I-Platelet-rich rich plasma (PRP) okwamanje isetshenziswa kabanzi emikhakheni ehlukahlukene yezokwelapha.Eminyakeni yamuva, ukusetshenziswa kwe-PRP ku-orthopedics kuye kwakhanga ukunakwa okwengeziwe, futhi ukusetshenziswa kwayo emikhakheni ehlukene njengokuvuselelwa kwezicubu, ukuphulukiswa kwesilonda, ukulungiswa kwezibazi, ukuhlinzwa kwepulasitiki nobuhle kuye kwanda kakhulu.Kumagazini wanamuhla, sizohlaziya i-biology ye-PRP, indlela yayo yokusebenza, kanye nokuhlukaniswa kwe-PRP ukuze siqonde kangcono ukuthi yini engenziwa nokungafanele yenziwe nge-PRP.
Umlando we-PRP
I-PRP yaziwa nangokuthi i-platelet-rich plasma (PRP), i-platelet-rich growth factor (GFS) kanye ne-platelet-rich fibrin (PRF) matrix.Umqondo kanye nencazelo ye-PRP yaqala emkhakheni we-hematology.Izazi ze-Hematologists zakha igama elithi PRP ngawo-1970, ikakhulukazi ukwelapha iziguli ezine-thrombocytopenia ngokukhipha ama-platelet nokwengeza ukumpontshelwa.
Eminyakeni eyishumi kamuva, i-PRP yaqala ukusetshenziswa ekuhlinzweni kwe-maxillofacial njenge-PRF.I-Fibrin ine-adhesive kanye ne-homeostatic properties, futhi i-PRP inezici zokulwa nokuvuvukala ezikhuthaza ukwanda kwamaseli.Kamuva, i-PRP yaqala ukusetshenziswa kabanzi emkhakheni we-musculoskeletal wokulimala kwezemidlalo futhi yazuza imiphumela emihle yokwelapha.Ngenxa yokuthi okuhloswe ukwelashwa ikakhulukazi abasubathi abangochwepheshe, kuye kwaheha ukunakwa okukhulu kwabezindaba futhi sekusetshenziswe kabanzi emkhakheni wezokwelapha zezemidlalo.Kamuva, i-PRP yathuthukiswa kancane kancane ku-orthopedics, ukuhlinzwa, ukuhlinzwa kwezingane, i-gynecology, i-urology, ukuhlinzwa kwepulasitiki kanye nezimonyo kanye ne-ophthalmology.
I-Platelet Biology
Amangqamuzana egazi azungezayo ahlanganisa amangqamuzana egazi abomvu, amangqamuzana egazi amhlophe nama-platelet, konke asuselwa kuseli elivamile le-pluripotent stem elingahlukana libe imigqa yamaseli ehlukene.Le migqa yeseli iqukethe amaseli andulelayo angahlukanisa futhi avuthwe.Ama-platelet asuselwa kumnkantsha wethambo futhi angamaseli amise okwe-nucleated disc anobukhulu obuhlukene, anobubanzi obuyisilinganiso obungaba ngu-2 μm, futhi angamangqamuzana egazi aminyene kakhulu.Izibalo ze-Platelet ngegazi elijwayelekile elijikelezayo zisukela ku-150,000 kuya ku-400,000 nge-microliter ngayinye.Ama-platelet aqukethe ama-granules ayimfihlo abalulekile, okukhona amathathu ayinhloko: ama-granules aminyene, ama-o-granules, nama-lysosomes.Iplatelet ngayinye inezinhlayiya ezingaba ngu-50-80.
Incazelo ye-PRP
Ekuphetheni, i-PRP iwumkhiqizo wezinto eziphilayo, okuyi-plasma egxilile ene-platelet concentration ephakeme kakhulu kunegazi le-peripheral.I-PRP ayiqukethe kuphela amazinga aphezulu amaplatelet, kodwa futhi iqukethe zonke izici ze-coagulation, kuhlanganise nochungechunge lwezici zokukhula, ama-chemokines, ama-cytokines namaprotheni e-plasma.
I-PRP ikhishwa egazini le-peripheral elithathwe izindlela ezihlukahlukene zokulungiselela elabhorethri.Ngemuva kokulungiswa, ngokusho kwama-gradients ahlukene, amangqamuzana egazi abomvu, i-PRP, ne-PPP ezingxenyeni zegazi ahlukaniswa ngokulandelana.Ku-PRP, ngaphezu kokuhlushwa okuphezulu kwamaplatelet, kuyadingeka futhi ukucabangela ukuthi iqukethe i-leukocyte nokuthi iyasebenza yini.Ngokusekelwe kulezi zici, izinhlobo ezahlukene ze-PRP ezifanele izimo ezihlukene ze-pathological ziyanqunywa.
Amadivayisi amaningana ezentengiselwano akhona njengamanje angenza kube lula ukulungiswa kwe-PRP.Lawa madivayisi we-PRP ngokuvamile akhiqiza ukugxila kwe-PRP kweplatelet okuphindwe ka-2-5.Nakuba umuntu angase acabange ukuthi ukuphakama kwe-platelet kanye nenani eliphezulu lokukhula, umphumela wokwelapha kufanele ube ngcono, lokhu akukakasungulwa, futhi izikhathi ezingu-3-5 ukugxila ngokuvamile kubhekwa njengokufanelekile.
Imishini yezentengiselwano inenzuzo yokuba ifane futhi ibe lula, kodwa inemikhawulo yamadivayisi afanele.Abanye abakwazi ukususa ukungcola okuthile kahle, kanti amanye amalungiselelo e-PRP awaphezulu ekugxiliseni ingqondo.Ngokuyisisekelo, yonke imishini yezentengiselwano ayikwazi ukulungiswa ngayinye futhi ngokunembile.Lena inkinga enkulu ngemishini ejwayelekile.Njengamanje, ubuchwepheshe bokulungiselela ilabhorethri obuqondile kuphela obungakwazi ukumboza zonke izidingo zesiguli, ezinezidingo eziphakeme kubuchwepheshe baselabhorethri.
Ukuhlukaniswa kwe-PRP
Ngo-2006, u-Everts et al uhlongoze umqondo we-PRP ecebile nge-leukocyte.Ngakho-ke, i-PRP ingahlukaniswa cishe ibe izinhlobo ezimbili ngokuya ngenani lama-leukocyte aqukethwe: I-PRP enamaleukocyte ampofu kanye ne-PRP enamaleukocyte acebile.
I-1) I-plasma ene-Platelet ecebile equkethe ukuhlushwa okuphezulu kwama-leukocyte, okubizwa ngokuthi i-L-PRP (i-Leukocyte Platelet-Rich Plasma, equkethe inani elincane lamangqamuzana abomvu egazi), isetshenziselwa ikakhulukazi izilonda eziphikisayo, unyawo lwesifo sikashukela, i-gout engapholi. amanxeba, ukulungiswa kwamathambo, ukunganakwa, ukuvuvukala komnkantsha kanye nokunye ukwelashwa komtholampilo.
I-2) I-Platelet-rich rich plasma ngaphandle noma ene-concentration ephansi ye-leukocyte ibizwa ngokuthi i-P-PRP (I-Platelet-Rich Plasma ehlanzekile, engenawo amangqamuzana egazi abomvu), ikakhulukazi esetshenziselwa ukulimala kwezemidlalo kanye nezifo eziwohlokayo, kuhlanganise nokulimala kwe-meniscus, ukulimala kwe-ligament kanye ne-tendon. , indololwane yethenisi, i-arthritis yamadolo, ukuwohloka kwe-cartilage, i-lumbar disc herniation nezinye izifo.
I-3) Ngemuva kokuthi i-PRP ye-liquid icushwe yi-thrombin noma i-calcium, i-gel-like PRP noma i-PRF ingakhiwa.(Ilungiswe okokuqala ngu-Dohan et al. e-France)
Ngo-2009, u-Dohan Ehrenfest et al.Izigaba ezi-4 ezihlongozwayo ezisekelwe ebukhoneni noma ekungabibikho kwezingxenye zamaselula (njengama-leukocyte) kanye nesakhiwo se-fibrin:
I-1) I-PRP ehlanzekile noma i-leukocyte-poor PRP: I-PRP elungiselelwe ayinayo i-leukocyte, futhi okuqukethwe kwe-fibrin ngemva kokusebenza kuphansi.
I-2) Amangqamuzana egazi amhlophe kanye ne-PRP: aqukethe amangqamuzana egazi amhlophe, futhi okuqukethwe kwe-fibrin ngemva kokusebenza kuphansi.
I-3) I-PRF ehlanzekile noma i-leukocyte-poor PRF: ukulungiswa akuqukethe i-leukocyte futhi ine-high-density fibrin.Le mikhiqizo iza ngendlela yamajeli acushiwe futhi ayikwazi ukusetshenziselwa umjovo.
4) I-Leukocyte-rich fibrin ne-PRF: equkethe ama-leukocyte kanye ne-high-density fibrin.
Ngo-2016, uMagalon et al.ihlongoze ukuhlukaniswa kwe-DEPA (umthamo, ukusebenza kahle, ukuhlanzeka, ukwenza kusebenze), kugxile ekubaleni kwe-PRP platelet, ubumsulwa bomkhiqizo, nokusebenza kweplatelet.
1. Umthamo womjovo weplatelet: Bala ngokuphindaphinda ukugcwala kweplatelet ngevolumu yeplatelet.Ngokomthamo ojovwe (ngezigidigidi noma izigidi zamaplatelet), ingahlukaniswa ibe (a) umthamo ophezulu kakhulu: > 5 billion;(b) umthamo omkhulu: ukusuka ezigidini eziyizinkulungwane ezi-3 kuya kwezingu-5;(c) umthamo ophakathi: ukusuka ebhiliyoni eli-1 ukuya ezigidini ezi-3;(d) umthamo ophansi: ngaphansi kwebhiliyoni elingu-1.
2. Ukusebenza kahle kwamalungiselelo: iphesenti lamaplatelet aqoqwe egazini.(a) Ukusebenza okuphezulu kwedivayisi: izinga lokutholwa kweplatelet >90%;(b) ukusebenza kahle kwedivayisi okumaphakathi: izinga lokutholwa kweplatelet phakathi kuka-70-90%;(c) ukusebenza kahle kwedivayisi okuphansi: izinga lokutakula phakathi kuka-30-70% ;(d) Ukusebenza kahle kwemishini kuphansi kakhulu: izinga lokuthola kabusha lingaphansi kwama-30%.
3. Ukuhlanzeka kwe-PRP: Kuhlobene nokwakheka okuhlobene kwamaplatelet, amangqamuzana egazi amhlophe namaseli abomvu egazi ku-PRP.Siyichaza ngokuthi (a) i-PRP ehlanzekile kakhulu: > ama-platelet angu-90% ahlobene nama-erythrocytes nama-leukocyte ku-PRP;(b) i-PRP ehlanzekile: i-70-90% platelet;(c) i-PRP ene-heterogeneous: % platelets Phakathi kuka-30-70%;(d) I-PRP yegazi lonke: iphesenti lamaplatelet ku-PRP lingaphansi kwama-30%.
4. Inqubo yokwenza kusebenze: noma ukwenza ama-platelet asebenze anezici ze-exogenous coagulation, njenge-autologous thrombin noma i-calcium chloride.
(Okuqukethwe yile ndatshana kukhiqizwa kabusha.)
Isikhathi sokuthumela: May-16-2022