Kushandiswa kwePlatelet Rich Plasma (PRP)Muminda Yakasiyana-siyana uye Nzira Yokusarudza PRP Yakapfuma muMasero Machena Eropa (L-PRP) uye PRP Yakashata muMasero Machena Eropa (P-PRP)
Kuwanikwa kwechangobva kuwanikwa kwehuwandu hwehupupuriro hwepamusoro hunotsigira kushandiswa kwejekiseni yeLR-PRP yekurapa kwe lateral Epicondylitis uye LP-PRP yekurapa kwemabvi Articular bone.Uchapupu hwehutano hwepakati hunotsigira kushandiswa kwejekiseni yeLR-PRP ye patellar tendinosis uye jekiseni rePRP rePlantar fasciitis uye marwadzo ekupa nzvimbo mu patellar tendon transplantation BTB ACL reconstruction.Iko hakuna humbowo hwakakwana hwekugara uchikurudzira PRP ye rotator cuff tendinosis, hip Articular bone osteoarthritis kana yakakwirira ankle sprain.Uchapupu huripo hunoratidza kuti PRP haina simba mukurapa Achilles tendon chirwere, kukuvara kwemhasuru, acute fractures kana bone non union, yakawedzera rotator cuff kugadzirisa kuvhiyiwa, Achilles tendon kugadzirisa, uye ACL kuvakazve.
Platelet rich plasma (PRP) ndeye autologous yemunhu plasma gadziriro iyo inowedzera platelet concentration ne centrifuging huwandu hukuru hweropa remurwere.Platelets mune ayo α Particles (TGF- β 1. PDGF, bFGF, VEGF, EGF, IGF-1) ine huwandu hwakanyanya hwekukura kwezvinhu uye varevereri, iyo inoiswa kuburikidza ne centrifugation process kuburitsa suprabiological huwandu hweizvi kukura zvinhu uye cytokines. kunzvimbo yakakuvadzwa uye kuwedzera maitiro ekuporesa echisikigo.
Izvo zvinowanzoitwa platelet count range ndeye 150000 kusvika 350000 / μ L. Kuvandudzwa kwepfupa uye kuporesa kwenyama yakapfava kwakaratidzwa, nemaplatelet akaiswa anosvika kusvika ku1000000 / μ L. Inomiririra katatu kusvika kashanu kuwedzera kwekukura kwezvinhu.Kugadzirira kwePRP kunowanzo kupatsanurwa kuva PRP yakapfuma mumasero machena eropa (LR-PRP), inotsanangurwa seneutrophil concentration pamusoro pekutanga, uye PRP ine urombo mumasero machena eropa (LP-PRP), inotsanangurwa semachena eropa (neutrophil) kusungwa pasi pekutanga. .
Kurapa Kwekukuvara KweTendon
Kushandiswa kwePRP yekurapa kukuvara kwetendon kana tendon chirwere chave chiri musoro wezvidzidzo zvakawanda, uye ma cytokines akawanda anowanikwa muPRP anobatanidzwa mukuratidza nzira dzinoitika panguva yekuporesa nhanho yekuputika, kuwedzera kwesero, uye kunotevera kuchinjwa kwezviviri.PRP inogonawo kukurudzira kuumbwa kwemitsipa mitsva yeropa, iyo inogona kuwedzera kugoverwa kweropa uye kudya kunodiwa kuti sero rigadziriswe yezvinyama zvakakanganisika, pamwe nekuunza masero matsva uye kubvisa marara kubva kune zvakakanganisika.Aya maitiro echiito angave anonyanya kukosha kune kusingaperi tendinosis, apo mamiriro ehupenyu haabatsiri kupora kwenyama.Kuongororwa kwakarongeka kwechangobva kuitika uye meta-analysis yakagumisa kuti kujova PRP kunogona kunyatsobata zviratidzo tendinosis.
Lateral Epicondylitis
PRP yakaongororwa senzira inogona kurapwa kune varwere vane lateral Epicondylitis avo vasingabatsiri mu physiotherapy.Muchidzidzo chikuru chakadai, Mishra et al.Muchidzidzo cheCohort chinotarisirwa, varwere ve230 vasina kupindura kune Conservative management ye lateral Epicondylitis kwemwedzi inenge ye3 vakaongororwa.Murwere akagamuchira kurapwa kweLR-PRP, uye pamasvondo e24, jekiseni reLR-PRP rakabatanidzwa nekuvandudzika kukuru mukurwadziwa kuenzaniswa neboka rinodzora (71.5% vs 56.1%, P = 0.019), pamwe nekuderera kukuru kwe muzana yevarwere vanotaura zvakasara zvegokora hunyoro (29.1% vs 54.0%, P=0.009).Pamasvondo makumi maviri nemana, varwere vakarapwa neLR-PRP vakaratidza kukiriniki kwakakosha uye kwenhamba kwakakosha kuvandudzwa zvichienzaniswa neanoshanda majekiseni ekudzora eanotindivadza emunharaunda.
Ongororo dzakapfuura dzakaratidza kuti LR-PRP inogona kupawo zororo rinogara kwenguva refu kune zviratidzo zve lateral Epicondylitis kana ichienzaniswa nejekiseni reCorticosteroid, saka ine mhedzisiro yekurapa kwakasimba.PRP inoratidzika seyo nzira inobatsira yekurapa kwekunze kweEpicondylitis.Uchapupu hwepamusoro hunoratidza kushanda kwenguva pfupi uye kwenguva refu.Uchapupu hwakanakisisa huripo hunoratidza zvakajeka kuti LR-PRP inofanira kuva nzira yekutanga yekurapa.
Patellar Tendinosis
Randomized controlled studies inotsigira kushandiswa kweLR-PRP yekurapa kwechirwere chisingaperi chisingaiti patellar tendon.Draco et al.Varwere makumi maviri nevatatu vane patellar tendinosis vakakundikana Conservative management vakaongororwa.Varwere vakagoverwa kuti vagamuchire ultrasound-inotungamirirwa nemunhu yakaoma tsono kana jekiseni reLR-PRP, uye yakateverwa kune> mavhiki e26.Kuburikidza neVISA-P kuyerwa, boka rekurapa rePRP rakaratidza kuvandudzwa kukuru kwezviratidzo pamavhiki e12 (P = 0.02), asi kusiyana kwakanga kusina kukosha pa> mavhiki e26 (P = 0.66), zvichiratidza kuti zvikomborero zvePRP zvepatellar tendon chirwere. inogona kunge iri kuvandudzwa kwezviratidzo zvekutanga.Vitrano et al.Zvakanakira jekiseni rePRP mukurapa chisingaperi chisingaperi patellar tendon chirwere kana chichienzaniswa nekutarisa extracorporeal shock wave therapy (ECSWT) zvakataurwa zvakare.Kunyange zvazvo pakanga pasina misiyano yakakura pakati pemapoka panguva yekutevera-mwedzi we2, boka rePRP rakaratidza kuvandudzwa kwakakosha pa6 uye 12 mwedzi yekutevera, kupfuura ECSWT yakayerwa neVISA-P neVAS, uye kuyera Blazina. chikero pamwedzi gumi nemiviri yekutevera (zvese P <0.05).
Kuongorora uku kunoongorora zvinyorwa zvemakiriniki zvemazuva ano pamusoro pekushandiswa kweplatelet-rich plasma (PRP), kusanganisira leukocyte rich PRP (LR PRP) uye leukocyte poor PRP (LP PRP), kuitira kuti pave neuchapupu-based mazano kune zvirwere zvakasiyana-siyana zvemusculoskeletal.
Kuwanikwa kwechangobva kuwanikwa kwehuwandu hwehupupuriro hwepamusoro hunotsigira kushandiswa kwejekiseni yeLR-PRP yekurapa kwe lateral Epicondylitis uye LP-PRP yekurapa kwemabvi Articular bone.Uchapupu hwehutano hwepakati hunotsigira kushandiswa kwejekiseni yeLR-PRP ye patellar tendinosis uye jekiseni rePRP rePlantar fasciitis uye marwadzo ekupa nzvimbo mu patellar tendon transplantation BTB ACL reconstruction.Iko hakuna humbowo hwakakwana hwekugara uchikurudzira PRP ye rotator cuff tendinosis, hip Articular bone osteoarthritis kana yakakwirira ankle sprain.Uchapupu huripo hunoratidza kuti PRP haina simba mukurapa Achilles tendon chirwere, kukuvara kwemhasuru, acute fractures kana bone non union, yakawedzera rotator cuff kugadzirisa kuvhiyiwa, Achilles tendon kugadzirisa, uye ACL kuvakazve.
Introduce
Platelet rich plasma (PRP) ndeye autologous yemunhu plasma gadziriro iyo inowedzera platelet concentration ne centrifuging huwandu hukuru hweropa remurwere.Platelets mune ayo α Particles (TGF- β 1. PDGF, bFGF, VEGF, EGF, IGF-1) ine huwandu hwakanyanya hwekukura kwezvinhu uye varevereri, iyo inoiswa kuburikidza ne centrifugation process kuburitsa suprabiological huwandu hweizvi kukura zvinhu uye cytokines. kunzvimbo yakakuvadzwa uye kuwedzera maitiro ekuporesa echisikigo.Izvo zvinowanzoitwa platelet count range ndeye 150000 kusvika 350000 / μ L. Kuvandudzwa kwepfupa uye kuporesa kwenyama yakapfava kwakaratidzwa, nemaplatelet akaiswa anosvika kusvika ku1000000 / μ L. Inomiririra katatu kusvika kashanu kuwedzera kwekukura kwezvinhu.
Kugadzirira kwePRP kunowanzo kupatsanurwa kuva PRP gadziriro dzakapfuma mumasero machena eropa (LR-PRP), inotsanangurwa seneutrophil concentrations pamusoro pekutanga, uye PRP kugadzirira kwakashata mumasero machena eropa (LP-PRP), inotsanangurwa semachena eropa (neutrophil) concentrations. pazasi pekutanga.
Kugadzirira uye Kuumbwa
Iko hakuna kubvumirana kwakawanda pamusoro peiyo yakakwana yePRP kuumbwa kwechikamu cheropa, uye kune parizvino akawanda akasiyana ekutengeserana PRP masisitimu pamusika.Naizvozvo, maererano neakasiyana masisitimu ekutengeserana, kune misiyano muPRP yekuunganidza maprotocol uye maitiro ekugadzirira, ichipa yega yega PRP system yakasarudzika hunhu.Masisitimu ekutengesa anowanzo siyana mukubata kweplatelet, nzira yekuparadzanisa (imwe-nhanho kana maviri-nhanho centrifugation), centrifugation kumhanya, uye mhando yekuunganidza chubhu system uye kushanda.Kazhinji, pamberi pe centrifugation, ropa rose rinounganidzwa uye rinosanganiswa ne anticoagulant zvinhu kuti zviparadzanise masero matsvuku eropa (RBCs) kubva kuplatelet-poor plasma (PPP) uye "erythrocyte sedimentation brown layer" ine concentrated platelets uye masero machena eropa.Nzira dzakasiyana-siyana dzinoshandiswa kuparadzanisa maplatelet, ayo anogona kubaiwa zvakananga mumuviri wemurwere kana kuti “activated” nekuwedzera calcium chloride kana thrombin, zvichiita kuti maplatelet degranulation and release of growth factors.Zvinhu zviviri zvakatarisana nemurwere, zvinosanganisira kushandiswa kwezvinodhaka uye nzira dzekugadzirisa zvirongwa zvekutengeserana, zvinokanganisa kuumbwa kwakananga kwePRP, pamwe chete nekushanduka uku mukuumbwa kwePRP maitiro mukutsanangura kushanda kwekliniki yePRP.
Nzwisiso yedu yazvino ndeyekuti PRP ine yakawedzera chena masero eropa, iyo PRP yakapfuma mumasero machena eropa (neutrophils), inosanganiswa nepro-inflammatory effects.Kuwedzerwa kwemasero machena eropa (neutrophils) muLR-PRP kunobatanidzawo nekuwedzera kwecatabolic cytokines, yakadai se interleukin-1 β, Tumor Necrosis Factor α Uye metalloproteinases, iyo inogona kupikisa anabolic cytokines iri mumaplatelet.Mhedzisiro yekiriniki uye mhedzisiro yemagetsi emhando dzakasiyana dzePRP, kusanganisira chena masero eropa, zvichiri kujekeswa.Ongororo iyi ine chinangwa chekuongorora humbowo hwemhando yepamusoro hunowanikwa kune dzakasiyana siyana zviratidzo zvekiriniki zvezvakasiyana PRP maumbirwo.
Achilles Tendon Chirwere
Miedzo yakawanda yezvakaitika kare yakakundikana kuratidza kusiyana kwemigumisiro yekliniki pakati pePRP uye placebo chete mukurapa kweAchilles tendinitis.Muedzo uchangoburwa wakasarudzika wakaenzanisa nhevedzano yemajekiseni mana eLP-PRP nejekiseni re placebo rakasanganiswa ne centrifugal load rehabilitation program.Kuenzaniswa neboka re placebo, boka rekurapa rePRP rakaratidza kuvandudzwa kukuru mukurwadziwa, basa, uye zviitiko zvezviitiko panguva dzose nguva yose ye6-mwedzi yekutevera.Chidzidzo chacho chakawanawo kuti jekiseni rimwe guru revhoriyamu (50 mL) ye0.5% Bupivacaine (10 mL), methylprednisolone (20 mg) uye physiological saline (40 mL) yakave nekuvandudzwa kwakafanana, asi kana uchifunga nezvekurapa uku, kutarisirwa kunofanira kutorwa. maonero ekuwedzera kwengozi yekuparara kwetendon mushure mejekiseni re steroid.
Rotator Cuff Tendinosis
Kune zvishoma zvidzidzo zvepamusoro-soro pamusoro pePRP jekiseni mune isiri-yekuvhiya kurapwa kwe rotator cuff tendon chirwere.Zvishoma zvidzidzo zvakabudiswa zvakaenzanisa migumisiro yekliniki ye subacromial injection yePRP ne placebo uye Corticosteroid, uye hapana chidzidzo chakaongorora jekiseni yakananga yePRP mutendon pachayo.Casey Buren et al.Yakawanikwa kuti pakanga pasina misiyano mumakiriniki emhedzisiro zvikoro zvichienzaniswa nekujova physiological saline pasi pepamusoro pepfudzi.Zvisinei, muedzo wakarongwa wakarongwa wakaona kuti majekiseni maviri eLR-PRP mavhiki mana oga oga anovandudza marwadzo kana achienzaniswa nejekiseni re placebo.Shams et al.Iko kuenzaniswa kwekuvandudzwa kwe subacromial PRP uye Corticosteroid jekiseni pakati pe Xi'an Ontario RC index (WORI), pfudzi yekuremara kwepafudzi index (SPDI) uye VAS kurwadziwa kwepfudzi uye Neer test yakashumwa.
Kusvika ikozvino, tsvakurudzo yakaratidza kuti kupinza PRP pasi pepamusoro pepfudzi kune kuvandudzwa kukuru mumigumisiro yakashumwa yevarwere vane rotator cuff tendon chirwere.Zvimwe zvidzidzo zvinoda kutevera kwenguva refu, kusanganisira kuongorora jekiseni rakananga rePRP mumatendon.Aya majekiseni ePRP akaratidzwa kuva akachengeteka uye anogona kunge ari imwe nzira yeCorticosteroid majekiseni mu rotator cuff tendinosis.
Plantar Fasciitis
Dzakawanda Randomized controlled trial yakaongororwa PRP jekiseni rekusingaperi Plantar fasciitis.Izvo zvinogoneka zvePRP semushonga wejekiseni wemunharaunda unoderedza kunetseka kune chekuita nejekiseni reCorticosteroid, senge atrophy yemafashoni pads kana kuputika kweplantar fascia.Maviri echangobva kuitika meta-analysis akaongorora kuenzanisa pakati pePRP jekiseni neCorticosteroid jekiseni, uye akagumisa kuti jekiseni rePRP inzira inogoneka kune Corticosteroid jekiseni maererano nekubudirira.Zvimwe zvidzidzo zvakaratidza hukuru hwePRP.
Kuvhiya kwakasanganiswa nePRP
Shoulder Sleeve Kugadzirisa
Zvidzidzo zvakawanda zvepamusoro-soro zvekiriniki zvakaongorora kushandiswa kwezvigadzirwa zvePRP muArthroscopy kugadziriswa kwe rotator cuff misodzi.Zvidzidzo zvakawanda zvakanyatso dzidza kushandiswa kweplatelet rich fibrin matrix gadziriro dzekusimudzira (PRFM), nepo zvimwe zvidzidzo zvakabaya PRP zvakananga munzvimbo yekugadzirisa.Pane zvakakosha heterogeneity muPRP kana PRFM maumbirwo.Mhedzisiro yakanangana nemurwere yakawanikwa, yakadai seYunivhesiti yeCalifornia, Los Angeles (UCLA), American Shoulder neElbow Association (ASES), Constant Shoulder Score, Simple Shoulder Test (SST) mamakisi, uye VAS marwadzo chibodzwa, pamwe nechinangwa chekiriniki. data senge rotator cuff simba uye pfudzi ROM yakaunganidzwa kuyera misiyano mumhedzisiro inoshanda.Zvidzidzo zvakawanda zvega zvakaratidza musiyano mudiki muzviyero zvezvigumisiro izvi muPRP zvichienzaniswa nekugadzirisa kwega [zvakadai semapadhi eArthroscopy rotator cuff kugadzirisa.Uye zvakare, iyo huru meta-kuongorora uye ichangoburwa yakaomesesa ongororo yakaratidza kuti Arthroscopy kugadziriswa kwepfudzi cuff [PRP] haina bhenefiti yakakosha mukuwedzera mazamu.Zvisinei, data shoma inoratidza kuti ine imwe mhedzisiro mukuderedza marwadzo eperioperative, izvo zvingangodaro zvichikonzerwa ne-anti-inflammatory properties yePRP.
Kuongororwa kweboka rediki kwakaratidza kuti pakati nemisodzi midiki inobatwa neArthroscopy kaviri mutsara kugadzirisa, jekiseni rePRP rinogona kuderedza kuwanda kwekubvarura, nokudaro kuwana mhedzisiro iri nani.Qiao et al.Zvakaonekwa kuti PRP inobatsira mukuderedza chiyero chekubvarurazve kwepakati uye yakakura rotator cuff misodzi kana ichienzaniswa nekuvhiyiwa chete.
Randomized kliniki miedzo uye yakakura-yakakura meta-analysis inoratidza kushayikwa kweuchapupu hwekushandiswa kwePRP nePRFM sekusimbisa kwekugadzirisa cuff rotator.Kumwe kuongorora kweboka kunoratidza kuti kugadzirisa mitsara kaviri kunogona kuva nezvimwe zvakanaka zvekurapa misodzi midiki kana ine mwero.PRP inogonawo kubatsira kukurumidza kuderedza kurwadziwa kwepashure.
Achilles Tendon Kugadzirisa
Zvidzidzo zvepreclinical zvakaratidza kuti PRP ine chivimbiso chekusimudzira kuporeswa kweAchilles tendon rupture.Zvisinei, uchapupu hunopesana hunodzivisa kutendeuka kwePRP sehutano hunobudirira hweadjuvant for acute Achilles tendon rupture muvanhu.Semuenzaniso, mune imwe chidzidzo, maitiro ekugadzirisa uye anoshanda evarwere vane Achilles tendon rupture yakabatwa uye pasina PRP yakanga yakafanana.Mukupesana, Zou et al.Muchidzidzo chinotarisirwa chekuongorora, varwere ve36 vakanyorerwa avo vakawana acute Achilles tendon rupture kugadziriswa uye uye pasina intraoperative injection yeLR-PRP.Varwere vari muboka rePRP vaiva nani isokinetic muscles pamwedzi ye3, uye vaiva nepamusoro SF-36 uye Leppilahti scores pa 6 uye 12 mwedzi, maererano (zvose P <0.05).Mukuwedzera, iyo ankle joint range yekufamba muboka rePRP zvakare yakagadziridzwa zvakanyanya panguva dzese pa6, 12, uye 24 mwedzi (P <0.001).Kunyange zvazvo mimwe miedzo yekiriniki yepamusoro ichidiwa, kubaya PRP sekusimudzira kwekuvhiya kweacute Achilles tendon kugadzirisa hakuiti sekubatsira.
Anterior Cruciate Ligament Surgery
Kubudirira kwekuvhiyiwa kwe anterior cruciate ligament (ACL) hakubvi pazvinhu zvehunyanzvi (sekuiswa kwegraft tunnel nekugadzirisa), asiwo pakurapa kwebiological yeACL grafts.Tsvakurudzo pamusoro pekushandiswa kwePRP mukuvhiyiwa kweAACL yekuvakazve inotarisa pane zvitatu zvehupenyu: (1) kubatanidzwa kwemapfupa emapfupa pakati pegraft uye tibial uye femoral tunnels, (2) kukura kwechikamu chekubatana kwegraft, uye (2) 3) kuporesa uye kuderedza marwadzo panzvimbo yekukohwa.
Kunyange zvazvo zvidzidzo zvakawanda zvakatarisa kushandiswa kwePRP jekiseni mukuvhiyiwa kweAACL mumakore mashanu apfuura, kwave kune zvidzidzo zviviri zvepamusoro-soro.Ongororo dzakapfuura dzakaratidza kuti humbowo hwakavhenganiswa hunotsigira kubatanidzwa kwekutapurirana kana graft mature Osteoligamous masero anoshandisa PRP jekiseni, asi humwe humbowo hwakaratidzwa hunotsigira marwadzo munzvimbo yevanopa.Nezve kushandiswa kwePRP kukwidziridzwa kuvandudza kusungirirwa kwepfupa pfupa kusungirirwa, data ichangoburwa inoratidza kuti PRP haina zvibatsiro zvechipatara mukuwedzera kwetanho kana kubatanidzwa kwepfupa.
Miedzo yekiriniki yemazuva ano yakaratidza kuvimbisa mhedzisiro yekutanga mukurwadziwa kwevanopa nzvimbo uye kuporesa vachishandisa PRP.Sajas et al.Kucherechedza kurwadziwa kwemabvi anterior mushure me autologous ACL reconstruction of bone patella bone (BTB), yakawanikwa kuti kana ichienzaniswa neboka rinodzora, kurwadziwa kwemabvi anterior kwakaderedzwa panguva yekutevera kwemwedzi we2.
Kutsvakurudza kwakawanda kunodiwa kuti uongorore migumisiro yePRP pane ACL graft integration, maturation, uye donor site pain.Zvisinei, panguva ino, zvidzidzo zvakaratidza kuti PRP haina kukosha kwekliniki yehutano pakubatanidzwa kwegraft kana kukura, asi zvidzidzo zvishoma zvakaratidza migumisiro yakanaka mukuderedza marwadzo munharaunda yepatellar tendon donor.
Osteoarthritis
Vanhu vari kuwedzera kufarira kushanda kwePRP intra-articular jekiseni mukurapwa kusina kuvhiyiwa kwemabvi Articular bone osteoarthritis.Shen et al.Meta-analysis ye14 randomized clinical trials (RCTs) kusanganisira varwere ve1423 yakaitwa kuenzanisa PRP nemhando dzakasiyana-siyana dzekutonga (kusanganisira placebo, hyaluronic acid, Corticosteroid injection, oral medicine uye Homeopathy kurapwa).Meta kuongororwa kwakaratidza kuti panguva yekutevera kwe3, 6 uye 12 mwedzi, nhamba yeOsteoarthritis index (WOMAC) yeWestern Ontario University uye McMaster University yakavandudza zvikuru (= 0.02, 0.04, <0.001, maererano).A subgroup analysis of PRP efficacy inobva pakuoma kwemabvi osteoarthritis yakaratidza kuti PRP inonyanya kushanda kune varwere vane OA yakapfava kusvika pakati.Munyori anotenda kuti maererano nekunyaradza marwadzo uye murwere akashuma migumisiro, intra articular PRP jekiseni inoshanda kupfuura mamwe majekiseni ekurapa mabvi osteoarthritis.
Riboh et al.yakaita meta-analysis kuenzanisa basa reLP-PRP uye LR-PRP mukurapa kwebvi Osteoarthritis, uye yakawana kuti kana ichienzaniswa neHA kana placebo, LP-PRP jekiseni inogona kuvandudza zvakanyanya chikamu cheWOMAC.Ferrado et al.akadzidza jekiseni reLR-PRP, kana kuti akawana kuti pakanga pasina mutsauko wenhamba uchienzaniswa nejekiseni reHA, zvichiratidza kuti LP-PRP inogona kuva sarudzo yekutanga yekurapa zviratidzo zveOsteoarthritis.Hwaro hwayo hwehupenyu hunogona kunge huri muhuwandu hwekuzvimba uye anti-inflammatory mediators varipo muLR-PRP uye LP-PRP.Pamberi peLR-PRP, murevereri anopisa TNF- α, IL-6, IFN- ϒ Uye IL-1 β Yakawedzera zvakanyanya, nepo jekiseni reLP-PRP rinowedzera IL-4 uye IL-10, iyo inopesana nekuputika. varevereri.Inowanikwa kuti IL-10 inonyanya kubatsira mukurapa hip osteoarthritis, uye inogonawo kudzivisa murevereri wekuputika TNF- α, IL-6 uye IL-1 β Kusunungura uye kuvhara nzira yekuputika ne neutralizing nuclear factor kB basa.Mukuwedzera kune zvinokuvadza pachondrocytes, LR-PRP inogonawo kusakwanisa kubatsira kubata zviratidzo zveOsteoarthritis nekuda kwemigumisiro yayo pamasero e synovial.Braun et al.Yakawanikwa kuti kurapa masero e synovial neLR-PRP kana masero matsvuku eropa anogona kutungamirira kune zvakakosha pro-inflammatory mediator kugadzirwa uye kufa kwesero.
Intra articular jekiseni reLP-PRP inzira yakachengeteka yekurapa, uye pane Level 1 humbowo hwekuti inogona kuderedza zviratidzo zvekurwadziwa uye kuwedzera basa revarwere vanoonekwa vaine mabvi Articular bone osteoarthritis.Zvidzidzo zvakakura uye zvekutevera zvinodikanwa kuti zvione kushanda kwayo kwenguva refu.
Hip Osteoarthritis
Zvidzidzo zvina chete zvemakiriniki zvakaenzaniswa nePRP jekiseni uye hyaluronic acid (HA) jekiseni rekurapa hip osteoarthritis.Mhedzisiro zviratidzo ndeyeVAS marwadzo mamakisi, WOMAC mamakisi, uye Harris hip joint mamakisi (HHS).
Batalya et al.akawana kuvandudzwa kwakakosha muVAS zvibodzwa uye HHS pa1, 3, 6, uye 12 mwedzi.Kuvandudzwa kwepamusoro kwakaitika pamwedzi ye3, uye mhedzisiro yacho yakadzikira zvishoma nezvishoma [72].Nhamba pamwedzi ye12 ichiri kuvandudzwa zvakanyanya kana ichienzaniswa nechikamu chekutanga (P <0.0005);Zvisinei, pakanga pasina mutsauko wakakosha mumigumisiro pakati pePRP neHA mapoka.
Di Sante et al.akaona kuti chikamu cheVAS cheboka rePRP chakavandudzwa zvakanyanya pamasvondo e4, asi akadzoka kune imwe nheyo pamasvondo e16.Pakange pasina misiyano yakakosha muzvikamu zveVAS pakati peboka reHA pamavhiki e4, asi pakanga paine kuvandudzwa kwakakosha pamasvondo e16.Dalari et al.Isu takaongorora maitiro ePRP paHA jekiseni, asi zvakare tichienzanisa musanganiswa weHA uye PRP jekiseni kune ese ari maviri.Boka rePRP rakawanikwa riine chikamu chakaderera cheVAS pakati pemapoka ose matatu panguva dzese dzekutevera (2 mwedzi, 6 mwedzi, uye 12 mwedzi).PRP zvakare yaive nani zvirinani WOMAC mamakisi pa2 uye 6 mwedzi, asi kwete pamwedzi gumi nemiviri.Doria et al.A kaviri-mapofu randomized kliniki yekuedza yakaitwa kuenzanisa varwere vakagamuchira matatu akateedzana majekiseni evhiki nevhiki ePRP uye matatu akateedzana majekiseni eHA.Ichi chidzidzo chakawana kuvandudzwa kweHHS, WOMAC, uye VAS zvikoro muHA uye PRP mapoka panguva ye6 uye 12 mwedzi kutevera.Zvisinei, panguva dzose, pakanga pasina musiyano mukuru pakati pemapoka maviri aya.Hapana tsvakurudzo yakaratidza kuti intra-articular injection yePRP muhudyu ine migumisiro yakaipa, uye vose vakagumisa kuti PRP yakachengeteka.
Kunyange zvazvo data yacho ishoma, intra-articular injection yePRP mukurapa kwehudyu Articular bone osteoarthritis yakaratidza kuti yakachengeteka, uye ine humwe hunobudirira mukuderedza marwadzo nekuvandudza basa, sezvinoyerwa nemigumisiro yezvikamu zvakashumwa nevarwere.Zvidzidzo zvakawanda zvakaratidza kuti PRP inogona kutanga iri nani kuderedza marwadzo kana ichienzaniswa neHA;Zvisinei, sezvo PRP neHA vane simba rakanyanya kufanana pamwedzi gumi nemiviri, chero rubatsiro rwekutanga runoratidzika kuva rusina simba nekufamba kwenguva.Sezvo zvidzidzo zvishomanana zvekliniki zvakaongorora kushandiswa kwePRP muhudyu OA, humwe uchapupu hwepamusoro hunodiwa kuti uone kana PRP inogona kushandiswa seimwe nzira yeConservative management kunonoka kushanda kwehudyu Articular bone osteoarthritis.
Ankle Sprain
Zviyero zviviri chete zvemakiriniki zvakasangana nemaitiro edu ekubatanidza akaongorora kushandiswa kwePRP mune acute ankle sprain.Roden et al.A kaviri-mapofu placebo-inodzorwa randomized kliniki yekuedza yakaitwa kune varwere vane acute ankle sprain mu ED, vachienzanisa jekiseni rinotungamirirwa ne ultrasound reanesthetic yemunharaunda LR-PRP ine saline uye yemunharaunda anesthetic injection.Havana kuwana mutsauko wakakosha muzvikamu zveVAS zvinorwadza kana chikamu chezasi chechikamu (LEFS) pakati pemapoka maviri.
Laval et al.zvisina kurongeka 16 vatambi vepamusoro vakaonekwa vaine ankle sprains kuti vagamuchire ultrasound-inotungamirwa LP-PRP jekiseni kurapwa panguva yekutanga yekurapa nhanho, uye inodzokororwa majekiseni ehurongwa hwekuvandudza hwakabatanidzwa kana chirongwa chakasiyana chekuvandudza 7 mazuva gare gare.Vese varwere vakagamuchira zvakafanana rehabilitation treatment protocol uye regression criteria.Chidzidzo chacho chakawana kuti boka reLP-PRP rakatangazve kukwikwidzana munguva pfupi (40.8 mazuva vs. 59.6 mazuva, P <0.006).
PRP inoratidzika kunge isingabatsiri kune acute ankle sprain.Kunyangwe humbowo hushoma hunoratidza kuti jekiseni reLP-PRP rinogona kukanganisa ankle yepamusoro yevatambi vepamusoro.
Kukuvara Kwetsandanyama
Kushandiswa kwePRP pakurapa kukuvara kwemhasuru kwakaratidza humbowo husina kujeka hwekiriniki.Zvakafanana nekuporesa tendon, nhanho dzekuporesa kwemhasuru dzinosanganisira mhinduro yekutanga yekuputira, inoteverwa nekuwedzera kwesero, kusiyanisa, uye kugadzirisa matishu.Hamid et al.Chidzidzo chimwechete chebofu chakaitwa pavarwere ve28 vane giredhi 2 hamstring kukuvara, kuenzanisa jekiseni reLR-PRP nezvirongwa zvekugadzirisa uye kugadzirisa chete.Boka raigamuchira kurapwa kweLR-PRP rakakwanisa kupora kubva kumakwikwi nekukurumidza (yevhareji yenguva mumazuva, 26.7 vs. 42.5, P = 0.02), asi haina kuwana kuvandudzwa kwemaitiro.Mukuwedzera, zvakakosha zvinokonzerwa ne placebo muboka rekurapa zvinogona kuvhiringidza izvi migumisiro.Mune kaviri-mapofu Randomized controlled muyedzo, Reurink et al.Takaongorora varwere makumi masere uye tikaenzanisa jekiseni rePRP nejekiseni re placebo saline.Vese varwere vakagamuchira kurapwa kwakajairwa.Murwere akateverwa kwemwedzi ye6 uye pakanga pasina misiyano yakakura maererano nenguva yekudzorera kana chiyero chekukuvara zvakare.Iyo yakakodzera PRP fomula yekuvandudza mhasuru kuporeswa munzira dzekiriniki ichiri kunetsa uye tsvakiridzo yeramangwana inofanira kuitwa.
Kutungamira kweMafractures uye Non Union
Kunyange zvazvo kune uchapupu hunonzwisisika hunotsigira kushandiswa kwePRP kuvandudza kuporesa kwepfupa, hapana kubvumirana kwekliniki kutsigira kushandiswa kwemaitiro ePRP kukurudzira kuporesa kwepfupa.Ongororo ichangoburwa paPRP uye kurapwa kwakanyanya kwekuputsika kwakaratidza matatu maRCT asina kuratidza mabhenefiti maererano nemhedzisiro inoshanda, nepo zvidzidzo zviviri zvakaratidza mhedzisiro yekiriniki yepamusoro.Zvizhinji zvezviedzo muongororo iyi (6/8) yakadzidza kushanda kwePRP pamwe chete nemamwe mabhii (zvakadai semesenchymal stem cells uye / kana bone grafts) kukurudzira kuporeswa kwekuputsika.
Nheyo yekushanda yeplatelet-rich plasma (PRP) ndeyekupa zvinhu zvinokura uye macytokines ari mumaplatelet ane kuwanda kwemuviri.Mumusculoskeletal mushonga, PRP inzira inovimbisa yekurapa ine humbowo hwakajeka hwekuchengetedza.Zvisinei, humbowo hwekushanda kwayo hwakavhenganiswa uye hunoenderana zvikuru nezvinosanganiswa uye zviratidzo zvakananga.Mamwe emhando yepamusoro uye akakura makiriniki miedzo mune ramangwana akakosha pakuumba maonero edu paPRP.
(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: Jul-24-2023