona nqanaba liphantsi le-VAS phakathi kwawo onke amaqela amathathu kuwo onke amaxesha okulandelela (iinyanga ze-2, iinyanga ze-6 kunye neenyanga ze-12).I-PRP iphinde ibe namanqaku angcono kakhulu e-WOMAC kwi-2 kunye neenyanga ze-6, kodwa kungekhona kwiinyanga ze-12.UDoria et al.Ulingo lwekliniki oluyimfama oluphindwe kabini lwenziwe ukuthelekisa izigulane ezifumene iinaliti ezintathu zeveki ezilandelelanayo ze-PRP kunye neenaliti ezintathu ezilandelelanayo ze-HA.Olu pho nonongo lufumene ukuphuculwa kwe-HHS, i-WOMAC, kunye namanqaku e-VAS kumaqela e-HA kunye ne-PRP ngexesha le-6 kunye ne-12 yokulandelelana kweenyanga.Nangona kunjalo, ngamaxesha onke, kwakungekho mahluko ubalulekileyo phakathi kwamaqela amabini.Akukho uphando oluye lwabonisa ukuba i-intra-articular injection ye-PRP kwi-hip inemiphumo emibi, kwaye bonke baye bagqiba ekubeni i-PRP ikhuselekile.
Nangona idatha ilinganiselwe, i-intra-articular injection ye-PRP kunyango lwe-hip Articular bone osteoarthritis ibonakaliswe ikhuselekile, kwaye inokusebenza okuthile ekunciphiseni intlungu kunye nokuphucula umsebenzi, njengoko kulinganiswe ngamanqaku eziphumo ezichazwe zizigulane.Izifundo ezininzi zibonise ukuba i-PRP inokuqala ngcono ukunciphisa intlungu xa kuthelekiswa ne-HA;Nangona kunjalo, njengoko i-PRP kunye ne-HA zisebenza ngokufanayo kwiinyanga ze-12, nayiphi na inzuzo yokuqala ibonakala iyancipha ngokuhamba kwexesha.Ekubeni izifundo ezimbalwa zeklinikhi ziye zavavanya ukusetyenziswa kwe-PRP kwi-hip OA, ubungqina obungaphezulu obuphezulu bufunekayo ukufumanisa ukuba i-PRP ingasetyenziselwa njengenye indlela yokulawula i-Conservative ukulibazisa ukusebenza kwe-hip Articular bone osteoarthritis.
I-Ankle Sprain
Izilingo ezimbini kuphela zeklinikhi eziye zadibana neendlela zethu zokubandakanywa ezivavanya ukusetyenziswa kwe-PRP kwi-ankle sprain.Roden et al.Ulingo lwekliniki oluyimfama oluphindwe kabini lwe-placebo lwenziwe kwizigulane ezine-ankle sprain kwi-ED, kuthelekisa i-ultrasound ekhokelwa yi-injection ye-anesthetic yendawo ye-LR-PRP kunye ne-saline kunye ne-injection ye-anesthetic yendawo.Abafumananga nantlukwano ephawulekayo kwi-VAS yamanqaku entlungu okanye isikali esisezantsi sokusebenza kwemilenze (LEFS) phakathi kwamaqela amabini.
Laval et al.I-random inikwe i-16 abadlali be-elite abafunyanwe ukuba bane-sprains ephezulu ye-ankle ukuze bafumane unyango lwe-injection ye-LP-PRP ekhokelwa yi-ultrasound kwinqanaba lokuqala lonyango, kunye nokujongwa ngokuphindaphindiweyo kwesicwangciso sokuvuselela esidibeneyo okanye isicwangciso esahlukileyo sokubuyisela emva kweentsuku ze-7.Zonke izigulane zafumana iprotocol yonyango yokubuyisela kunye neendlela zokubuyisela.Uphononongo lufumene ukuba iqela le-LP-PRP liphinde laqala ukhuphiswano ngexesha elifutshane (iintsuku ze-40.8 vs. 59.6 iintsuku, P <0.006).
I-PRP ibonakala ingasebenzi kwi-ankle sprain.Nangona ubungqina obuncinane bubonisa ukuba i-LP-PRP injection inokuchaphazela i-ankle ephezulu yabadlali be-elite.
Ukwenzakala Kwemisipha
Ukusetyenziswa kwe-PRP ekuphatheni ukulimala kwemisipha kubonise ubungqina obucacileyo bekliniki.Ngokufana nokuphulukiswa kwe-tendon, amanyathelo okuphulukiswa kwemisipha abandakanya impendulo yokuqala yokuvuvukala, elandelwa kukwanda kweeseli, ukuhlukana, kunye nokulungiswa kwezicubu.UHamid et al.Uphononongo olulodwa olungaboniyo oluyimfama lwenziwa kwizigulane ze-28 ezine-grade 2 ukulimala kwe-hamstring, ukuthelekisa i-injection ye-LR-PRP kunye nezicwangciso zokuvuselela kunye nokuvuselela yedwa.Iqela elifumana unyango lwe-LR-PRP lakwazi ukubuyisela ukhuphiswano ngokukhawuleza (ixesha eliqhelekileyo ngeentsuku, i-26.7 vs. 42.5, P = 0.02), kodwa ayizange iphumelele ukuphuculwa kwesakhiwo.Ukongezelela, iziphumo ezibalulekileyo ze-placebo kwiqela lonyango zinokudida ezi ziphumo.Kulingo olulawulwayo oluyimfama oluphindwe kabini, Reurink et al.Sivavanye izigulane ezingama-80 kwaye sithelekisa inaliti ye-PRP kunye nenaliti ye-placebo ye-saline.Zonke izigulane zafumana unyango olusemgangathweni lokubuyisela kwisimo sangaphambili.Isigulane salandelwa kwiinyanga ze-6 kwaye kwakungekho mmahluko obalulekileyo malunga nexesha lokubuyisela okanye izinga lokulimala kwakhona.Ifomula efanelekileyo ye-PRP yokuphucula ukuphulukiswa kwemisipha kwiindlela ezifanelekileyo zeklinikhi kusenzima kwaye uphando lwexesha elizayo kufuneka lwenziwe.
Ulawulo lweeFractures kunye neNon Union
Nangona kukho ubungqina obunobungqina obucacileyo bokuxhasa ukusetyenziswa kwe-PRP ukuphucula ukuphulukiswa kwamathambo, akukho mvumelwano yekliniki yokuxhasa ukusetyenziswa kwesiqhelo kwe-PRP ukukhuthaza ukuphulukiswa kwamathambo.Uphononongo lwakutsha nje kwi-PRP kunye nonyango oluqatha lwe-fracture lubonise ii-RCT ezintathu ezingazange zibonise inzuzo ngokweziphumo zokusebenza, ngelixa izifundo ezimbini zibonise iziphumo eziphezulu zeklinikhi.Uninzi lwezilingo kolu hlaziyo (6/8) lufunde ukusebenza kakuhle kwe-PRP ngokudibanisa nezinye izinto eziphilayo (ezifana neeseli ze-mesenchymal stem kunye / okanye i-bone grafts) ukukhuthaza ukuphulukiswa kwe-fracture.
Umgaqo osebenzayo we-platelet-rich plasma (PRP) kukubonelela ngezinto zokukhula kunye ne-cytokines eziqulethwe kwiiplatelet ezinobuninzi bezinto eziphilayo.Kwiyeza le-musculoskeletal, i-PRP yindlela yonyango ethembisayo enobungqina obucacileyo bokhuseleko.Nangona kunjalo, ubungqina bokusebenza kwayo buxubene kwaye buxhomekeke kakhulu kwizithako kunye nezibonakaliso ezithile.Uvavanyo oluthe kratya oluphezulu kunye nolukhulu kwixa elizayo lubalulekile ekumiseni imbono yethu nge-PRP.
(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: Jul-24-2023