I-Platelet-rich plasma (PRP) ngoku isetyenziswa ngokubanzi kwiinkalo ezahlukeneyo zonyango.Kwiminyaka yakutshanje, ukusetyenziswa kwe-PRP kwi-orthopedics kuye kwatsala ingqalelo ngakumbi nangakumbi, kwaye ukusetyenziswa kwayo kwiinkalo ezahlukeneyo ezifana nokuvuselelwa kwezicubu, ukuphulukiswa kwesilonda, ukulungiswa kwezibazi, utyando lweplastiki kunye nobuhle buye banda kakhulu.Kwimiba yanamhlanje, siya kuhlalutya i-biology ye-PRP, indlela yokusebenza kwayo, kunye nokuhlelwa kwe-PRP ukuqonda ngcono ukuba yintoni enokuyenza kwaye akufanele yenziwe nge-PRP.
Imbali ye-PRP
I-PRP yaziwa nangokuthi i-platelet-rich plasma (PRP), i-platelet-rich growth factor (GFS) kunye ne-platelet-rich fibrin (PRF) matrix.Ingcamango kunye nenkcazo ye-PRP yaqala kwintsimi ye-hematology.I-Hematologists yaqulunqa igama elithi PRP kwiminyaka ye-1970, ngokukodwa ukuphatha izigulane ezine-thrombocytopenia ngokukhupha iiplatelet kunye nokongeza utofelo-gazi.
Kwiminyaka elishumi kamva, i-PRP yaqala ukusetyenziswa kwi-maxillofacial surgery njenge-PRF.I-Fibrin ine-adhesive kunye ne-homeostatic properties, kwaye i-PRP inezixhobo ezichasayo ezikhuthaza ukwanda kweeseli.Emva koko, i-PRP yaqala ukusetyenziswa ngokubanzi kwintsimi ye-musculoskeletal yokulimala kwezemidlalo kwaye yafumana iziphumo ezilungileyo zonyango.Ngenxa yokuba iithagethi zonyango ziziimbaleki eziziingcali, kuye kwatsala ingqalelo ebanzi kumajelo eendaba kwaye isetyenziswe ngokubanzi kwicandelo lamayeza ezemidlalo.Emva koko, i-PRP yanyuswa ngokuthe ngcembe kwi-orthopedics, utyando, utyando lwabantwana, i-gynecology, i-urology, iplastiki kunye nokuhlinzwa kwe-cosmetic kunye ne-ophthalmology.
Platelet Biology
Iiseli zegazi ze-peripheral ziquka iiseli ezibomvu zegazi, iiseli ezimhlophe zegazi kunye neeplatelet, zonke ziphuma kwi-pluripotent stem cell eqhelekileyo ekwazi ukuhlukana kwiiseli ezahlukeneyo.Le migca yeeseli iqulathe iiseli ze-precursor ezinokuzahlula kwaye zivuthwe.Iiplatelets zithathwe kumongo wethambo kwaye ziyi-nucleated disc-shaped cells ezinobungakanani obuhlukeneyo, kunye nobubanzi obuyi-2 μm, kwaye zincinci iiseli zegazi ezixineneyo.Iiplatelet zibala kwigazi elijikelezayo eliqhelekileyo ukusuka kwi-150,000 ukuya kwi-400,000 nge-microliter nganye.Iiplatelets ziqulethe iigranules ezininzi ezibalulekileyo, apho kukho ezintathu eziphambili: iigranules ezixineneyo, i-o-granules, kunye ne-lysosomes.Iplatelet nganye inamasuntswana angama-50-80.
Inkcazo ye-PRP
Ukuqukumbela, i-PRP yimveliso yebhayoloji, eyi-plasma egxininisiweyo ene-concentration yeplatelet ephezulu kakhulu kunegazi le-peripheral.I-PRP ayinayo kuphela amanqanaba aphezulu eeplatelet, kodwa iqulethe zonke izinto zokudibanisa, kubandakanywa uchungechunge lwezinto ezikhulayo, i-chemokines, i-cytokines kunye neeprotheni ze-plasma.
I-PRP itsalwa kwigazi le-peripheral elitsalwa ngeendlela ezahlukeneyo zokulungiselela iilebhu.Emva kokulungiswa, ngokweendlela ezahlukeneyo zokuxinana, iiseli ezibomvu zegazi, i-PRP, kunye ne-PPP kumacandelo egazi ahlukaniswe ngokulandelelana.Kwi-PRP, ngaphezu koxinzelelo oluphezulu lweeplatelet, kuyafuneka kwakhona ukuqwalasela ukuba iqulethe i-leukocytes kunye nokuba iyasebenza.Ngokusekelwe kule miba, iintlobo ezahlukeneyo ze-PRP ezifanelekileyo kwiimeko ezahlukeneyo ze-pathological zichongwa.
Izixhobo ezininzi zorhwebo zikhoyo ngoku ezinokwenza lula ukulungiswa kwe-PRP.Ezi zixhobo ze-PRP ngokuqhelekileyo zivelisa i-2-5 fold high-PRP concentrations yeplatelet.Nangona umntu unokucinga ukuba i-concentration ye-platelet iphezulu kwaye iphakamileyo yexabiso lokukhula, ngcono isiphumo sonyango kufuneka sibe, oku akuzange kusekwe, kwaye amaxesha angama-3-5 ukugxininiswa ngokuqhelekileyo kuthathwa njengento efanelekileyo.
Izixhobo zorhwebo zinenzuzo yokuba zibekwe emgangathweni kwaye zibe lula, kodwa zinemida yezixhobo zazo.Abanye abakwazi ukususa ukungcola okuthile kakuhle, kwaye amanye amalungiselelo e-PRP awaphezulu ekugxininiseni.Ngokusisiseko, zonke izixhobo zorhwebo azinakulungiswa ngabanye nangokuchanekileyo.Le yeyona ngxaki inkulu ngezixhobo ezisemgangathweni.Okwangoku, kuphela itekhnoloji yokulungiselela ilabhoratri echanekileyo kuphela enokugubungela zonke iimfuno zesigulane, ezineemfuno eziphezulu kwitekhnoloji yelabhoratri.
Ukuhlelwa kwe-PRP
Kwi-2006, u-Everts et al ucebise ingcamango ye-PRP ecebileyo ye-leukocyte.Ngoko ke, i-PRP inokuthi ihlulwe ngokufanelekileyo ibe ziindidi ezimbini ngokwenani le-leukocytes equlethwe: I-PRP ene-leukocytes embi kunye ne-PRP ene-leukocytes ecebileyo.
I-1) I-plasma ene-Platelet ecebileyo equkethe i-leukocytes ephezulu, ebizwa ngokuba yi-L-PRP (i-Leukocyte Platelet-Rich Plasma, equkethe inani elincinci leeseli ezibomvu zegazi), isetyenziselwa kakhulu amanxeba aphikisayo, unyawo lwesifo sikashukela, i-gout kunye nokungabikho kokuphilisa. amanxeba, ukulungiswa kwamathambo, i-nonunion, umongo wethambo ukudumba kunye nolunye unyango lweklinikhi.
I-2) I-Platelet-rich plasma ngaphandle okanye nge-concentrations ephantsi ye-leukocytes ibizwa ngokuba yi-P-PRP (i-Platelet-Rich Plasma ecocekileyo, ngaphandle kweeseli ezibomvu zegazi), isetyenziselwa ukulimala kwezemidlalo kunye nezifo eziphazamisayo, kubandakanywa ukulimala kwe-meniscus, i-ligament kunye nokulimala kwe-tendon. , i-tennis elbow, i-knee Arthritis, i-cartilage degeneration, i-lumbar disc herniation kunye nezinye izifo.
3) Emva kokuba i-PRP yolwelo isebenze nge-thrombin okanye i-calcium, i-gel-efana ne-PRP okanye i-PRF inokuqulunqwa.(Kuqale kulungiswe nguDohan et al. eFransi)
Kwi-2009, u-Dohan Ehrenfest et al.Ukuhlelwa kwe-4 ecetywayo ngokusekelwe kubukho okanye ukungabikho kwamacandelo eselula (njenge-leukocytes) kunye nesakhiwo se-fibrin:
I-1) I-PRP ecocekileyo okanye i-leukocyte-poor PRP: I-PRP elungiselelwe ayinayo i-leukocytes, kwaye umxholo we-fibrin emva kokusebenza uphantsi.
I-2) Iiseli zegazi ezimhlophe kunye ne-PRP: ziqulethe iiseli ezimhlophe zegazi, kwaye umxholo we-fibrin emva kokusebenza uphantsi.
3) I-PRF ecocekileyo okanye i-leukocyte-poor PRF: ukulungiswa akuqukethe i-leukocytes kwaye ine-fibrin ephezulu.Ezi mveliso ziza ngohlobo lweejeli ezisebenzayo kwaye azinakusetyenziselwa inaliti.
I-4) I-Leukocyte-rich fibrin kunye ne-PRF: equkethe i-leukocytes kunye ne-high-density fibrin.
Kwi-2016, uMagalon et al.icetywe ulwahlulo lwe-DEPA (idosi, ukusebenza kakuhle, ukucoceka, ukusebenza), kugxininise kwi-PRP platelet count, ukucoceka kwemveliso, kunye nokusebenza kweplatelet.
1. Ithamo yesitofu sePlatelet: Bala ngokuphindaphinda ukugxilwa kweplatelet ngevolumu yeplatelet.Ngokwethamo elitofwayo (kwiibhiliyoni okanye kwizigidi zeeplatelets), inokwahlulwa ibe (a) idosi ephezulu kakhulu:> 5 billion;(b) idosi ephezulu: ukusuka kwiibhiliyoni ezi-3 ukuya kwiibhiliyoni ezi-5;(c) idosi ephakathi: ukusuka kwibhiliyoni e-1 ukuya kwiibhiliyoni ezi-3;(d) idosi ephantsi: ngaphantsi kwebhiliyoni enye.
2. Ukulungiselela kakuhle: ipesenti yeeplatelet eziqokelelwe egazini.(a) Ukusebenza okuphezulu kwesixhobo: izinga lokubuyisela iplatelet > 90%;(b) ukusebenza kwesixhobo esiphakathi: izinga lokubuyisela iplatelet phakathi kwe-70-90%;(c) ukusebenza kwesixhobo esiphantsi: izinga lokubuyisela phakathi kwe-30-70%;(d) Ukusebenza kwesixhobo kuphantsi kakhulu: izinga lokubuyisela lingaphantsi kwama-30%.
3. Ukuhlanjululwa kwe-PRP: Ihambelana nokubunjwa kweplatelet, iiseli ezimhlophe zegazi kunye neeseli ezibomvu zegazi kwi-PRP.Siyichaza njenge (a) i-PRP ecocekileyo kakhulu:> I-90% yeeplatelets ezinxulumene ne-erythrocytes kunye ne-leukocytes kwi-PRP;(b) i-PRP ecocekileyo: i-70-90% yeplatelet;(c) i-PRP ene-heterogeneous: % platelets Phakathi kwe-30-70%;(d) I-PRP yegazi elipheleleyo: ipesenti yeeplatelet kwi-PRP ingaphantsi kwe-30%.
4. Inkqubo yokuqalisa: nokuba kusebenze iiplatelets ezinemiba ye-exogenous coagulation, njenge-autologous thrombin okanye i-calcium chloride.
(Umxholo weli nqaku uveliswe ngokutsha.)
Ixesha lokuposa: May-16-2022