I-Platelet rich plasma (PRP) isetshenziswa kabanzi ekwelashweni kwamathambo, kodwa kusenempikiswano eshubile.Ngakho-ke, i-German "Clinical Tissue Regeneration Working Group" ye-German Orthopedics and Trauma Society yenza inhlolovo ukuze ifinyelele ukuvumelana mayelana namandla amanje okwelapha e-PRP.
Izicelo ze-PRP zokwelapha zibhekwa njengeziwusizo (89%) futhi zingase zibaluleke kakhulu esikhathini esizayo (90%).Izinkomba ezivame kakhulu yisifo se-tendon (77%), i-osteoarthritis (OA) (68%), ukulimala kwemisipha (57%), nokulimala kwe-cartilage (51%).Kufinyelelwe kuvumelana esitatimendeni sangomhla ka-16/31.Ukusetshenziswa kwe-PRP ekuqaleni kwe-knee osteoarthritis (Kellgren Lawrence II) kuthathwa njengokungaba usizo, kanye nezifo ze-tendon eziyingozi nezingapheli.Ngezilonda ezingapheli (i-cartilage, i-tendon), imijovo eminingi (2-4) inconywa kakhulu kunemijovo eyodwa.Nokho, ayikho idatha eyanele ngesikhathi sokuphumula phakathi kwemijovo.Kunconywa kakhulu ukulinganisa ukulungiswa, ukusetshenziswa, ukuvama, nokuzimisela kwezinkomba ze-PRP.
I-Platelet rich plasma (PRP) isetshenziswa kabanzi emithini yokuvuselela kabusha, ikakhulukazi emithini yezemidlalo yamathambo.Ucwaningo oluyisisekelo lwesayensi lubonise ukuthi i-PRP inemiphumela eminingi emihle kumaseli amaningi wesistimu ye-musculoskeletal, njengama-chondrocyte, amaseli e-tendon, noma amaseli emisipha, kokubili ku-vitro kanye ne-vivo.Kodwa-ke, ikhwalithi yezincwadi ezikhona zisanqunyelwe, okuhlanganisa isayensi eyisisekelo kanye nocwaningo lomtholampilo.Ngakho-ke, ocwaningweni lomtholampilo, umphumela awumuhle njengocwaningo lwesayensi oluyisisekelo.
Ziningi izizathu ezingenzeka.Okokuqala, izindlela eziningi zokulungiselela (okwamanje zingaphezu kwama-25 amasistimu ahlukene atholakalayo kwezohwebo) akhona ukuze kutholwe izici zokukhula ezisuselwa ku-platelet, kodwa umkhiqizo wokugcina we-PRP wakhiwe ukwakheka kwawo okuhlukahlukene kanye nemizamo yawo enzima.Isibonelo, izindlela ezahlukene zokulungiselela i-PRP zibonisa imiphumela ehlukene kuma-chondrocyte ahlangene.Ngaphezu kwalokho, ngenxa yokuthi imingcele eyisisekelo njengokwakheka kwegazi (amangqamuzana egazi abomvu, amangqamuzana egazi amhlophe, nama-platelet) ayikabikwa kulo lonke ucwaningo, ukubikwa okujwayelekile kwalezi zici kudingekile ngokuphuthumayo.Umkhiqizo wokugcina we-PRP nawo unomehluko omkhulu ngamunye.Okwenza inkinga ibe nzima ukuthi umthamo, isikhathi, kanye nenani lezicelo ze-PRP akukakamiswanga, futhi akuzange kufundwe ngokugcwele ocwaningweni oluyisisekelo lwesayensi.Mayelana nalokhu, isidingo sokwakheka okujwayelekile kwe-platelet derived growth factor siyabonakala, esizovumela ukuhlolwa okuyisisekelo okuyisisekelo kwemiphumela yemingcele ehlukene efana nokwakheka kwe-PRP, umthamo womjovo we-PRP, nesikhathi somjovo.Ukwengeza, ukusebenzisa izigaba ukuchaza kangcono imikhiqizo ye-PRP esetshenzisiwe kufanele kube yimpoqo.Abanye ababhali bahlongoze izinhlelo ezihlukene zokuhlukanisa, okuhlanganisa i-Mishra (ukubalwa kweplatelet, ukuba khona kwamangqamuzana amhlophe egazi, ukwenziwa kusebenze) kanye no-Dohan Ellenfest (isibalo samaplatelet, ukubala kwamangqamuzana egazi amhlophe, ukuba khona kwe-fibrinogen), i-Delong (i-P latelet count, ukusebenza kwezinzipho, w ^ Isibalo samaseli egazi e-Haide; ukuhlukaniswa kwe-PAW) kanye ne-Mautner (Isibalo sePlatelet, ukuba khona kwe-eukocyte enkulu, ukuba khona kwamaseli egazi abhalwe ngu-R, nokusebenzisa ukusebenza kwezinzipho; ukuhlukaniswa kwe-PLRA) 。 UMagalon et al.Ukuhlukaniswa okuhlongozwayo kwe-DEPA kuhilela umjovo we-platelet OSE, ukusebenza kahle kokukhiqiza, ukuphepha kwe-PRP, nokusebenza kwayo.Harrison et al.Olunye uhlelo olubanzi lokuhlukanisa lwanyatheliswa, oluhlanganisa izindlela zokuvula ezisetshenzisiwe, isamba sevolumu esetshenzisiwe, imvamisa yokuphatha nezigatshana ezicushiwe, ukugxilwa kweplatelet kanye namasu okulungiselela, kanye nezibalo ezijwayelekile ezijwayelekile kanye nobubanzi (okuphansi okuphezulu) ukubala kwamangqamuzana egazi amhlophe (neutrophils, lymphocytes, kanye monocyte) yamaplatelet, amaseli abomvu egazi, kanye nezigaba.Ukuhlelwa kwakamuva kuvela ku-Kon et al.Ngokusekelwe ekuvumelaneni kochwepheshe, izici ezibaluleke kakhulu zichazwa njengokubunjwa kwe-platelet (i-platelet concentration ne-concentration ratio), ubumsulwa (ukuba khona kwamangqamuzana egazi abomvu/amangqamuzana egazi amhlophe), kanye nokwenza kusebenze (i-endogenous/exogenous, i-calcium).
Ukusetshenziswa kwezinkomba eziningi ze-PRP kuye kwaxoxwa kabanzi, njengokuthi ukwelashwa kwesifo se-tendon kuye kwachazwa ezifundweni zemitholampilo mayelana nezindawo ezihlukahlukene [ngemiphumela emihle kanye nemibi].Ngakho-ke, ngokuvamile akunakwenzeka ukuthola ubufakazi obuphelele ezincwadini.Lokhu futhi kwenza kube nzima ukuthi ukwelashwa kwe-PRP kufakwe eziqondisweni ezehlukene.Ngenxa yezinkinga eziningi ezingaxazululiwe ezizungeze ukusetshenziswa kwe-PRP, isimiso esiyisisekelo salesi sihloko ukukhombisa imibono yochwepheshe abavela eJalimane "Iqembu Lokusebenza Lokuvuselelwa Kwezicubu Zomtholampilo" le-German Orthopedics and Trauma Society (DGOU) mayelana nokusetshenziswa nangesikhathi esizayo. kwe-PRP.
Indlela
Iqembu laseJalimane elithi “Clinical Tissue Regeneration Working Group” lakhiwe ngamalungu angu-95, ngalinye lisebenza ngokukhethekile ekuhlinzeni amathambo nokuvuselelwa kwezicubu (bonke odokotela bezokwelapha noma odokotela, abekho abelaphi bomzimba noma ososayensi bokuzivocavoca).Iqembu elisebenzayo elakhiwe ngabantu abangu-5 (ukubuyekezwa okungaboni) linesibopho sokugqugquzela uphenyo.Ngemva kokubuyekeza izincwadi ezikhona, ithimba elisebenzayo lalungisa izinto zolwazi ezingase zifakwe emzuliswaneni wokuqala wophenyo.Inhlolovo yokuqala yenziwa ngo-Ephreli 2018, ihlanganisa imibuzo ye-13 kanye nezici ezijwayelekile zohlelo lokusebenza lwe-PRP, okuhlanganisa imibuzo evaliwe nevulekile, nokukhuthaza ochwepheshe ukuthi baphakamise amaphrojekthi engeziwe noma ukuguqulwa.Ngokusekelwe kulezi zimpendulo, umjikelezo wesibili wocwaningo wasungulwa futhi wenziwa ngoNovemba 2018, nenani eliphelele lemibuzo engu-31 evaliwe emikhakheni engu-5 ehlukene: izinkomba zokulimala kwe-cartilage kanye ne-osteoarthritis (OA), izinkomba ze-tendon pathology, izinkomba zokulimala kwemisipha. , ukusetshenziswa kwe-PRP, nezindawo zocwaningo zesikhathi esizayo.
Ngokusebenzisa inhlolovo ye-inthanethi (i-Survey Monkey, e-USA), kwafinyelelwa esivumelwaneni sokuvumela abaphendulayo ukuba balinganisele ukuthi iphrojekthi kufanele ifakwe ezidingweni ezincane zokubika, kanye nokuhlinzeka ngezikali ezinhlanu zokuphendula ezingaba khona ku-Likert: 'Very agree';Vumelana;Ungavumelani noma uphikise;Ungavumelani noma uphikise ngokuqinile.Inhlolovo ihlolwe ngochwepheshe abathathu mayelana nokuba semthethweni kobuso, ukuqonda nokwamukeleka, futhi imiphumela yashintshwa kancane.Emzuliswaneni wokuqala, bangu-65 sebebonke ababambe iqhaza, kwathi emzuliswaneni wesibili, bangu-40 sebebonke ababambe iqhaza.Emzuliswaneni wesibili wokuvumelana, incazelo ye-priori ithi uma abaphenduli abangaphezu kuka-75% bevuma, iphrojekthi izofakwa kudokhumenti yokugcina yokuvumelana, futhi abangaphansi kuka-20% abaphendulile abavumelani.U-75% wabahlanganyeli uyavuma ukuthi isinqumo sokuvumelana esivame ukucaciswa, esisetshenziswe ocwaningweni lwethu.
Umphumela
Emzuliswaneni wokuqala, abantu abangu-89% baphendule ukuthi isicelo se-PRP siwusizo, futhi abantu abangu-90% bakholelwa ukuthi i-PRP izoba ebaluleke kakhulu esikhathini esizayo.Amalungu amaningi ajwayelene nesayensi eyisisekelo kanye nocwaningo lwezokwelapha, kodwa amalungu angama-58% kuphela asebenzisa i-PRP emisebenzini yawo yansuku zonke.Izizathu ezivame kakhulu zokungasebenzisi i-PRP ukuntuleka kwendawo efanelekile, njengezibhedlela zasenyuvesi (41%), ezibizayo (19%), zisebenzisa isikhathi (19%), noma ubufakazi besayensi obanele (33%).Izinkomba ezivame kakhulu zokusetshenziswa kwe-PRP yisifo se-tendon (77%), i-OA (68%), ukulimala kwemisipha (57%), nokulimala kwe-cartilage (51%), okuyisisekelo somjikelezo wesibili wophenyo.Isibonakaliso sokusetshenziswa kwe-intraoperative ye-PRP ibonakala ngokuhambisana ne-18% ukulungiswa kwe-cartilage kanye nokulungiswa kwe-tendon ye-32%.Ezinye izinkomba zibonakala ku-14%.Bangu-9% kuphela abantu abathi i-PRP ayinakho ukusetshenziswa komtholampilo.Umjovo we-PRP ngezinye izikhathi usetshenziswa ngokuhambisana ne-hyaluronic acid (11%).Ngaphandle kwe-PRP, ochwepheshe baphinde bajova izinzwa zendawo (65%), i-cortisone (72%), i-hyaluronic acid (84%), ne-Traumel/Zeel (28%).Ukwengeza, ochwepheshe basho kakhulu isidingo sokucwaninga okwengeziwe komtholampilo ngokusetshenziswa kwe-PRP (76%) kanye nesidingo sokumiswa okungcono (ukwakheka 70%, izinkomba 56%, isikhathi 53%, imvamisa yomjovo 53%).Ukuze uthole ukwaziswa okwengeziwe ngomzuliswano wokuqala, sicela ubheke isithasiselo.Ochwepheshe basho ngokungananazi ukuthi ucwaningo olwengeziwe lwezokwelapha luyadingeka ekusetshenzisweni kwe-PRP (76%), futhi ukulinganisa okungcono kufanele kufinyelelwe (ukwakheka 70%, izinkomba 56%, isikhathi 53%, imvamisa yomjovo 53%).Ukuze uthole ukwaziswa okwengeziwe ngomzuliswano wokuqala, sicela ubheke isithasiselo.Ochwepheshe basho ngokungananazi ukuthi ucwaningo olwengeziwe lwezokwelapha luyadingeka ekusetshenzisweni kwe-PRP (76%), futhi ukulinganisa okungcono kufanele kufinyelelwe (ukwakheka 70%, izinkomba 56%, isikhathi 53%, imvamisa yomjovo 53%).
Ngokusekelwe kulezi zimpendulo, umjikelezo wesibili ugxile kakhulu esihlokweni esithakaselwa kakhulu.Kufinyelelwe kuvumelana esitatimendeni sangomhla ka-16/31.Iphinde ibonise izindawo lapho kunokuvumelana okuncane, ikakhulukazi emkhakheni wezinkomba.Ngokuvamile abantu bayavuma (92%) ukuthi kukhona umehluko omkhulu ezinkomba ezihlukahlukene zesicelo se-PRP (njenge-OA, isifo se-tendon, ukulimala kwemisipha, njll.).
[Ishadi lebha etshekile estakiwe limelela ukuhlukaniswa kweziqephu kwezinga okuvunyelwene ngalo emzuliswaneni wesibili wenhlolovo (imibuzo engu-31 (Q1 - Q31)), okubonisa kahle izindawo zokungavumelani.
Ibha engakwesokunxele se-eksisi ye-Y ikhombisa ukungavumelani, kuyilapho ibha engakwesokudla ikhombisa ukuvumelana.Ukungavumelani okuningi kuvela emkhakheni wezinkomba.]
Izinkomba zokulimala kwe-cartilage kanye ne-OA
Kukhona isivumelwano esijwayelekile (77.5%) sokuthi i-PRP ingasetshenziselwa i-knee osteoarthritis yasekuqaleni [Kellgren Lawrence (KL) Level II].Ngokulimala okuncane kakhulu kwe-cartilage (KL Level I) kanye nezigaba ezinzima kakhulu (i-KL Level III ne-IV), akukho ukuvumelana okwamanje mayelana nokusetshenziswa kwe-PRP ngesikhathi noma ngemva kokuhlinzwa kokuvuselelwa kwe-cartilage, nakuba i-67.5% yochwepheshe ikholelwa ukuthi lokhu kuyinkambu ethembisayo. .
Izinkomba zezilonda ze-tendon
Kulolu cwaningo, ochwepheshe bamele iningi (82.5% kanye ne-80%) ukuthi ukusetshenziswa kwe-PRP kuyasiza ezifweni ze-tendon ezinzima nezingapheli.Endabeni yokulungiswa kwe-rotator cuff, i-50% yochwepheshe bakholelwa ukuthi ukusetshenziswa kwe-intraoperative ye-PRP kungase kube usizo, kodwa i-17.5% yochwepheshe inombono ophambene.Inombolo efanayo yochwepheshe (57.5%) ikholelwa ukuthi i-PRP inendima enhle ekwelapheni kwangemva kokuhlinzwa ngemva kokulungiswa kwe-tendon.
Inkomba yokulimala kwemisipha
Kodwa akukho ukuvumelana okutholakele ekusetshenzisweni kwe-PRP yokwelashwa kokulimala okunamandla noma okungapheli kwemisipha (njengokuvumelana kwe-75%).
Izici Ezisebenzayo ze-PRP Isicelo
Kunezitatimende ezintathu okungavunyelwana ngazo:
(1) Izilonda ezingapheli zidinga umjovo ongaphezu kowodwa we-PRP
(2) Ulwazi olunganele ngesikhawu sesikhathi esilungile phakathi kwemijovo (akukho ukuvumelana okutholakala ngezikhathi zamasonto onke)
(3) Ukuhlukahluka kokwakheka okuhlukile kwe-PRP kungase kudlale indima ebalulekile emiphumeleni yabo yezinto eziphilayo
Izindawo Zocwaningo Lwesikhathi esizayo
Ukukhiqizwa kwe-PRP kufanele kufane kangcono (ukuvumelana okungamaphesenti angu-95) kanye nokusetshenziswa kwayo emtholampilo (njengemvamisa yomjovo, isikhathi sokufaka isicelo, izinkomba zomtholampilo).Ngisho nasezindaweni ezifana nokwelashwa kwe-OA lapho kubikwa ukuthi kunemininingwane emihle yomtholampilo, amalungu angochwepheshe akholelwa ukuthi kusenesidingo esikhulu socwaningo oluyisisekelo lwesayensi nolwezokwelapha.Lokhu kusebenza nakwezinye izinkomba.
Xoxa
Imiphumela yocwaningo ibonisa ukuthi kusekhona impikiswano ebanzi mayelana nokusetshenziswa kwe-PRP ku-orthopedics, ngisho nasemaqenjini ochwepheshe kazwelonke.Ezinkulumeni ezingama-31, ziyi-16 kuphela ezifinyelele ukuvumelana okufanayo.Kukhona ukuvumelana okukhulu kakhulu emkhakheni wocwaningo lwesikhathi esizayo, okubonisa isidingo esinamandla sokukhiqiza ubufakazi obandisiwe ngokuqhuba izifundo eziningi ezahlukene zesikhathi esizayo.Mayelana nalokhu, ukuhlolwa okubalulekile kobufakazi obutholakalayo ngamaqembu asebenzayo ochwepheshe kuyindlela yokuthuthukisa ulwazi lwezokwelapha.
Izinkomba ze-OA nokulimala kwe-cartilage
Ngokusho kwezincwadi zamanje, i-PRP ingase ifaneleke i-OA yangaphambi kwesikhathi nelinganiselwe.Ubufakazi bamuva bubonisa ukuthi umjovo we-intra-articular we-PRP ungase uthuthukise izimpawu zesiguli kungakhathaliseki izinga lokulimala kwe-cartilage, kodwa ngokuvamile kukhona ukuntuleka kokuhlaziywa kweqembu elincane elisekelwe ku-Kellgren no-Lawrence.Mayelana nalokhu, ngenxa yedatha enganele etholakalayo, ochwepheshe okwamanje abancomi ukusebenzisa i-PRP yezinga le-KL 4. I-PRP nayo inamandla okuthuthukisa umsebenzi ohlangene wamadolo, mhlawumbe ngokunciphisa ukusabela kokuvuvukala nokunciphisa inqubo yokuguqulwa okuwohlokayo kwe-cartilage ehlangene.I-PRP ngokuvamile ifinyelela imiphumela engcono kwabesilisa, abasha, iziguli ezinamazinga aphansi omonakalo we-cartilage kanye ne-body mass index (BMI).
Lapho utolika idatha yomtholampilo eshicilelwe, ukwakheka kwe-PRP kubonakala kuyipharamitha eyinhloko.Ngenxa yomphumela obonisiwe we-cytotoxic we-plasma ecebile ngamaseli amhlophe egazi kumaseli e-synovial in vitro, i-LP-PRP inconywa kakhulu ukuthi isetshenziswe ngaphakathi kwe-intra articular.Ocwaningweni lwakamuva oluyisisekelo lwesayensi, imiphumela yeseli elimhlophe legazi elimpofu (LP) kanye neseli elimhlophe legazi elicebile (LR) PRP ekuthuthukisweni kwe-OA liqhathaniswe kumodeli yegundane ngemva kwe-meniscectomy.I-LP-PRP ibonise ukusebenza okuphezulu ekulondolozeni umthamo we-cartilage uma kuqhathaniswa ne-LR-PRP.Ukuhlaziywa kwe-meta kwakamuva kokuhlolwa okulawulwa ngokungahleliwe kutholwe ukuthi i-PRP ibe nemiphumela engcono uma iqhathaniswa ne-hyaluronic acid (HA), futhi ukuhlaziywa kweqembu elincane kubonise ukuthi i-LP-PRP ibe nemiphumela engcono kune-LR-PRP.Nokho, kwakungekho ukuqhathanisa okuqondile phakathi kwe-LR – ne-LP-PRP, okwenza olunye ucwaningo ludingekile.Eqinisweni, ucwaningo olukhulu kakhulu oluqhathanisa i-LR-PRP ne-HA lubonisa ukuthi i-LR-PRP ayinayo imiphumela emibi.Ukwengeza, ucwaningo lomtholampilo oluqhathanisa i-LR-PRP ne-LP-PRP lubonisa ngokuqondile ukungafani komtholampilo emiphumeleni ngemva kwezinyanga ezingu-12.I-LR-PRP iqukethe ama-molecule amaningi ane-pro-inflammatory kanye nokugxila okuphezulu kwezinto zokukhula, kodwa futhi iqukethe ukugxila okuphezulu kwama-cytokines aphikisana nokuvuvukala, njengama-interleukin-1 receptor antagonists (IL1-Ra).Ucwaningo lwakamuva luye lwachaza inqubo "yokuvuselela ukuvuvukala" yamangqamuzana egazi amhlophe afihla ama-cytokines aphikisana nokuvuvukala, okubonisa umthelela omuhle ekuvuseleleni izicubu.Izifundo zomtholampilo ezengeziwe ezinokuklama okungahleliwe ziyadingeka ukuze kunqunywe ukukhiqizwa okuphelele noma ukwakheka kwe-PRP kanye nephrothokholi yesicelo efanelekile ku-OA.
Ngakho-ke, abanye basikisela ukuthi i-HA ne-PRP kungase kube izindlela zokwelashwa ezingcono kakhulu ezigulini ezine-OA ethambile ne-BMI ephansi.Ukuhlola okuhlelekile kwakamuva kubonise ukuthi i-PRP inomphumela ongcono wokwelapha uma kuqhathaniswa ne-HA.Kodwa-ke, amaphuzu avulekile ahlongozwa ngazwi linye ahlanganisa isidingo sokulungiswa kwe-PRP okujwayelekile, amanani okufaka isicelo, kanye nesidingo sokuqhubeka nokuhlolwa komtholampilo okungahleliwe okunekhwalithi ephezulu yamanzi.Ngakho-ke, okwamanje izincomo ezisemthethweni neziqondiso ngokuvamile azihlanganisi ekusekeleni noma ekuphikisaneni nokusetshenziswa kwe-knee osteoarthritis.Ngamafuphi, ngokusekelwe ebufakazini bamanje, izinhlelo ezihlukene zokulungiselela zinciphisa ukuhluka okuphezulu kwendlela, futhi i-PRP ingase iholele ekuthuthukisweni kobuhlungu ku-OA encane kuya kokulinganisela.Iqembu lochwepheshe alincomi ukusebenzisa i-PRP ezimweni ezinzima ze-OA.Ucwaningo lwakamuva luye lwabonisa ukuthi i-PRP iphinde ifake isandla kumphumela we-placebo, ikakhulukazi ekwelapheni i-OA noma i-Epicondylitis yangemuva.Umjovo we-PRP ungase ube yingxenye yesu lokwelapha eliphelele lokubhekana nezinkinga zebhayoloji ye-OA.Ngaphezu kwezinye izici ezibalulekile ezifana nokuncipha kwesisindo, ukulungisa ukugudluka, ukuqeqeshwa kwemisipha, nama-knee pads, kungasiza ekunciphiseni ubuhlungu futhi kulethe imiphumela engcono ezigulini.
Indima ye-PRP ekuhlinzekweni kwe-cartilage yokuvuselela ingenye indawo ephikisana kakhulu.Nakuba ucwaningo oluyisisekelo lwesayensi lubonise umthelela omuhle kuma-chondrocyte, ubufakazi bomtholampilo bokusetshenziswa kwe-PRP ngesikhathi sokuhlinzwa, ukuhlinzwa kokuvuselelwa kwe-cartilage, noma izigaba zokuvuselela akwanele, kubonisa lokho esikutholile.Ngaphezu kwalokho, isikhathi esifanele sokwelashwa kwe-PRP kwangemva kokuhlinzwa asikaqiniseki.Kodwa ochwepheshe abaningi bayavuma ukuthi i-PRP ingasiza ekukhuthazeni ukuvuselelwa kwe-cartilage yezinto eziphilayo.Kafushane, imiphumela yamanje yesahlulelo esibucayi iphakamisa ukuthi ukuhlolwa okwengeziwe kwendima engaba khona ye-PRP ekuhlinzekweni kwe-cartilage yokuvuselela kuyadingeka.
Izinkomba zezilonda ze-tendon
Ukusetshenziswa kwe-PRP yokwelashwa kwe-tendinosis kuyisihloko esiphikisanayo ezincwadini.Ukubuyekezwa kocwaningo oluyisisekelo lwesayensi kubonisa ukuthi i-PRP inemiphumela emihle ku-vitro (njengokwandisa ukwanda kwe-tendon cell, ukukhuthaza imiphumela ye-anabolic, njengokwandisa ukukhiqizwa kwe-collagen) kanye ne-vivo (ukwandisa ukuphulukiswa kwe-tendon).Emisebenzini yomtholampilo, ucwaningo oluningi luye lwabonisa ukuthi ukwelashwa kwe-PRP kunakho kokubili okuhle futhi akukho miphumela ezifweni ezihlukahlukene ze-tendon ezinzima nezingapheli.Isibonelo, ukubuyekezwa okuhlelekile kwakamuva kugcizelele imiphumela eyimpikiswano yohlelo lokusebenza lwe-PRP ezilonda ze-tendon ezihlukene, ikakhulukazi ezinomthelela omuhle ezilonda ze-tendon elbow kanye nezilonda ze-tendon patellar, kodwa hhayi ku-Achilles tendon noma izilonda ze-rotator cuff.Iningi lamarekhodi e-RCT okuhlinzwa alinayo imiphumela ezuzisayo, futhi akukabikho ubufakazi obuqand’ikhanda bokusetshenziswa kwayo okuqinile ezifweni ze-rotator cuff.Nge-Epicondylitis yangaphandle, ukuhlaziywa kwe-meta yamanje kubonisa ukuthi i-corticosteroids inomphumela omuhle wesikhashana, kodwa umphumela wesikhathi eside we-PRP uphakeme.Ngokusekelwe ebufakazini bamanje, i-patellar ne-lateral elbow tendinosis ibonise ukuthuthukiswa ngemva kokwelashwa kwe-PRP, kuyilapho i-Achilles tendon kanye ne-rotator cuff ibonakala ingazuzi ekusetshenzisweni kwe-PRP.Ngakho-ke, ukuvumelana kwakamuva kweKomidi Lesayensi Eyisisekelo le-ESSKA kuphethe ngokuthi okwamanje akukho ukuvumelana ngokusetshenziswa kwe-PRP yokwelapha i-tendinosis.Naphezu kokuphikisana ezincwadini, njengoba kuboniswe ucwaningo lwakamuva nokuhlola okuhlelekile, i-PRP inendima enhle ekwelapheni izifo ze-tendon kusuka kokubili okuyisisekelo kwesayensi kanye nemibono yomtholampilo.Ikakhulukazi ukucabangela imiphumela emibi engaba khona ye-corticosteroids lapho usebenzisa izifo ze-tendon.Imiphumela yalolu cwaningo ibonisa ukuthi umbono wamanje waseJalimane uwukuthi i-PRP ingasetshenziswa ukwelapha izifo ze-tendon ezinzima nezingapheli.
Inkomba yokulimala kwemisipha
Ukuphikisana okwengeziwe ukusetshenziswa kwe-PRP ukwelapha ukulimala kwemisipha, okungenye yezingozi ezivame kakhulu emidlalweni yezobuchwepheshe, okuholela cishe ku-30% wezinsuku ze-field.I-PRP inikeza ithuba lokuthuthukisa ukuphulukiswa kwezinto eziphilayo kanye nokusheshisa amazinga okuzivocavoca okubuyisela, okuthole ukunakwa okukhulayo eminyakeni embalwa edlule.Nakuba i-57% yezimpendulo ezinikezwe emzuliswaneni wokuqala zibala ukulimala kwemisipha njengenkomba evamile yokusetshenziswa kwe-PRP, kusenokuntuleka kwesizinda sesayensi esiqinile.Izifundo eziningana ze-in vitro ziye zabona izinzuzo ezingaba khona ze-PRP ekulimaleni kwemisipha.Ukusheshisa komsebenzi wamaseli wesathelayithi, ukwanda kobubanzi be-fibril evuselelwe kabusha, ukukhuthazwa kwe-myogenesis, nokwanda komsebenzi we-MyoD ne-myostatin konke kuhlolwe kahle.Olunye ulwazi mayelana noMazoka et al.Ukwanda kokugxila kwezinto zokukhula ezifana ne-HGF, i-FGF, ne-EGF kubonwe ku-PRP-LP.Tsai et al.yagcizelela le miphumela.Ngaphezu kokufakazela ukubonakaliswa kwamaprotheni okwenyuka kwe-cyclin A2, i-cyclin B1, i-cdk2 ne-PCNA, kufakazelwa ukuthi ubungqabavu be-skeletal muscle cell kanye nokwanda kwamaseli kuyanda ngokudlulisa amaseli kusuka esigabeni se-G1 kuya ku-S1 ne-G2&M izigaba.Ukubuyekezwa okuhlelekile kwakamuva kufingqa isizinda sesayensi samanje ngale ndlela elandelayo: (1) Ezifundweni eziningi, ukwelashwa kwe-PRP kwandise ukwanda kwamaseli emisipha, ukubonakaliswa kwesici sokukhula (njenge-PDGF-A/B ne-VEGF), ukuqashwa kwamangqamuzana egazi amhlophe, kanye ne-angiogenesis emisipha. uma kuqhathaniswa nemodeli yeqembu lokulawula;(2) Ubuchwepheshe bokulungiselela i-PRP abuhambisani nocwaningo lwezincwadi zesayensi eziyisisekelo;(3) Ubufakazi obuvela ocwaningweni oluyisisekelo lwesayensi ku-vitro kanye ne-vivo buphakamisa ukuthi i-PRP ingase isebenze njengendlela yokwelapha ephumelelayo engasheshisa inqubo yokuphulukisa izilonda zemisipha uma kuqhathaniswa neqembu lokulawula, ngokusekelwe emiphumeleni ebonwe emazingeni amaselula kanye nezicubu iqembu lokwelapha.
Nakuba isifundo sokubuyisela emuva sichaza ukuphulukiswa okuphelele futhi kucatshangelwa ukuthi isikhathi esingekho endaweni asizange sibe nenzuzo enkulu, u-Bubnov et al.Esifundweni seqembu labasubathi be-30, kwaphawulwa ukuthi ubuhlungu buncishisiwe futhi isivinini sokululama emncintiswaneni sashesha kakhulu.UHamid et al.Esivivinyweni esilawulwa ngokungahleliwe (RCT) esiqhathanisa ukungena kwe-PRP nemithi yokwelapha elondolozayo, ukululama ngokushesha okukhulu emncintiswaneni kwachazwa.Okuwukuphela kwe-RCT eyizimpumputhe ephindwe kabili eyizimpumputhe ihlanganisa ukulimala kwe-hamstring kubasubathi (n=80), futhi akukho ukungena okuphawulekayo kwe-placebo okubonwe uma kuqhathaniswa ne-PRP.Izimiso zebhayoloji ezithembisayo, ukutholwa kwangaphambi komtholampilo okuhle, kanye nesipiliyoni esiphumelelayo somtholampilo ngomjovo we-PRP okukhulunywe ngaso ngenhla akuzange kuqinisekiswe i-RCT yakamuva yezinga eliphezulu.Ukuvumelana kwamanje phakathi kwamalungu e-GOTS kuye kwahlola izindlela zokwelapha ezilondolozayo zokulimala kwemisipha futhi kwaphetha ngokuthi okwamanje abukho ubufakazi obucacile bokuthi umjovo we-intramuscular ungasetshenziswa ukwelapha ukulimala kwemisipha.Lokhu kuhambisana nemiphumela yethu, futhi akukho ukuvumelana ekusetshenzisweni kwe-PRP ekwelapheni ukulimala kwemisipha.Ucwaningo olwengeziwe luyadingeka ngokuphuthumayo kumthamo, isikhathi, kanye nemvamisa ye-PRP ekulimaleni kwemisipha.Uma kuqhathaniswa nokulimala kwe-cartilage, ekulimazeni kwemisipha, ukusetshenziswa kwe-algorithms yokwelashwa, ikakhulukazi i-PRP, kungase kuhlotshaniswe nezinga kanye nobude besikhathi sokulimala, ukuhlukanisa phakathi kokubandakanyeka kobubanzi be-muscle elimele kanye nokulimala okungenzeka noma ukulimala kwe-avulsion.
Inkambu yesicelo se-PRP ingenye yezindawo okuxoxwa ngazo kakhulu, futhi ukuntuleka kokumisa okwamanje kungenye yezinkinga eziyinhloko ekuhlolweni kwemitholampilo.Ochwepheshe abaningi abazange babone ukwanda kokusetshenziswa kwe-PRP, noma kunjalo, ezinye izifundo zibonise ukuthi ukusetshenziswa okwengeziwe kwe-hyaluronic acid kungaqhathaniswa nokusetshenziswa okukodwa kwe-PRP ye-OA.Ukuvumelana ukuthi imijovo eminingi kufanele inikezwe izifo ezingelapheki, futhi inkundla ye-OA iyasisekela lesi siphakamiso, lapho imijovo eminingi iphumelela kakhulu kunomjovo owodwa.Ucwaningo lwesayensi oluyisisekelo luhlola ubudlelwano bomthamo-nomphumela we-PRP, kodwa le miphumela isadinga ukudluliselwa ocwaningweni lomtholampilo.Ukugxiliswa okuphelele kwe-PRP akukakanqunywa okwamanje, futhi ucwaningo lubonise ukuthi ukugxila okuphezulu kungase kube nemiphumela emibi.Ngokufanayo, umthelela wamangqamuzana egazi amhlophe uncike enkombeni, futhi ezinye izinkomba zidinga i-PRP enamaseli amhlophe egazi ampofu.Ukuhlukahluka kokwakheka kwe-PRP ngayinye kudlala indima ebalulekile kumthelela we-PRP.
Izindawo Zocwaningo Lwesikhathi esizayo
Kuvunyelwene ngazwi linye ukuthi ngokwezincwadi zakamuva, ucwaningo olwengeziwe nge-PRP luyadingeka esikhathini esizayo.Enye yezinkinga eziyinhloko ukuthi ukwakheka kwe-PRP kufanele kufane kangcono (ngokuvumelana okungama-95%).Isici esisodwa esingaba khona sokufeza lo mgomo kungaba ukuhlanganiswa kwamaplatelet ukuze kuzuzwe imiqulu emikhulu, esezingeni eliphezulu.Ngaphezu kwalokho, imingcele ehlukahlukene yokusetshenziswa komtholampilo akwaziwa, njengokuthi mingaki imijovo okufanele isetshenziswe, isikhathi esiphakathi kwemijovo, kanye nomthamo we-PRP.Kungale ndlela kuphela lapho kungenziwa khona ucwaningo lwezinga eliphezulu futhi kuhlolwe ukuthi yiziphi izinkomba ezifanele kakhulu ukusebenzisa i-PRP, ukwenza ucwaningo oluyisisekelo lwesayensi nokwelapha, okungcono kakhulu izifundo ezilawulwa ngokungahleliwe, ezidingekayo.Nakuba kufinyelelwe kuvumelana ukuthi i-PRP ingase idlale indima ebalulekile esikhathini esizayo, kubonakala sengathi ucwaningo olwengeziwe nolwemitholampilo luyadingeka manje.
Umngcele
Omunye umkhawulo ongaba khona womzamo wale nhlolovo wokubhekana nesihloko okuphikiswana ngaso kabanzi sohlelo lwe-PRP izici zayo zobuzwe.Ukutholakala kwe-PRP kanye nokwehluka kwezwe ekubuyiselweni kwemali kungase kuthinte imiphumela nezici zokulawula.Ngaphezu kwalokho, ukuvumelana akuyona i-multidisciplinary futhi kufaka phakathi imibono yodokotela bamathambo.Kodwa-ke, lokhu kungase futhi kubonakale njengenzuzo njengoba kuyiqembu kuphela elenza futhi liqondise ukwelashwa komjovo we-PRP.Ngaphezu kwalokho, inhlolovo eyenziwe inekhwalithi ehlukile ye-methodological uma kuqhathaniswa nenqubo ye-Delphi eyenziwe ngokuqinile.Inzuzo iwukuvumelana okwakhiwe iqembu lodokotela bamathambo abangochwepheshe abanolwazi olunzulu lobungcweti emikhakheni yabo ngokwemibono yesayensi eyisisekelo nokusebenza komtholampilo.
Isincomo
Ngokusekelwe ekuvumelaneni okungenani kuka-75% wochwepheshe ababambe iqhaza, finyelela ukuvumelana kulawa maphuzu alandelayo:
I-OA kanye nokulimala kwe-cartilage: Ukusetshenziswa kwe-mild knee osteoarthritis (ibanga le-KL II) kungase kube usizo.
I-tendon pathology: Ukusetshenziswa kwezifo ze-tendon ezinzima nezingamahlalakhona kungase kube usizo
Isiphakamiso esiwusizo: Ngezilonda ezingapheli (uqwanga, izintambo), imijovo eminingi (2-4) ngezikhathi ezithile ituseka kakhulu kunomjovo owodwa.
Nokho, kunedatha eyanele ngesikhathi sokuphumula phakathi komjovo owodwa.
Ucwaningo lwesikhathi esizayo: Kutuswa ngokuqinile ukulinganisa ukukhiqizwa, ukulungiswa, ukusetshenziswa, imvamisa, kanye nohlu lwezinkomba lwe-PRP.Olunye ucwaningo oluyisisekelo nolwezempilo luyadingeka.
Isiphetho
Ukuvumelana okuvamile ukuthi kunomehluko ezinkomba ezihlukahlukene zohlelo lokusebenza lwe-PRP, futhi kusekhona ukungaqiniseki okuphawulekayo ekumisweni kohlelo lwe-PRP ngokwalo, ikakhulukazi izinkomba ezahlukene.Ukusetshenziswa kwe-PRP ku-knee osteoarthritis yokuqala (i-KL grade II) kanye nezifo ze-tendon ezinzima nezingapheli kungase kube usizo.Ngezilonda ezingapheli (uqwanga kanye ne-tendon), imijovo eminingi yesikhawu (2-4) ituseka kakhulu kunomjovo owodwa, kodwa kunedatha eyanele ngesikhathi sokuphumula phakathi komjovo owodwa.Inkinga enkulu ukuhlukahluka kokwakheka kwe-PRP ngayinye, okudlala indima ebalulekile endimeni ye-PRP.Ngakho-ke, ukukhiqizwa kwe-PRP kumele kufane kangcono, kanye nemingcele yomtholampilo efana nemvamisa yomjovo, nesikhathi phakathi komjovo nezinkomba ezinembile.Ngisho naku-OA, okwamanje emele inkambu yocwaningo engcono kakhulu yesicelo se-PRP, kudingeka ucwaningo oluyisisekelo lwesayensi nokwelapha, kanye nezinye izinkomba ezihlongozwayo.
(Okuqukethwe yile ndatshana kuphrintwe kabusha, futhi asinikezeli nganoma yisiphi isiqinisekiso esicacile noma esishiwoyo sokunemba, ukwethembeka noma ukuphelela kokuqukethwe okuqukethwe kulesi sihloko, futhi asinasibopho ngemibono yalesi sihloko, sicela uqonde.)
Isikhathi sokuthumela: May-24-2023