Ukusetshenziswa kweI-Platelet Rich Plasma (PRP)Ezindaweni Ezihlukahlukene nokuthi Ungayikhetha Kanjani I-PRP Ecebile Ngamaseli Amhlophe Egazi (L-PRP) kanye ne-PRP Impofu Emangqamuzaneni Egazi Amhlophe (P-PRP)
Ukutholwa kwamuva kwenani elikhulu lobufakazi bekhwalithi ephezulu kusekela ukusetshenziswa komjovo we-LR-PRP ekwelapheni i-Epicondylitis ehlangene kanye ne-LP-PRP yokwelashwa kwe-knee Articular bone.Ubufakazi bekhwalithi ephakathi busekela ukusetshenziswa komjovo we-LR-PRP we-patellar tendinosis kanye nomjovo we-PRP we-Plantar fasciitis kanye nobuhlungu besayithi lomnikezeli ekwakhiweni kabusha kwe-tendon ye-patellar yokwakhiwa kabusha kwe-BTB ACL.Abukho ubufakazi obanele bokuncoma i-PRP njalo nge-rotator cuff tendinosis, i-hip Articular bone osteoarthritis noma i-ankle sprain.Ubufakazi bamanje bubonisa ukuthi i-PRP ayinakho ukusebenza kahle ekwelapheni isifo se-tendon ye-Achilles, ukulimala kwemisipha, ama-acute fractures noma i-bone non union, ukuhlinzwa okuthuthukisiwe kwe-rotator cuff, ukulungiswa kwe-tendon ye-Achilles, nokwakhiwa kabusha kwe-ACL.
I-Platelet rich plasma (PRP) iwukulungiswa kwe-plasma yomuntu okuzenzakalelayo okwandisa ukugxila kwe-platelet ngokufaka i-centrifuging inani elikhulu legazi lesiguli.Ama-platelets kuma-α Particles ayo (TGF- β 1. PDGF, bFGF, VEGF, EGF, IGF-1) aqukethe inani eleqile lezici zokukhula kanye nabaxhumanisi, okugxilwe ngenqubo ye-centrifugation ukukhulula amanani we-suprabiological walezi zici zokukhula nama-cytokines. endaweni elimele futhi uthuthukise inqubo yokuphulukisa yemvelo.
Ibanga elivamile le-platelet count yi-150000 kuya ku-350000 / μ L. Ukuthuthukiswa kokuphulukiswa kwethambo nezicubu ezithambile kuye kwaboniswa, nama-platelet agxilile afinyelela ku-1000000 / μ L. Imelela ukwanda okuphindwe kathathu kuya kahlanu ezicini zokukhula.Amalungiselelo e-PRP avame ukuhlukaniswa abe yi-PRP ecebile kumaseli egazi amhlophe (LR-PRP), echazwa njengokuhlushwa kwe-neutrophil ngaphezu kwesisekelo, kanye ne-PRP impofu kumaseli amhlophe egazi (LP-PRP), echazwa ngokuthi i-white blood cell (neutrophil) ukuhlushwa ngaphansi kwesisekelo. .
Ukwelashwa Kokulimala Kwe-Tendon
Ukusetshenziswa kwe-PRP ekwelapheni ukulimala kwe-tendon noma isifo se-tendon kuye kwaba isihloko sezifundo eziningi, futhi ama-cytokines amaningi atholakala ku-PRP ahilelekile ekuboniseni izindlela ezenzeka ngesikhathi sesigaba sokuphulukisa sokuvuvukala, ukwanda kwamangqamuzana, nokuvuselelwa kwezicubu ezilandelayo.I-PRP ingase futhi ikhuthaze ukwakheka kwemithambo yegazi emisha, engakhuphula ukunikezwa kwegazi nokudla okudingekayo ukuze kuvuselelwe amangqamuzana ezicubu ezonakalisiwe, kanye nokuletha amangqamuzana amasha futhi asuse imfucumfucu ezicutshini ezonakele.Lezi zindlela zesenzo zingase zifaneleke ikakhulukazi ku-tendinosis engapheli, lapho izimo zezinto eziphilayo zingahambisani nokuphulukiswa kwezicubu.Ukubuyekezwa okuhlelekile kwakamuva kanye nokuhlaziywa kwe-meta kuphethe ngokuthi ukujova i-PRP kungaphatha ngokuphumelelayo i-tendinosis enezimpawu.
I-Lateral Epicondylitis
I-PRP iye yahlolwa njengendlela yokwelapha engase ibe khona ezigulini ezine-Epicondylitis yangemuva engasebenzi kahle ku-physiotherapy.Ocwaningweni olukhulu kakhulu olunjalo, uMishra et al.Esifundweni se-Cohort esizoba khona, iziguli ze-230 ezingaphenduli ekuphathweni kwe-Conservative ye-Epicondylitis ye-lateral okungenani izinyanga ze-3 zahlolwa.Isiguli sathola ukwelashwa kwe-LR-PRP, futhi emavikini e-24, umjovo we-LR-PRP wawuhlotshaniswa nokuthuthukiswa okuphawulekayo kobuhlungu uma kuqhathaniswa neqembu lokulawula (71.5% vs 56.1%, P = 0.019), kanye nokwehla okukhulu iphesenti leziguli ezibika ukuthamba kwendololwane okusele (29.1% vs 54.0%, P=0.009).Emavikini angu-24, iziguli eziphathwe nge-LR-PRP zibonise ukuthuthukiswa okuphawulekayo komtholampilo kanye nezibalo uma kuqhathaniswa nemijovo yokulawula esebenzayo yama-anesthetics wendawo.
Ucwaningo lwangaphambilini lubonise ukuthi i-LR-PRP ingaphinde inikeze ukukhululeka okuhlala isikhathi eside kwezimpawu ze-lateral Epicondylitis uma kuqhathaniswa nomjovo we-Corticosteroid, ngakho-ke inomphumela oqhubekayo wokwelapha.I-PRP ibonakala iyindlela ephumelelayo yokwelashwa kwe-Epicondylitis yangaphandle.Ubufakazi bekhwalithi ephezulu bubonisa ukusebenza kahle kwesikhashana nesikhathi eside.Ubufakazi obuhle kakhulu obutholakalayo bubonisa ngokucacile ukuthi i-LR-PRP kufanele ibe indlela yokuqala yokwelapha.
I-Patellar Tendinosis
Izifundo ezilawulwa ngokungahleliwe zisekela ukusetshenziswa kwe-LR-PRP ekwelapheni isifo se-tendon refractory patellar.Draco et al.Iziguli ezingamashumi amabili nantathu ezine-patellar tendinosis ezihlulekile ukuphathwa kwe-Conservative zahlolwa.Iziguli zabelwa ngokungahleliwe ukuthola izinaliti ezomile eziqondiswa yi-ultrasound noma umjovo we-LR-PRP, futhi zalandelwa> amaviki angu-26.Ngesilinganiso se-VISA-P, iqembu lokwelapha le-PRP libonise ukuthuthukiswa okuphawulekayo kwezimpawu kumaviki e-12 (P = 0.02), kodwa umehluko wawungabalulekile ku-> amaviki angu-26 (P = 0.66), okubonisa ukuthi izinzuzo ze-PRP ze-patellar tendon isifo. kungase kube ukuthuthuka kwezimpawu zokuqala.Vitrano et al.Izinzuzo zomjovo we-PRP ekwelapheni isifo se-tendon patellar esingapheli uma kuqhathaniswa ne-focused extracorporeal shock wave therapy (ECSWT) nazo zabikwa.Nakuba kwakungekho umehluko omkhulu phakathi kwamaqembu ngesikhathi sokulandelwa kwezinyanga ze-2, iqembu le-PRP libonise ukuthuthukiswa okuphawulekayo kwezibalo ku-6 kanye nezinyanga ze-12 zokulandelela, ukudlula i-ECSWT njengoba kulinganiswa yi-VISA-P ne-VAS, nokulinganisa i-Blazina. amaphuzu esikalini ezinyangeni eziyi-12 zokulandelela (zonke P<0.05).
Lokhu kubuyekezwa kuhlola izincwadi zamanje zemitholampilo ekusetshenzisweni kwe-plasma ecebile nge-platelet (PRP), kuhlanganise ne-leukocyte ecebile i-PRP (LR PRP) kanye ne-leukocyte empofu ye-PRP (LP PRP), ukuze kuthuthukiswe izincomo ezisekelwe ebufakazini bezifo ezihlukahlukene ze-musculoskeletal.
Ukutholwa kwamuva kwenani elikhulu lobufakazi bekhwalithi ephezulu kusekela ukusetshenziswa komjovo we-LR-PRP ekwelapheni i-Epicondylitis ehlangene kanye ne-LP-PRP yokwelashwa kwe-knee Articular bone.Ubufakazi bekhwalithi ephakathi busekela ukusetshenziswa komjovo we-LR-PRP we-patellar tendinosis kanye nomjovo we-PRP we-Plantar fasciitis kanye nobuhlungu besayithi lomnikezeli ekwakhiweni kabusha kwe-tendon ye-patellar yokwakhiwa kabusha kwe-BTB ACL.Abukho ubufakazi obanele bokuncoma i-PRP njalo nge-rotator cuff tendinosis, i-hip Articular bone osteoarthritis noma i-ankle sprain.Ubufakazi bamanje bubonisa ukuthi i-PRP ayinakho ukusebenza kahle ekwelapheni isifo se-tendon ye-Achilles, ukulimala kwemisipha, ama-acute fractures noma i-bone non union, ukuhlinzwa okuthuthukisiwe kwe-rotator cuff, ukulungiswa kwe-tendon ye-Achilles, nokwakhiwa kabusha kwe-ACL.
Ngenisa
I-Platelet rich plasma (PRP) iwukulungiswa kwe-plasma yomuntu okuzenzakalelayo okwandisa ukugxila kwe-platelet ngokufaka i-centrifuging inani elikhulu legazi lesiguli.Ama-platelets kuma-α Particles ayo (TGF- β 1. PDGF, bFGF, VEGF, EGF, IGF-1) aqukethe inani eleqile lezici zokukhula kanye nabaxhumanisi, okugxilwe ngenqubo ye-centrifugation ukukhulula amanani we-suprabiological walezi zici zokukhula nama-cytokines. endaweni elimele futhi uthuthukise inqubo yokuphulukisa yemvelo.Ibanga elivamile le-platelet count yi-150000 kuya ku-350000 / μ L. Ukuthuthukiswa kokuphulukiswa kwethambo nezicubu ezithambile kuye kwaboniswa, nama-platelet agxilile afinyelela ku-1000000 / μ L. Imelela ukwanda okuphindwe kathathu kuya kahlanu ezicini zokukhula.
Amalungiselelo e-PRP avame ukuhlukaniswa abe amalungiselelo e-PRP acebile ngamaseli amhlophe egazi (LR-PRP), achazwa njengokugxila kwe-neutrophil ngenhla kwesisekelo, kanye namalungiselelo e-PRP ampofu kumaseli amhlophe egazi (LP-PRP), achazwa ngokuthi ukugxila kwe-white blood cell (neutrophil) ngaphansi kwesisekelo.
Ukulungiselela Nokubunjwa
Akukho ukuvumelana okujwayelekile mayelana nokwakhiwa kwe-PRP okuphelele kokugxilisa ingxenye yegazi, futhi okwamanje kunezinhlelo eziningi ezahlukene ze-PRP ezentengiso emakethe.Ngakho-ke, ngokusho kwezinhlelo ezehlukene zezohwebo, kukhona umehluko kumaphrothokholi eqoqo le-PRP nezici zokulungiselela, okunikeza uhlelo ngalunye lwe-PRP izimfanelo eziyingqayizivele.Izinhlelo zezentengiselwano zivame ukuhluka ekusebenzeni kahle kokuthwebula i-platelet, indlela yokuhlukanisa (isinyathelo esisodwa noma izinyathelo ezimbili ze-centrifugation), isivinini se-centrifugation, kanye nohlobo lwesistimu yeshubhu yokuqoqa nokusebenza.Ngokuvamile, ngaphambi kokufakwa kwe-centrifugation, igazi eliphelele liyaqoqwa futhi lixutshwe nezici ze-anticoagulant ukuze kuhlukaniswe amangqamuzana egazi abomvu (RBCs) ku-platelet-poor plasma (PPP) kanye "nongqimba olunsundu lwe-erythrocyte sedimentation" oluqukethe ama-platelet agxilile namaseli egazi amhlophe.Izindlela ezihlukahlukene zisetshenziselwa ukuhlukanisa ama-platelet, angajovwa ngokuqondile emzimbeni wesiguli noma “acushwe” ngokwengeza i-calcium chloride noma i-thrombin, okuholela ekuwohlokeni kweplatelet nokukhululwa kwezici zokukhula.Izici ezimbili eziqondene nesiguli, ezihlanganisa ukuphathwa kwezidakamizwa kanye nezindlela zokulungiselela uhlelo lwezohwebo, zithinta ukwakheka okuqondile kwe-PRP, kanye nalolu shintsho ekubunjweni kokwakhiwa kwe-PRP ekuchazeni ukusebenza komtholampilo kwe-PRP.
Ukuqonda kwethu kwamanje ukuthi i-PRP enokuqukethwe kwamangqamuzana amhlophe egazi anyukile, okungukuthi i-PRP ecebile kumaseli egazi amhlophe (ama-neutrophils), ihlotshaniswa nemiphumela ye-pro-inflammatory.Ukwanda kokuhlushwa kwamangqamuzana amhlophe egazi (neutrophils) ku-LR-PRP kuphinde kuhlotshaniswe nokwanda kwama-cytokines e-catabolic, njenge-interleukin-1 β, Tumor Necrosis Factor α Kanye nama-metalloproteinases, angase aphikisane nama-anabolic cytokines aqukethwe kuma-platelet.Imiphumela yomtholampilo kanye nemiphumela yamaselula yalokhu kwakheka okuhlukile kwe-PRP, okuhlanganisa nokuqukethwe kwamangqamuzana amhlophe egazi, kusacaciswa.Lokhu kubuyekezwa kuhlose ukuhlola ubufakazi bekhwalithi engcono kakhulu etholakalayo yezinkomba ezihlukahlukene zomtholampilo zokubunjwa okuhlukile kwe-PRP.
Izifo ze-Achilles Tendon
Izilingo eziningana zomlando zehlulekile ukukhombisa umehluko emiphumeleni yomtholampilo phakathi kwe-PRP ne-placebo yodwa ekwelapheni i-Achilles tendinitis.Uhlolo lwakamuva olulawulwa ngokungahleliwe luqhathanise uchungechunge lwemijovo emine ye-LP-PRP nomjovo we-placebo ohlanganiswe nohlelo lokuvuselela umthwalo omaphakathi.Uma kuqhathaniswa neqembu le-placebo, iqembu lokwelapha le-PRP libonise ukuthuthukiswa okuphawulekayo ebuhlungu, umsebenzi, kanye nezikolo zomsebenzi ngaso sonke isikhathi amaphuzu phakathi nesikhathi sokulandelela sezinyanga ze-6.Ucwaningo luphinde lwathola ukuthi umjovo owodwa omkhulu wevolumu (50 mL) we-0.5% Bupivacaine (10 mL), i-methylprednisolone (20 mg) kanye ne-physiological saline (40 mL) ibe nokuthuthuka okufanayo, kodwa uma kucutshungulwa lokhu kwelashwa, kufanele kuthathwe ukunakekelwa. umbono wengozi eyengeziwe yokuqhekeka kwe-tendon ngemva komjovo we-steroid.
I-Rotator Cuff Tendinosis
Kunezifundo ezimbalwa ezisezingeni eliphezulu kumjovo we-PRP ekwelapheni okungahlinzeki kwe-rotator cuff tendon isifo.Ucwaningo olumbalwa olushicilelwe luqhathanise imiphumela yomtholampilo yomjovo we-subacromial we-PRP ne-placebo ne-Corticosteroid, futhi akukho cwaningo oluhlole umjovo oqondile we-PRP ku-tendon ngokwayo.U-Casey Buren et al.Kutholwe ukuthi awukho umehluko kumiphumela yomtholampilo uma kuqhathaniswa nokujova usawoti we-physiological ngaphansi kwehlombe eliphakeme.Nokho, uhlolo olulawulwa ngokungahleliwe lwathola ukuthi imijovo emibili ye-LR-PRP njalo ngemva kwamasonto amane ithuthukisa ubuhlungu uma iqhathaniswa nemijovo ye-placebo.Shams et al.Ukuthuthukiswa okuqhathaniswayo komjovo we-subacromial PRP kanye ne-Corticosteroid phakathi kwe-Xi'an Ontario RC index (WORI), inkomba yokukhubazeka kwehlombe (SPDI) kanye nobuhlungu behlombe be-VAS kanye nokuhlolwa kwe-Neer kwabikwa.
Kuze kube manje, ucwaningo luye lwabonisa ukuthi ukujova i-PRP ngaphansi kwesiqongo sehlombe kunokuthuthukiswa okuphawulekayo emiphumeleni ebikiwe yeziguli ezine-rotator cuff tendon disease.Ezinye izifundo ezidinga ukulandelwa isikhathi eside, kuhlanganise nokuhlola umjovo oqondile we-PRP kuma-tendon.Le mijovo ye-PRP iboniswe ukuthi iphephile futhi ingase ibe enye indlela yokujova i-Corticosteroid ku-rotator cuff tendinosis.
I-Plantar Fasciitis
Izivivinyo eziningana ezilawulwa ngokungahleliwe zihlole umjovo we-PRP we-Plantar fasciitis engapheli.Amandla e-PRP njengokwelashwa komjovo wendawo anciphisa ukukhathazeka okuhlobene nomjovo we-Corticosteroid, okufana ne-atrophy yamaphedi emfashini noma ukuphuka kwe-plantar fascia.Ukuhlaziywa kwe-meta kwakamuva okubili kuhlole ukuqhathanisa phakathi komjovo we-PRP nomjovo we-Corticosteroid, futhi kwaphetha ngokuthi umjovo we-PRP ungenye indlela engenzeka yomjovo we-Corticosteroid ngokuya ngokusebenza ngempumelelo.Ezinye izifundo ziye zafakazela ukuphakama kwe-PRP.
Ukuhlinzwa okuhlanganiswe ne-PRP
Ukulungiswa Kwemikhono Yehlombe
Ucwaningo oluningi lwezinga eliphezulu lomtholampilo lwahlola ukusetshenziswa kwemikhiqizo ye-PRP ekulungisweni kwe-Arthroscopy yezinyembezi ze-rotator cuff.Ucwaningo oluningi luye lwafunda ngokukhethekile ukusetshenziswa kwe-platelet rich fibrin matrix amalungiselelo okuthuthukisa (PRFM), kuyilapho ezinye izifundo zijove i-PRP ngqo endaweni yokulungisa.Kukhona i-heterogeneity ebalulekile ekwakhiweni kwe-PRP noma kwe-PRFM.Kutholwe imiphumela eqondiswe esigulini, efana ne-University of California, Los Angeles (UCLA), American Shoulder and Elbow Association (ASES), Constant Shoulder Score, Simple Shoulder Test (SST) score, kanye ne-VAS pain score, kanye nenhloso yomtholampilo. idatha efana namandla e-rotator cuff kanye ne-ROM yehlombe yaqoqwa ukuze kulinganiswe umehluko emiphumeleni yokusebenza.Ucwaningo oluningi ngalunye lubonise umehluko omncane ezilinganisweni zale miphumela ku-PRP uma kuqhathaniswa nokukhanda komuntu ngamunye [njengamaphedi okulungisa i-Arthroscopy rotator cuff.Ngaphezu kwalokho, ukuhlaziywa kwe-meta enkulu kanye nokubuyekezwa okuqinile kwakamuva kufakazele ukuthi ukulungiswa kwe-Arthroscopy ye-shoulder cuff [PRP] akunayo inzuzo ephawulekayo ekukhuliseni ibele.Kodwa-ke, idatha elinganiselwe ibonisa ukuthi inomphumela othile ekunciphiseni ubuhlungu be-perioperative, okungenzeka ngenxa yezakhiwo zokulwa nokuvuvukala ze-PRP.
Ukuhlaziywa kweqembu elincane kubonise ukuthi phakathi nezinyembezi ezincane eziphathwa nge-Arthroscopy yokulungisa imigqa ephindwe kabili, umjovo we-PRP unganciphisa izinga lokuklebhula kabusha, ngaleyo ndlela uzuze imiphumela engcono.Qiao et al.Kutholakale ukuthi i-PRP inenzuzo ekunciphiseni izinga lokudabula kabusha izinyembezi ezimaphakathi nezinkulu ezijikelezayo uma kuqhathaniswa nokuhlinzwa kuphela.
Ukuhlolwa komtholampilo okungahleliwe kanye nokuhlaziywa kwe-meta-scale kubonisa ukuntuleka kobufakazi bokusetshenziswa kwe-PRP ne-PRFM njengokuqiniswa kokulungiswa kwe-rotator cuff.Okunye ukuhlaziya kweqembu elincane kusikisela ukuthi ukulungiswa kwemigqa emibili kungase kube nezinzuzo ezithile zokwelapha izinyembezi ezincane noma ezimaphakathi.I-PRP ingasiza futhi ekudambiseni ngokushesha ubuhlungu bangemva kokuhlinzwa.
Ukulungisa i-Achilles Tendon
Ucwaningo lwe-preclinical lubonise ukuthi i-PRP inomphumela othembisayo ekukhuthazeni ukuphulukiswa kwe-Achilles tendon rupture.Kodwa-ke, ubufakazi obuphikisanayo buvimbela ukuguqulwa kwe-PRP njengendlela yokwelapha ephumelelayo ye-adjuvant ye-acute Achilles tendon rupture kubantu.Isibonelo, esifundweni esisodwa, imiphumela yesakhiwo kanye nokusebenza kweziguli ezine-Achilles tendon rupture ephathwayo futhi ngaphandle kwe-PRP yayifana.Ngokuphambene, uZou et al.Ocwaningweni olulawulwa ngokungahleliwe, iziguli ze-36 zaqashwa ezabhekana nokulungiswa kwe-tendon ye-Achilles acute kanye nangaphandle komjovo we-intraoperative we-LR-PRP.Iziguli eqenjini le-PRP zinemisipha ye-isokinetic engcono ezinyangeni ze-3, futhi zinezibalo eziphakeme ze-SF-36 ne-Leppilahti ku-6 nezinyanga ze-12, ngokulandelana (yonke i-P <0.05).Ukwengeza, uhla oluhlangene lwe-ankle lokunyakaza eqenjini le-PRP nalo luthuthuke kakhulu kuzo zonke izikhathi amaphuzu ku-6, i-12, nezinyanga ze-24 (P <0.001).Nakuba kudingeka ezinye izivivinyo zomtholampilo ezisezingeni eliphezulu, ukujova i-PRP njengesithuthukisi sokuhlinzwa sokulungiswa kwe-tendon ye-Achilles acute akubonakali kunenzuzo.
I-Anterior Cruciate Ligament Surgery
Ukuphumelela kokuhlinzwa kwe-anterior cruciate ligament (ACL) akuxhomekile kuphela ezintweni zobuchwepheshe (njengokubekwa komhubhe wokuxhunyelelwa kanye nokulungiswa kwegraft), kodwa futhi nasekuphulukisweni kwebhayoloji yamagrafti e-ACL.Ucwaningo mayelana nokusetshenziswa kwe-PRP ekuhlinzeni kabusha kwe-ACL lugxile ezinqubweni ezintathu zezinto eziphilayo: (1) ukuhlanganiswa kwemigqa yamathambo phakathi kwe-graft kanye nemigudu ye-tibial ne-femoral, (2) ukuvuthwa kwengxenye ehlangene ye-graft, kanye (2) 3) ukuphulukiswa nokunciphisa ubuhlungu endaweni yokuvuna.
Nakuba izifundo eziningi zigxile ekusetshenzisweni komjovo we-PRP ekuhlinzweni kwe-ACL eminyakeni emihlanu edlule, kube nezifundo ezimbili kuphela ezisezingeni eliphezulu.Ucwaningo lwangaphambili lubonise ukuthi ubufakazi obuxubekile busekela ukuhlanganiswa kokufakelwa noma ukuxhunyelelwa amaseli e-Osteoligamous avuthiwe esebenzisa umjovo we-PRP, kodwa ubufakazi obuthile buye baboniswa ukusekela ubuhlungu endaweni yomnikeli.Ngokuphathelene nokusetshenziswa kokuthuthukiswa kwe-PRP ukuze kuthuthukiswe i-graft bone tunnel bonding, idatha yakamuva ibonisa ukuthi i-PRP ayinazo izinzuzo zomtholampilo ekwandiseni umhubhe noma ukuhlanganiswa kwethambo lokuxhunyelelwa.
Ukuhlolwa komtholampilo kwakamuva kubonise imiphumela ethembisayo yokuqala ebuhlungu besayithi labanikezeli kanye nokuphulukiswa kusetshenziswa i-PRP.Sajas et al.Ukubona ubuhlungu bamadolo angaphambili ngemuva kokwakhiwa kabusha kwe-ACL ye-autologous ye-bone patella bone (BTB), kutholakale ukuthi uma kuqhathaniswa neqembu lokulawula, ubuhlungu bamadolo obungaphambili buncishisiwe ngesikhathi sokulandelwa kwezinyanga ze-2.
Ucwaningo olwengeziwe luyadingeka ukuze kuphenywe imiphumela ye-PRP ekuhlanganisweni kwe-graft ye-ACL, ukuvuthwa, nobuhlungu besayithi labanikezeli.Kodwa-ke, kuleli phuzu, ucwaningo luye lwabonisa ukuthi i-PRP ayinawo umthelela obalulekile womtholampilo ekuhlanganiseni kwe-graft noma ukuvuthwa, kodwa izifundo ezilinganiselwe zibonise imiphumela emihle ekunciphiseni ubuhlungu endaweni yomnikeli we-tendon patellar.
I-Osteoarthritis
Abantu baya ngokuya benesithakazelo ekusebenzeni komjovo we-PRP we-intra-articular ekwelapheni okungahlinzeki kwe-knee Articular bone osteoarthritis.Shen et al.Ukuhlaziywa kwe-meta yokuhlolwa kwe-14 okungahleliwe kwemitholampilo (RCTs) okubandakanya iziguli ze-1423 kwenziwa ukuze kuqhathaniswe i-PRP nezilawuli ezihlukahlukene (kuhlanganise ne-placebo, i-hyaluronic acid, umjovo we-Corticosteroid, imithi yomlomo kanye nokwelashwa kwe-Homeopathy).Ukuhlaziywa kwe-Meta kubonise ukuthi phakathi nokulandelwa kwezinyanga ezingu-3, 6 kanye ne-12, amaphuzu e-Osteoarthritis index (WOMAC) yaseWestern Ontario University kanye neMcMaster University athuthuke kakhulu (=0.02, 0.04, <0.001, ngokulandelana).Ukuhlaziywa kweqembu elingaphansi kokusebenza kwe-PRP okusekelwe ebukhulu be-knee osteoarthritis kubonise ukuthi i-PRP iphumelela kakhulu ezigulini ezine-OA emnene kuya emaphakathi.Umbhali ukholelwa ukuthi mayelana nokunciphisa ubuhlungu kanye nemiphumela ebikiwe ngesiguli, umjovo we-PRP we-intra articular uphumelela kakhulu kuneminye imijovo ehlukile ekwelapheni i-knee osteoarthritis.
Riboh et al.yenza ukuhlaziywa kwe-meta ukuze kuqhathaniswe indima ye-LP-PRP ne-LR-PRP ekwelapheni i-knee Osteoarthritis, futhi yathola ukuthi uma kuqhathaniswa ne-HA noma i-placebo, umjovo we-LP-PRP ungathuthukisa kakhulu amaphuzu we-WOMAC.Ferrado et al.wafunda umjovo we-LR-PRP, noma wathola ukuthi awukho umehluko wezibalo uma kuqhathaniswa nomjovo we-HA, okubonisa ngokuqhubekayo ukuthi i-LP-PRP ingaba yisinqumo sokuqala sokwelashwa kwezimpawu ze-Osteoarthritis.Isisekelo sayo sebhayoloji singase silale emazingeni ahlobene okuvuvukala kanye nabalamuli abalwa nokuvuvukala abakhona ku-LR-PRP naku-LP-PRP.Ebukhoneni be-LR-PRP, umlamuleli ovuthayo we-TNF- α, IL-6, IFN- ϒ Futhi IL-1 β Ukhuphuke ngokuphawulekayo, kuyilapho umjovo we-LP-PRP wanda i-IL-4 ne-IL-10, ephikisana nokuvuvukala. abalamuli.Kutholakala ukuthi i-IL-10 iyasiza ikakhulukazi ekwelapheni i-hip osteoarthritis, futhi ingase ivimbele umlamuleli ovuthayo we-TNF- α, IL-6 kanye ne-IL-1 β Ukukhululwa futhi uvimbele indlela yokuvuvukala ngokuphazamisa umsebenzi we-nuclear factor kB.Ngaphandle kwemiphumela yayo eyingozi kuma-chondrocyte, i-LR-PRP ingase futhi ingakwazi ukusiza ukuphatha izimpawu ze-Osteoarthritis ngenxa yemiphumela yayo kumaseli e-synovial.Braun et al.Kutholakale ukuthi ukwelapha amangqamuzana e-synovial nge-LR-PRP noma amangqamuzana egazi abomvu kungaholela ekukhiqizeni umlamuleli obalulekile we-pro-inflammatory kanye nokufa kweseli.
Umjovo we-intra articular we-LP-PRP uyindlela yokwelapha ephephile, futhi kunobufakazi bezinga loku-1 bokuthi unganciphisa izimpawu zobuhlungu futhi uthuthukise ukusebenza kweziguli ezitholwe zine-knee Articular bone osteoarthritis.Kudingeka izifundo zesilinganiso esikhulu nezinde ukuze kutholwe ukusebenza kwayo kwesikhathi eside.
I-Hip Osteoarthritis
Izivivinyo zomtholampilo ezine kuphela eziqhathaniswa nomjovo we-PRP kanye nomjovo we-hyaluronic acid (HA) wokwelapha i-hip osteoarthritis.Izinkomba zomphumela yimiphumela yobuhlungu be-VAS, i-WOMAC score, kanye ne-Harris hip joint score (HHS).
Bataliya et al.uthole ukuthuthukiswa okubalulekile kuzikolo ze-VAS kanye ne-HHS ku-1, 3, 6, kanye nezinyanga ezingu-12.Ukuthuthukiswa okuphezulu kwenzeka ezinyangeni ezi-3, futhi umphumela waba buthakathaka kancane kancane ngemva kwalokho [72].Amaphuzu ezinyangeni ze-12 asathuthuke kakhulu uma kuqhathaniswa namaphuzu ayisisekelo (P<0.0005);Kodwa-ke, kwakungekho umehluko ophawulekayo wezibalo emiphumeleni phakathi kwamaqembu e-PRP ne-HA.
Di Sante et al.wabona ukuthi amaphuzu we-VAS weqembu le-PRP athuthuke kakhulu emavikini e-4, kodwa abuyele kusisekelo kumaviki e-16.Kwakungekho umehluko ophawulekayo kumaphuzu we-VAS phakathi kweqembu le-HA kumaviki e-4, kodwa kube nokuthuthukiswa okuphawulekayo kumaviki e-16.UDalari et al.Sihlole umthelela we-PRP kumjovo we-HA, kodwa futhi saqhathanisa inhlanganisela yomjovo we-HA ne-PRP kuzo zombili izimo.Iqembu le-PRP litholakale linenani eliphansi le-VAS phakathi kwawo wonke amaqembu amathathu kuwo wonke amaphuzu wesikhathi sokulandelela (izinyanga ze-2, izinyanga ze-6, nezinyanga ze-12).I-PRP futhi ibe nezikolo ezingcono kakhulu ze-WOMAC ezinyangeni ezi-2 nezi-6, kodwa hhayi ezinyangeni eziyi-12.UDoria et al.Ukuhlolwa komtholampilo okungahleliwe okuyizimpumputhe okuphindwe kabili kwenziwa ukuze kuqhathaniswe iziguli ezithole imijovo emithathu yeviki elandelanayo ye-PRP kanye nemijovo emithathu elandelanayo ye-HA.Lolu cwaningo luthole ukuthuthukiswa kwamaphuzu e-HHS, WOMAC, kanye ne-VAS kumaqembu e-HA ne-PRP phakathi ne-6 nezinyanga ze-12 zokulandela.Nokho, ngaso sonke isikhathi amaphuzu, kwakungekho umehluko omkhulu phakathi kwamaqembu amabili.Alukho ucwaningo oluye lwabonisa ukuthi umjovo we-intra-articular we-PRP ku-hip unemiphumela emibi, futhi bonke baye baphetha ngokuthi i-PRP iphephile.
Nakuba idatha ilinganiselwe, umjovo we-intra-articular we-PRP ekwelapheni i-hip Articular bone osteoarthritis kuye kwafakazelwa ukuthi kuphephile, futhi kunokusebenza okuthile ekunciphiseni ubuhlungu nokuthuthukisa umsebenzi, njengoba kulinganiswa nemiphumela yemiphumela ebikwe iziguli.Ucwaningo oluningi luye lwabonisa ukuthi i-PRP ingadambisa kangcono ubuhlungu uma iqhathaniswa ne-HA;Kodwa-ke, njengoba i-PRP ne-HA zinokusebenza okufanayo kakhulu ezinyangeni ze-12, noma iyiphi inzuzo yokuqala ibonakala ibuthakathaka ngokuhamba kwesikhathi.Njengoba izifundo ezimbalwa zemitholampilo ziye zahlola ukusetshenziswa kwe-PRP ku-hip OA, ubufakazi obuphezulu obungaphezulu buyadingeka ukuze kunqunywe ukuthi i-PRP ingasetshenziswa njengenye indlela yokuphatha i-Conservative ukuze kubambezeleke ukusebenza kwe-hip Articular bone osteoarthritis.
I-Ankle Sprain
Izivivinyo ezimbili zomtholampilo ezingahleliwe kuphela ezihlangabezane nenqubo yethu yokufaka ehlolwe ukusetshenziswa kwe-PRP ku-ankle sprain enzima.Roden et al.Ukuhlolwa okungahleliwe komtholampilo okulawulwa ngokungahleliwe okuphindwe kabili kwe-placebo kwenziwa ezigulini ezine-ankle sprain e-ED, kuqhathaniswa umjovo oqondiswa yi-ultrasound we-anesthetic yendawo ye-LR-PRP nomjovo we-saline kanye nomjovo wendawo wokubulala izinzwa.Abatholanga umehluko obalulekile wezibalo kumaphuzu obuhlungu be-VAS noma isikali sokusebenza kwemilenze ephansi (LEFS) phakathi kwamaqembu amabili.
Laval et al.abasubathi be-elite be-16 abanikezwe ngokungahleliwe abatholakala benama-ankle sprains ukuze bathole ukwelashwa komjovo we-LP-PRP oqondiswa yi-ultrasound esigabeni sokuqala sokwelashwa, kanye nemijovo ephindaphindiwe yohlelo lokuvuselela oluhlanganisiwe noma uhlelo oluhlukile lokuvuselela izinsuku ezingu-7 kamuva.Zonke iziguli zithole iphrothokholi yokwelashwa yokuvuselela efanayo kanye nenqubo yokuhlehla.Ucwaningo lwathola ukuthi iqembu le-LP-PRP liphinde laqala ukuncintisana ngesikhathi esifushane (izinsuku ezingu-40.8 vs. 59.6 days, P <0.006).
I-PRP ibonakala ingasebenzi ku-acute i-ankle sprain.Nakuba ubufakazi obulinganiselwe bubonisa ukuthi umjovo we-LP-PRP ungase uthinte i-ankle ephezulu yabadlali be-elite.
Ukulimala Kwemisipha
Ukusetshenziswa kwe-PRP yokwelapha ukulimala kwemisipha kubonise ubufakazi bomtholampilo obungacacile.Ngokufanayo nokuphulukiswa kwe-tendon, izinyathelo zokuphulukisa imisipha zihlanganisa impendulo yokuqala yokuvuvukala, elandelwa ukwanda kwamaseli, ukuhlukaniswa, nokulungiswa kabusha kwezicubu.UHamid et al.Ucwaningo olulodwa oluyimpumputhe oluhleliwe lwenziwa ezigulini ze-28 ezinokulimala kwe-hamstring yebanga le-2, ukuqhathanisa umjovo we-LR-PRP nezinhlelo zokuvuselela nokuvuselela yedwa.Iqembu elithola ukwelashwa kwe-LR-PRP likwazile ukululama emncintiswaneni ngokushesha (isikhathi esimaphakathi ezinsukwini, 26.7 vs. 42.5, P=0.02), kodwa alizange lizuze ukuthuthukiswa kwesakhiwo.Ukwengeza, imiphumela ebalulekile ye-placebo eqenjini lokwelapha ingase idide le miphumela.Esivivinyweni esilawulwa ngokungahleliwe esingaboni kahle kabili, u-Reurink et al.Sihlole iziguli ezingama-80 futhi saqhathanisa umjovo we-PRP nomjovo we-placebo saline.Zonke iziguli zithole ukwelashwa okujwayelekile kokuhlunyeleliswa.Isiguli silandelwe izinyanga ze-6 futhi kwakungekho umehluko obalulekile mayelana nesikhathi sokubuyisela noma izinga lokulimala kabusha.Ifomula efanelekile ye-PRP yokuthuthukisa ukuphulukiswa kwemisipha ngezindlela ezifanele emtholampilo isenzima futhi ucwaningo lwesikhathi esizayo kufanele lwenziwe.
Ukuphathwa Kweziqhekeko kanye Nezingezona Inyunyana
Nakuba kunobufakazi obuzwakalayo bokusekela ukusetshenziswa kwe-PRP ukuthuthukisa ukuphulukiswa kwamathambo, akukho ukuvumelana komtholampilo ukusekela ukusetshenziswa okujwayelekile kwe-PRP ukukhuthaza ukuphulukiswa kwamathambo.Ukubuyekezwa kwakamuva ku-PRP kanye nokwelashwa kwe-acute fracture kuqokomise ama-RCT amathathu angazange abonise izinzuzo ngokwemiphumela yokusebenza, kuyilapho izifundo ezimbili zibonise imiphumela yomtholampilo ephakeme.Iningi lezilingo kulokhu kubuyekezwa (6/8) lifunde ukusebenza kahle kwe-PRP ngokuhlanganiswa namanye ama-biological agents (njengamaseli e-mesenchymal stem kanye / noma ama-grafts amathambo) ukukhuthaza ukuphulukiswa kokuphuka.
Umgomo wokusebenza we-plasma ecebile nge-platelet (PRP) ukuhlinzeka ngezici zokukhula nama-cytokines aqukethwe kuma-platelet anomthamo oweqile we-physiological.Emithi ye-musculoskeletal, i-PRP iyindlela yokwelapha ethembisayo enobufakazi obucacile bokuphepha.Kodwa-ke, ubufakazi bokusebenza kwayo buxubene futhi buncike kakhulu kwizithako kanye nezinkomba ezithile.Izivivinyo zomtholampilo zekhwalithi ephezulu nezinkulu esikhathini esizayo zibalulekile ekulolongeni umbono wethu nge-PRP.
(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: Jul-24-2023