Platelet rich plasma (PRP) inoshandiswa zvakanyanya mu orthopedics, asi pachine gakava rinotyisa.Nokudaro, yeGermany "Clinical Tissue Regeneration Working Group" yeGermany Orthopedics uye Trauma Society yakaita tsvakurudzo kuti iwane kubvumirana pamusoro pehutano hwemazuva ano hwePRP.
Therapeutic PRP applications inonzi inobatsira (89%) uye inogona kuva yakakosha mune ramangwana (90%).Zviratidzo zvinowanzoonekwa ndeye tendon chirwere (77%), osteoarthritis (OA) (68%), kukuvara kwetsandanyama (57%), uye kukuvara kwecartilage (51%).Kubvumirana kwakasvikwa mukutaura kwa16/31.Kushandiswa kwePRP mukutanga kwemabvi osteoarthritis (Kellgren Lawrence II) inoonekwa seyakakosha, pamwe chete neacute uye asingagumi tendon zvirwere.Kune zvipembenene zvisingaperi (cartilage, tendons), majekiseni akawanda (2-4) anokurudzirwa kupfuura majekiseni ega.Nekudaro, hapana data rakakwana pane nguva yenguva pakati pemajekiseni.Inokurudzirwa zvakasimba kuenzanisa kugadzirira, kushandiswa, kuwanda, uye kutsunga kwezviratidzo zvePRP.
Platelet rich plasma (PRP) inoshandiswa zvakanyanya mukurapa regenerative, kunyanya mumishonga yemitambo yemapfupa.Kutsvakurudza kwesayenzi kwekutanga kwakaratidza kuti PRP ine zvakawanda zvakanaka pamasero akawanda emusculoskeletal system, akadai sechondrocytes, tendon masero, kana masero emasumbu, zvose mu vitro uye in vivo.Nekudaro, mhando yemabhuku aripo achiri mashoma, kusanganisira yekutanga sainzi uye tsvakiridzo yekiriniki.Naizvozvo, mukutsvagisa kwekiriniki, mhedzisiro yacho haina kunaka sekutsvagisa kwesainzi.
Pane zvikonzero zvakawanda zvinobvira.Chekutanga, nzira dzakawanda dzekugadzirira (parizvino pamusoro pemakumi maviri neshanu akasiyana ezvekutengesa masisitimu) aripo kuti awane maplatelet anotorwa ekukura zvinhu, asi yekupedzisira PRP chigadzirwa chinoumbwa nekuumbwa kwavo kwakasiyana uye kuedza kwavo kunorwadza.Semuenzaniso, nzira dzakasiyana dzekugadzirira PRP dzinoratidza zvakasiyana-siyana pazvibatanidza chondrocytes.Pamusoro pezvo, nekuda kwekuti zvinhu zvakakosha zvakaita sekuumbwa kweropa (masero matsvuku eropa, masero machena eropa, uye maplatelet) hazvisati zvashumwa muchidzidzo chega chega, kushuma kwakamisikidzwa kweizvi zvinhu kuri kudiwa nekukurumidza.Iyo yekupedzisira PRP chigadzirwa zvakare ine yakakosha misiyano yemunhu.Chinoomesa dambudziko ndechekuti muyero, nguva, uye huwandu hwePRP zvikumbiro hazvina kumiswa, uye hazvina kunyatso dzidza mukutsvagisa kwesainzi.Panyaya iyi, kudiwa kweakamisikidzwa maumbirwo eplatelet inotorwa kukura chinhu kunoonekwa, izvo zvinobvumira yakamisikidzwa yekutanga yesainzi kuyedzwa kwemhedzisiro yemaparamendi akasiyana senge PRP kuumbwa, PRP jekiseni vhoriyamu, uye jekiseni nguva.Pamusoro pezvo, kushandisa zvikwata kutsanangura zvirinani zvigadzirwa zvePRP zvinoshandiswa zvinofanirwa kuve zvinosungirwa.Vamwe vanyori vakakurudzira masisitimu akasiyana-siyana, anosanganisira Mishra (platelet count, kuvapo kwemasero machena eropa, activation) uye Dohan Ellenfest (platelet count, white blood cell count, kuvapo kwefibrinogen), Delong (P latelet count, chipikiri activation, w ^ Haide blood cell count; PAW classification) uye Mautner (Platelet count, kuvapo kweeukocyte huru, kuvapo kweR yakanyorwa masero eropa, uye kushandisa mbambo activation; PLRA classification) . Magalon et al.Iyo yakatsanangurwa DEPA kupatsanura inosanganisira jekiseni replatelet OSE, kugadzirwa kwakanaka, PRP's chengetedzo, uye activation yayo.Harrison et al.Imwe hurongwa hwakadzama hwekuronga hwakaburitswa, kusanganisira activation nzira dzakashandiswa, vhoriyamu yakazara yakashandiswa, kutungamira frequency uye zvikamu zvidiki activated, platelet concentration uye nzira dzekugadzirira, pamwe neavhareji avhareji kuverenga uye huwandu (yakaderera kumusoro) chena masero eropa kuverenga (neutrophils, lymphocytes, uye monocytes) yemaplatelet, masero matsvuku eropa, uye zvikamu.Iyo yazvino classification inobva kuKon et al.Kubva pakubvumirana kwenyanzvi, izvo zvinonyanya kukosha zvinotsanangurwa seplatelet kuumbwa (platelet concentration uye concentration ratio), kuchena (kuvapo kwemasero matsvuku eropa / masero machena eropa), uye activation (endogenous / exogenous, calcium kuwedzera).
Kushandiswa kwezviratidzo zvakawanda zvePRP kwave kuchikurukurwa zvakanyanya, sekuti kurapwa kwechirwere chetendon kwakatsanangurwa mune zvidzidzo zvekliniki maererano nenzvimbo dzakasiyana-siyana [nemigumisiro yakanaka uye yakaipa].Nokudaro, kazhinji hazvibviri kuwana uchapupu hunogutsa kubva mumabhuku.Izvi zvinoita zvakare kuti zviome kuti PRP therapy ibatanidzwe mumirayiridzo yakasiyana-siyana.Pamusana penyaya dzakawanda dzisina kugadziriswa dzakapoteredza kushandiswa kwePRP, nheyo inokosha yechinyorwa ichi ndeyekuratidza maonero enyanzvi kubva kuGermany "Clinical Tissue Regeneration Working Group" yeGermany Orthopedics uye Trauma Society (DGOU) pamusoro pekushandiswa uye ramangwana. zve PRP.
Nzira
The German "Clinical Tissue Regeneration Working Group" inoumbwa nenhengo dze95, imwe neimwe inyanzvi mukuvhiyiwa kwemapfupa uye kuvandudzwa kwetishu (vose vanachiremba kana vanachiremba, hapana varapi vemuviri kana masayendisiti ekurovedza muviri).Boka rinoshanda rinoumbwa nevanhu ve5 (kuongororwa kwemapofu) ndiro basa rekusimudzira kuferefeta.Mushure mekuongorora zvinyorwa zviripo, boka rekushanda rakagadzirira zvingangove zvinyorwa zvemashoko zvinogona kuiswa muchikamu chekutanga chekuongorora.Ongororo yekutanga yakaitwa muna Kubvumbi 2018, ichivhara mibvunzo ye13 uye zvakajairika zvePRP application, kusanganisira yakavharwa uye yakavhurika mibvunzo, uye nekukurudzira nyanzvi kuti dzipe mamwe mapurojekiti kana kugadziridzwa.Zvichienderana nemhinduro idzi, chikamu chechipiri cheongororo chakagadzirwa uye chakaitwa muna Mbudzi 2018, paine mibvunzo makumi matatu neimwe yakavharwa yakapera muzvikamu zvishanu zvakasiyana: zviratidzo zvekukuvara kwegorofu uye osteoarthritis (OA), zviratidzo zvetendon pathology, zviratidzo zvekukuvara kwetsandanyama. , kushandiswa kwePRP, uye nzvimbo dzekutsvakurudza mune ramangwana.
Kuburikidza neongororo yepadandemutande (Survey Monkey, USA), chibvumirano chakaitwa chekubvumidza vanobvunzwa kuti vaone kana chirongwa ichi chichifanira kuverengerwa pazvichemo zvishoma zvekushuma, uye kupa zvikero zvishanu zvinogoneka zvekupindura paLikert: 'Very agree';Agree;Regai kubvumirana kana kupikisa;Kupokana kana kuramba zvakanyanya.Ongororo iyi yakaedzwa nenyanzvi nhatu pamusoro pechokwadi chechiso, kunzwisisa uye kugamuchirwa, uye mhedzisiro yacho yakagadziridzwa zvishoma.Muchikamu chekutanga, huwandu hwenyanzvi makumi matanhatu neshanu dzakatora chikamu, nepo muchikamu chechipiri, nyanzvi makumi mana dzakatora chikamu.Pachikamu chechipiri chekubvumirana, tsanangudzo yekutanga inotaura kuti kana vanopfuura 75% yevakapindura vakabvumirana, chirongwa chichabatanidzwa mugwaro rekupedzisira rekubvumirana, uye pasi pe20% yevakapindura havabvumirani.75% yevatori vechikamu vanobvuma kuti ndiyo inonyanya kutsanangurwa sarudzo yekubvumirana, yakashandiswa muchidzidzo chedu.
Mhedzisiro
Muchikamu chekutanga, 89% yevanhu vakapindura kuti PRP application inobatsira, uye 90% yevanhu vanotenda kuti PRP ichave yakakosha mune ramangwana.Nhengo zhinji dzinoziva nezvekutanga sainzi uye tsvakurudzo yekiriniki, asi 58% chete yenhengo dzinoshandisa PRP mukuita kwavo kwezuva nezuva.Zvikonzero zvinowanzoitika zvekusashandisa PRP kushayikwa kwenzvimbo yakakodzera, yakadai sezvipatara zveyunivhesiti (41%), inodhura (19%), inopedza nguva (19%), kana humbowo husina kukwana hwesainzi (33%).Zviratidzo zvinowanzoonekwa zvekushandiswa kwePRP ndeye tendon chirwere (77%), OA (68%), kukuvara kwemhasuru (57%), uye kukuvara kwecartilage (51%), iyo ndiyo nheyo yechipiri yekuongorora.Chiratidzo chekushandiswa kwemukati kwePRP chinoratidzika pamwe chete ne18% kugadziriswa kwekatekete uye 32% kugadzirisa tendon.Zvimwe zviratidzo zvinoonekwa mu14%.Chete 9% yevanhu vakataura kuti PRP haina kushandiswa kwekiriniki.PRP jekiseni dzimwe nguva rinoshandiswa pamwe chete nehyaluronic acid (11%).Mukuwedzera kune PRP, nyanzvi dzakapinzawo anesthetics yemunharaunda (65%), cortisone (72%), hyaluronic acid (84%), uye Traumel / Zeel (28%).Pamusoro pezvo, nyanzvi dzakataura zvakanyanya kudiwa kwetsvakiridzo yekiriniki pakushandiswa kwePRP (76%) uye kudiwa kwekumisikidzwa kuri nani (kugadzira 70%, zviratidzo 56%, nguva 53%, jekiseni frequency 53%).Kuti uwane ruzivo rwakadzama pachikamu chekutanga, ndapota tarisa kune apendix.Nyanzvi dzakataura zvakanyanyisa kuti tsvakiridzo yekiriniki inodiwa pakushandiswa kwePRP (76%), uye kumisikidzwa kuri nani kunofanirwa kuwanikwa (kugadzira 70%, zviratidzo 56%, nguva 53%, jekiseni frequency 53%).Kuti uwane ruzivo rwakadzama pachikamu chekutanga, ndapota tarisa kune apendix.Nyanzvi dzakataura zvakanyanyisa kuti tsvakiridzo yekiriniki inodiwa pakushandiswa kwePRP (76%), uye kumisikidzwa kuri nani kunofanirwa kuwanikwa (kugadzira 70%, zviratidzo 56%, nguva 53%, jekiseni frequency 53%).
Zvichienderana nemhinduro idzi, denderedzwa rechipiri rinotarisa zvakanyanya pamusoro wenyaya inonyanya kufarirwa.Kubvumirana kwakasvikwa mukutaura kwa16/31.Inoratidzawo nzvimbo dzine kubvumirana kushoma, kunyanya mumunda wezviratidzo.Vanhu vanowanzobvumirana (92%) kuti kune misiyano yakakura muzviratidzo zvakasiyana-siyana zvekushandiswa kwePRP (zvakadai seOA, tendon chirwere, kukuvara kwemhasuru, nezvimwewo).
[Iyo yakaturikidzana oblique bar chart inomiririra kupatsanurwa kwechikamu chakabvumiranwa muchikamu chechipiri cheongororo (31 mibvunzo (Q1 - Q31)), iyo inonyatsoratidza nzvimbo dzekusawirirana.
Bhawa riri kuruboshwe rweY-axis rinoratidza kusawirirana, nepo bhari riri kurudyi richiratidza kubvumirana.Kusawirirana kuzhinji kunomuka mumunda wezviratidzo.]
Zviratidzo zvekukuvara kwecartilage uye OA
Pane kubvumirana kwakawanda (77.5%) kuti PRP inogona kushandiswa kutanga kwemabvi osteoarthritis [Kellgren Lawrence (KL) Level II].Nokuda kwekukuvadzwa kwakanyanya kwecartilage (KL Level I) uye mamwe matanho akaoma (KL Level III uye IV), hapana kubvumirana kuripo pamusoro pekushandiswa kwePRP panguva kana mushure mekuvhiyiwa kwecartilage regeneration, kunyange zvazvo 67.5% yenyanzvi dzinotenda kuti iyi imunda unovimbisa. .
Zviratidzo zvezvironda zvetendon
Muchidzidzo chacho, nyanzvi dzakamiririra huwandu hwakawanda (82.5% uye 80%) kuti kushandiswa kwePRP kunobatsira mune acute uye asingagumi tendon zvirwere.Panyaya yekugadzirisa cuff rotator, 50% yenyanzvi dzinotenda kuti intraoperative application yePRP inogona kubatsira, asi 17.5% yenyanzvi vanobata maonero akasiyana.Nhamba yakafanana yenyanzvi (57.5%) inotenda kuti PRP ine basa rakanaka mukurapa mushure mekugadzirisa tendon.
Chiratidzo chekukuvara kwemhasuru
Asi hapana kubvumirana kwakawanikwa pakushandiswa kwePRP yekurapa kwekukuvara kwakanyanya kana kusingaperi (zvakadai sepamusoro pe75% kubvumirana).
Zvinoshanda Zvimiro zvePRP Kushandisa
Pane zvirevo zvitatu zvinogona kubvumirana:
(1) Zvipembenene zvisingaperi zvinoda zvinopfuura jekiseni rimwe rePRP
(2) Ruzivo rwakakwana pamusoro penguva yakakwana pakati pemajekiseni (hapana kubvumirana kunowanikwa pavhiki nevhiki)
(3) Kusiyana kwezvakasiyana-siyana zvePRP zvingaita basa rinokosha mumigumisiro yavo yehupenyu
Remangwana Rekutsvaga Nzvimbo
Kugadzirwa kwePRP kunofanirwa kuve kwakamisikidzwa zviri nani (95% kuenderana) uye kushandiswa kwayo kwekiriniki (senge jekiseni frequency, nguva yekushandisa, zviratidzo zvekiriniki).Kunyangwe munzvimbo dzakaita seOA kurapwa uko kunonzi kune data rakanaka rekiriniki, nhengo dzenyanzvi dzinotenda kuti pachine kudiwa kukuru kwetsvakiridzo yesainzi neyekiriniki.Izvi zvinoshandawo kune zvimwe zviratidzo.
Kurukurai
Mhedzisiro yetsvagiridzo inoratidza kuti kuchine gakava rakapararira pamusoro pekushandiswa kwePRP mumapfupa emapfupa, kunyangwe mumapoka enyanzvi dzenyika.Pakutaura makumi matatu neimwe chete, gumi nematanhatu chete ndivo vakawana kubvumirana kwakafanana.Pane kubvumirana kukurusa mumunda wetsvakiridzo yeramangwana, zvichiratidza kudiwa kwakasimba kwekuburitsa humbowo hwakawedzerwa kuburikidza nekuitisa zvidzidzo zvakawanda zveramangwana zvakasiyana.Panyaya iyi, kuongororwa kwakakosha kwehumbowo huripo nemapoka enyanzvi anoshanda inzira yekuwedzera ruzivo rwekurapa.
Zviratidzo zveOA uye cartilage kukuvara
Maererano nemabhuku emazuva ano, PRP inogona kunge yakakodzera kune yekutanga uye ine mwero OA.Uchapupu huchangobva kuitika hunoratidza kuti intra-articular injection yePRP inogona kuvandudza zviratidzo zvevarwere pasinei nehuwandu hwekukuvara kwecartilage, asi kazhinji pane kushayikwa kwehutano hwakanaka hweboka hunoenderana neKellgren naLawrence classification.Panyaya iyi, nekuda kwehuwandu husina kukwana huripo, nyanzvi iye zvino hadzisi kukurudzira kushandisa PRP yeKL level 4. PRP inewo simba rekuvandudza mabvi akabatanidzwa, zvichida nekuderedza maitiro ekuputika uye kuderedza kuderera kwekugadzirisa kwekugadzirisa kwekubatana kwekubatana.PRP inowanzoita mhedzisiro iri nani mumurume, vechidiki, varwere vane yakaderera mwero yekukuvara kwekarati uye body mass index (BMI).
Paunenge uchidudzira yakadhindwa data yekiriniki, kuumbwa kwePRP kunoratidzika sechinhu chakakosha parameter.Nekuda kweiyo yakaratidza cytotoxic maitiro eplasma akapfuma mumasero machena eropa pane synovial masero in vitro, LP-PRP inonyanya kukurudzirwa intra articular application.Muchidzidzo chenguva pfupi yapfuura chesainzi, mhedzisiro yearombo chena sero reropa (LP) uye chena chena sero reropa (LR) PRP pakuvandudzwa kweOA yakaenzaniswa mumuenzaniso wembeva mushure memeniscectomy.LP-PRP yakaratidza kushanda kwepamusoro mukuchengetedza cartilage volume kana ichienzaniswa neLR-PRP.Meta ichangobva kuongororwa yeongororo yakadzivirirwa yakawana kuti PRP yaive nemhedzisiro iri nani kana ichienzaniswa nehyaluronic acid (HA), uye kuongororwa kweboka kwakaratidza kuti LP-PRP yaive nemhedzisiro iri nani pane LR-PRP.Nekudaro, pakanga pasina kuenzanisa kwakananga pakati peLR - neLP-PRP, kuita kumwe kutsvagisa kuri madikanwa.Muchokwadi, chidzidzo chikuru chekuenzanisa LR-PRP neHA inoratidza kuti LR-PRP haina mhedzisiro yakaipa.Mukuwedzera, chidzidzo chekliniki chinofananidza LR-PRP uye LP-PRP zvakananga chakaratidza kusasiyana kwekliniki mumigumisiro mushure memwedzi ye12.LR-PRP ine mamwe mamorekuru e-pro-inflammatory uye kuwedzera kwehuwandu hwekukura kwezvinhu, asi inewo maitiro akakwirira e-anti-inflammatory cytokines, akadai se interleukin-1 receptor antagonists (IL1-Ra).Zvidzidzo zvenguva ichangopfuura zvakatsanangura "kuzvimba patsva" maitiro emasero machena eropa achivanza pro-inflammatory uye anti-inflammatory cytokines, zvichiratidza maitiro akanaka pakuvandudzwa kwetishu.Zvidzidzo zvekiriniki zvekuwedzera zvine dhizaini yakasarudzika inodiwa kuti uone iyo yakakwana kugadzirwa kana PRP kuumbwa kwekuumbwa uye yakakodzera application protocol muOA.
Naizvozvo, vamwe vanofunga kuti HA nePRP dzingave nzira dzekurapa dzepamusoro kune varwere vane OA yakapfava uye yakaderera BMI.Ichangobva kuongororwa yakarongeka yakaratidza kuti PRP ine kurapa kuri nani kuenzaniswa neHA.Zvakadaro, iwo akavhurika akavhurika nebvumirano mapoinzi anosanganisira kudiwa kweyakamisikidzwa gadziriro yePRP, mitengo yekunyorera, uye kudiwa kweimwe randomized miyedzo yekiriniki ine mhando yepamusoro yemvura.Naizvozvo, pari zvino kurudziro yepamutemo uye nhungamiro kazhinji haigone kutsigira kana kupikisa kushandiswa kwemabvi osteoarthritis.Muchidimbu, zvichibva pauchapupu huripo, zvirongwa zvakasiyana-siyana zvekugadzirira zvinogadzirisa kushanduka kwemaitiro, uye PRP inogona kutungamirira kumarwadzo ekuvandudza munyoro kusvika pakati peOA.Iro boka renyanzvi harikurudziri kushandisa PRP mumamiriro ezvinhu akaoma OA.Zvimwe zvidzidzo zvenguva pfupi yapfuura zvakaratidza kuti PRP inobatsirawo kune placebo effect, kunyanya mukurapa OA kana lateral Epicondylitis.Jekiseni rePRP rinogona kungove chikamu chehurongwa hwese hwekurapa kugadzirisa nyaya dzebiological dzeOA.Mukuwedzera kune zvimwe zvinhu zvakakosha zvakadai sekurasikirwa nekurema, kugadzirisa kukanganiswa, kurovedza tsandanyama, uye mabvi emabvi, zvinogona kubatsira kuderedza marwadzo uye kuunza migumisiro iri nani kuvarwere.
Basa rePRP mukuvhiyiwa kwecartilage regenerative ndiyo imwe nzvimbo inokakavadzana.Kunyange zvazvo tsvakurudzo yesayenzi yepakutanga yakaratidza maitiro akanaka kune chondrocytes, uchapupu hwekliniki hwekushandiswa kwePRP panguva yekuvhiyiwa, chirwere chekugadzirisa marara, kana matanho ekugadzirisa hachiri kukwana, kuratidza zvatinowana.Mukuwedzera, iyo yakakwana nguva yekurapwa kwePRP yemashure haisati yanyatsozivikanwa.Asi nyanzvi dzakawanda dzinobvumirana kuti PRP inogona kubatsira kukurudzira biological cartilage regeneration.Mukupfupisa, mhedzisiro yemazuva ano yekutonga kwakakosha inoratidza kuti kumwe kuongororwa kweiyo inogona kuita basa rePRP mukuvhiya regenerative cartilage inofanirwa.
Zviratidzo zvezvironda zvetendon
Kushandiswa kwePRP yekurapa tendinosis inyaya inokakavadzana mumabhuku.Kuongororwa kwekutsvakurudza kwesayenzi kunoratidza kuti PRP ine migumisiro yakanaka mu vitro (yakadai sekuwedzera tendon cell proliferation, kukurudzira anabolic effects, zvakadai sekuwedzera collagen production) uye mu vivo (kuwedzera kuporesa tendon).Muchiito chekiriniki, zvidzidzo zvakawanda zvakaratidza kuti kurapwa kwePRP kune zvese zvakanaka uye hakuna mhedzisiro pane akasiyana acute uye asingaperi tendon zvirwere.Semuenzaniso, kuongorora kwakarongeka kwechangobva kuitika kwakasimbisa migumisiro inokakavadzana yePRP kushandiswa mumaronda akasiyana-siyana etendon, kunyanya kuva nemigumisiro yakanaka kune lateral elbow tendon maronda uye patellar tendon maronda, asi kwete paAchilles tendon kana rotator cuff maronda.Ruzhinji rwekuvhiya RCT rekodhi harina mhedzisiro inobatsira, uye hapasati paine humbowo hwekupedzisira hwekushandiswa kwayo kwekuchengetedza muzvirwere zve rotator cuff.Nokuda kweEpicondylitis yekunze, meta-analysis yemazuva ano inoratidza kuti corticosteroids ine nguva pfupi yakanaka, asi iyo yakareba kwenguva refu yePRP yakakwirira.Kubva pauchapupu huripo, patellar uye lateral elbow tendinosis yakaratidza kuvandudzwa mushure mekurapa kwePRP, nepo Achilles tendon uye rotator cuff isingaoneki inobatsirwa nePRP application.Nokudaro, kubvumirana kwemazuva ano neESSKA Basic Science Committee kwakagumisa kuti ikozvino hapana kubvumirana pamusoro pekushandiswa kwePRP yekurapa tendinosis.Pasinei nekukakavadzana mumabhuku, sezvakaratidzwa nekutsvakurudza kwemazuva ano uye kuongororwa kwakarongeka, PRP ine basa rakanaka mukurapa tendon zvirwere kubva kune zvose zvakakosha zvesayenzi uye zvekliniki.Kunyanya kufunga nezvezvingangoita mhedzisiro ye corticosteroids kana uchishandisa tendon zvirwere.Migumisiro yeongororo iyi inoratidza kuti maonero eGermany iye zvino ndeyekuti PRP inogona kushandiswa kurapa zvirwere zvakanyanya uye zvisingaperi.
Chiratidzo chekukuvara kwemhasuru
Zvimwe zvinokakavadzana ndezvekushandiswa kwePRP kurapa kukuvadzwa kwemisungo, iyo ndiyo imwe yekukuvara kwakanyanya mumitambo yezvenyanzvi, zvichiita kuti inenge 30% yemazuva emasikati.PRP inopa mukana wekuvandudza biological kuporesa uye kukurumidza kudzoreredza maekisesaizi mazinga, ayo akagamuchira kuwedzera kutariswa mumakore mashoma apfuura.Kunyange zvazvo 57% yemhinduro dzakapiwa muchikamu chekutanga chakanyorwa kukuvara kwemhasuru sechiratidzo chakajairika chekushandiswa kwePRP, pachine kushaikwa kweruzivo rwakasimba rwesainzi.Zvidzidzo zvakawanda zvemu vitro zvakaona zvingangobatsira zvePRP mukukuvara kwemhasuru.Kukwidziridzwa kwesero setiraiti kuita, kuwedzera kweyakagadziridzwa fibril dhayamita, kukurudzira myogenesis, uye kuwedzera kwekuita kweMyoD uye myostatin zvese zvakaedzwa zvakanaka.Rumwe ruzivo nezve Mazoka et al.Kuwedzera kwehuwandu hwekukura kwezvinhu zvakadai seHGF, FGF, uye EGF yakaonekwa muPRP-LP.Tsai et al.akasimbisa zvakawanikwa izvi.Pamusoro pekuratidza kuwedzera kweprotein kutaura kwecyclin A2, cyclin B1, cdk2 uye PCNA, zvinoratidzwa kuti skeletal muscle cell vitality uye kuwedzera kwesero kunowedzerwa nekufambisa masero kubva kuG1 chikamu kuenda kuS1 uye G2 & M zvikamu.Ongororo yazvino yakarongeka yakapfupisa mamiriro ezvesainzi seanotevera: (1) Muchidzidzo chakawanda, kurapwa kwePRP kwakawedzera tsandanyama cell proliferation, kukura factor kutaura (yakadai sePDGF-A / B uye VEGF), chena masero eropa recruitment, uye angiogenesis mumhasuru. zvichienzaniswa neboka rekutonga modhi;(2) Iyo PRP yekugadzirira tekinoroji ichiri kusawirirana mukutsvaga kwezvinyorwa zvesainzi zvekutanga;(3) Uchapupu hunobva pakutsvakurudza kwesayenzi mu vitro uye mu vivo hunoratidza kuti PRP inogona kushanda senzira inoshanda yekurapa iyo inogona kukurumidza kuporesa maitiro ezvironda zvemhasuru kana zvichienzaniswa neboka rinodzora, zvichienderana nemigumisiro yakaonekwa pamaserura uye mazinga emuviri. boka rekurapa.
Kunyange zvazvo chidzidzo chekudzoka kwakatsanangura kuporesa kwakakwana uye kwaifunga kuti nguva ye-off-site yakanga isina ruzivo rwakanyanya, Bubnov et al.Muchidzidzo cheboka chevatambi ve30, zvakaonekwa kuti kurwadziwa kwakaderedzwa uye kukurumidza kupora kubva kumakwikwi kwakakurumidza kukurumidza.Hamid et al.Muchiedzo chinongorongedzerwa (RCT) kuenzanisa PRP kupinda nekuchengetedzwa kwemaitiro ekurapa, zvakanyanya kukurumidza kupora kubva kumakwikwi kwakatsanangurwa.Iyo chete kaviri mapofu akawanda RCT yaisanganisira hamstring kukuvara muvatambi (n = 80), uye hapana yakakosha placebo infiltration yakaonekwa ichienzaniswa nePRP.Misimboti yebiological inovimbisa, zvakanaka preclinical zvakawanikwa, uye kubudirira kwekutanga kwekiriniki ruzivo nePRP jekiseni rataurwa pamusoro apa hazvina kusimbiswa nechangobva kuitika yepamusoro-level RCT.Ikozvino kubvumirana pakati penhengo dzeGOTS kwakaongorora marapirwo anochengetedza ekukuvara kwemhasuru uye akagumisa kuti parizvino hapana humbowo hwakajeka hwekuti jekiseni remukati memuscular rinogona kushandiswa kurapa tsandanyama kukuvara.Izvi zvinopindirana nemigumisiro yedu, uye hapana kubvumirana pamusoro pekushandiswa kwePRP mukurapa kwekukuvara kwemisumbu.Kuwedzera kutsvagisa kunodiwa nekukurumidza pamuyero, nguva, uye kuwanda kwePRP mukukuvara kwemhasuru.Kuenzaniswa nekukuvara kwekarati, mukukuvara kwemisungo, kushandiswa kwemaitiro ekurapa, kunyanya PRP, inogona kunge yakabatana nehuwandu uye nguva yekukuvara, kusiyanisa pakati pekubatanidzwa kwekukuvadzwa kwemisumbu dhayamita uye zvinokwanisika kukuvara kwetendon kana kukuvara kwekuputika.
Munda wekushandisa wePRP ndeimwe yenzvimbo dzinowanzokurukurwa, uye kushaikwa kwekumisikidza ndiyo imwe yenyaya huru mukuedzwa kwekiriniki.Nyanzvi dzakawanda hadzina kuona kuwedzera kwekushandiswa kwePRP, zvisinei, zvimwe zvidzidzo zvakaratidza kuti kushandiswa kwekuwedzera kwehyaluronic acid kunogona kuenzaniswa nekushandiswa kumwe chete kwePRP yeOA.Chibvumirano ndechekuti majekiseni akawanda anofanirwa kubaiwa kuzvirwere zvisingaperi, uye munda weOA unotsigira pfungwa iyi, apo majekiseni akawanda anoshanda kupfuura jekiseni rimwe chete.Tsvagiridzo yesainzi yekutanga iri kuongorora hukama-mhedzisiro yePRP, asi izvi zvawanikwa zvichiri kuda kuendeswa kukiriniki yekutsvaga.Iyo yakakwana yekusangana kwePRP haisati yatemerwa, uye tsvakiridzo yakaratidza kuti kukwirisa kwakanyanya kunogona kuve nemhedzisiro yakaipa.Saizvozvowo, kukanganisa kwemasero machena eropa kunoenderana nechiratidzo, uye zvimwe zviratidzo zvinoda PRP nemasero machena eropa.Kusiyanisa kwemunhu mumwe nomumwe PRP kuumbwa kunoita basa rinokosha mukukanganisa kwePRP.
Remangwana Rekutsvaga Nzvimbo
Zvinobvumirana pamwe chete kuti maererano nezvinyorwa zvemazuva ano, kutsvakurudza kwakawanda pamusoro pePRP kunokosha mune ramangwana.Imwe yenyaya huru ndeyekuti PRP maumbirwo anofanirwa kuve akamisikidzwa zvirinani (ane 95% kuenderana).Imwe nzira inogoneka yekuzadzisa chinangwa ichi inogona kunge iri kuunganidzwa kwemaplatelet kuti uwane mavhoriyamu akakura, ayo akamisikidzwa zvakanyanya.Pamusoro pezvo, zvakasiyana-siyana zvekushandiswa kwekiriniki hazvizivikanwe, sekuti majekiseni mangani anofanira kushandiswa, nguva iri pakati pemajekiseni, uye dosi yePRP.Nenzira iyi chete zvinogona kuita tsvakurudzo yepamusoro-soro uye kuongorora kuti ndezvipi zviratidzo zvinonyanya kukodzera kushandisa PRP, zvichiita tsvakurudzo yesayenzi uye yekiriniki, zvichida zvidzidzo zvinodzorwa zvisina kurongwa, zvinodiwa.Kunyange zvazvo kubvumirana kwave kwasvika kuti PRP inogona kuita basa rinokosha mune ramangwana, zvinoratidzika kuti tsvakurudzo yekuongorora uye yekliniki inodiwa ikozvino.
Boundedness
Imwe inogumira pakuedza kweongororo iyi kugadzirisa nyaya inokakavadzana zvikuru yekushandiswa kwePRP hunhu hwayo.Kuvapo kwePRP uye misiyano yenyika mukubhadhara inogona kukanganisa mhedzisiro uye zvimiro zvekutonga.Uyezve, kubvumirana hakusi kwemarudzi akawanda uye kunongosanganisira maonero evanachiremba vemapfupa.Zvisinei, izvi zvinogonawo kuonekwa semubairo sezvo riri iro rega boka riri kuita nekutarisa PRP jekiseni kurapwa.Mukuwedzera, tsvakurudzo yakaitwa ine nzira yakasiyana yehutano kana ichienzaniswa nemaitiro akanyatsoitwa eDelphi.Zvakanakira kubvumirana kwakaumbwa neboka revarapi vane hunyanzvi hwemabhonzo vane ruzivo rwakakura rwehunyanzvi mundima dzavo kubva pamaonero ekutanga sainzi uye maitiro ekiriniki.
Kurudziro
Zvichienderana nekubvumirana kweinenge 75% yenyanzvi dziri kutora chikamu, svika pakubvumirana pane zvinotevera pfungwa:
OA uye cartilage kukuvara: Kushandiswa kwemild knee osteoarthritis (KL II giredhi) kunogona kubatsira.
Tendon pathology: Kushandiswa kweacute uye zvisingaperi tendon zvirwere zvinogona kubatsira
Zano rinoshanda: Pazvironda zvisingaperi (cartilage, tendons), majekiseni akawanda (2-4) panguva dzakasiyana-siyana anokurudzirwa kupfuura jekiseni rimwe chete.
Zvisinei, pane data isina kukwana pane nguva yenguva pakati pejekiseni rimwe chete.
Tsvagiridzo yeramangwana: Inokurudzirwa zvakanyanya kumisikidza kugadzirwa, kugadzirira, kushandiswa, kuwanda, uye kuratidza huwandu hwePRP.Kumwe kutsvagisa kwekutanga uye kwekiriniki kunodiwa.
Mhedziso
Kubvumirana kwakawanda ndekwekuti kune misiyano muzviratidzo zvakasiyana-siyana zvePRP application, uye kuchine kusava nechokwadi kwakakosha mukumisikidzwa kwechirongwa chePRP pachayo, kunyanya kune zviratidzo zvakasiyana.Kushandiswa kwePRP mukutanga kwemabvi osteoarthritis (KL giredhi II) uye acute uye asingagumi tendon zvirwere zvinogona kubatsira.Kune zvisingaperi (cartilage uye tendon) maronda, interval majekiseni akawanda (2-4) inonyanya kukurudzirwa kupfuura jekiseni rimwe chete, asi pane data isina kukwana panguva yenguva pakati pejekiseni rimwe chete.Nyaya huru ndeyekusiyana kwemunhu mumwe nomumwe PRP yakagadzirwa, iyo inoita basa rinokosha mubasa rePRP.Naizvozvo, kugadzirwa kwePRP kunofanirwa kuve kwakamisikidzwa zvirinani, pamwe nemakiriniki ma paramita senge jekiseni frequency, uye nguva iri pakati pejekiseni uye chaiyo zviratidzo.Kunyangwe yeOA, iyo parizvino inomiririra yakanakisa nzvimbo yekutsvagisa yePRP application, tsvakiridzo yesainzi neyekiriniki inodiwa, pamwe nezvimwe zvinongedzo zvinoratidzwa.
(Zviri muchinyorwa ichi zvakadhindwa patsva, uye isu hatipe chero vimbiso yechokwadi, kuvimbika kana kuzara kwezviri muchinyorwa chino, uye hatina mhosva yemafungiro echinyorwa ichi, ndapota nzwisisa.)
Nguva yekutumira: May-24-2023