Platelet nplua nuj plasma (PRP) yog siv dav hauv orthopedics, tab sis tseem muaj kev sib cav sib ceg.Yog li ntawd, German "Clinical Tissue Regeneration Working Group" ntawm German Orthopedics thiab Trauma Society tau ua ib daim ntawv ntsuam xyuas kom ncav cuag qhov kev pom zoo ntawm qhov kev kho mob tam sim no ntawm PRP.
Kev kho mob PRP daim ntawv thov raug suav hais tias muaj txiaj ntsig (89%) thiab tej zaum yuav tseem ceeb dua yav tom ntej (90%).Feem ntau cov lus qhia yog kab mob leeg (77%), osteoarthritis (OA) (68%), nqaij raug mob (57%), thiab pob txha mos (51%).Kev pom zoo tau mus txog hauv nqe lus ntawm 16/31.Daim ntawv thov ntawm PRP nyob rau hauv lub hauv caug osteoarthritis thaum ntxov (Kellgren Lawrence II) yog suav hais tias muaj txiaj ntsig zoo, nrog rau cov kab mob hnyav thiab mob ntev.Rau cov mob ntev (mob pob txha, leeg), ntau qhov kev txhaj tshuaj (2-4) yog qhov pom zoo tshaj li kev txhaj tshuaj ib zaug.Txawm li cas los xij, tsis muaj cov ntaub ntawv txaus ntawm lub sijhawm luv ntawm kev txhaj tshuaj.Nws raug pom zoo kom ua tus qauv kev npaj, daim ntawv thov, zaus, thiab kev txiav txim siab ntawm kev qhia rau PRP.
Platelet nplua nuj plasma (PRP) yog dav siv nyob rau hauv cov tshuaj regenerative, tshwj xeeb tshaj yog nyob rau hauv orthopedic kis las tshuaj.Cov kev tshawb fawb tseem ceeb tau pom tias PRP muaj txiaj ntsig zoo rau ntau lub hlwb musculoskeletal, xws li chondrocytes, leeg hlwb, lossis cov leeg nqaij, ob leeg hauv vitro thiab hauv vivo.Txawm li cas los xij, qhov zoo ntawm cov ntaub ntawv uas twb muaj lawm tseem txwv, suav nrog kev tshawb fawb yooj yim thiab kev tshawb fawb soj ntsuam.Yog li ntawd, hauv kev tshawb fawb soj ntsuam, cov txiaj ntsig tsis zoo li kev tshawb fawb txog kev tshawb fawb.
Muaj ntau yam ua tau.Ua ntej, ntau txoj kev npaj (tam sim no tshaj 25 qhov sib txawv ntawm cov khoom lag luam) muaj nyob rau kom tau txais cov platelet los ntawm kev loj hlob, tab sis cov khoom PRP zaum kawg yog tsim los ntawm lawv cov khoom sib txawv thiab lawv cov kev mob siab rau.Piv txwv li, kev npaj PRP sib txawv muaj qhov sib txawv ntawm kev sib koom ua ke chondrocytes.Tsis tas li ntawd, vim qhov tseeb tias tsis muaj qhov tseem ceeb xws li cov ntshav muaj pes tsawg leeg (cov ntshav liab, cov qe ntshav dawb, thiab cov platelets) tseem tsis tau tshaj tawm hauv txhua txoj kev tshawb fawb, cov qauv qhia txog cov xwm txheej no yog qhov xav tau sai.Cov khoom PRP kawg kuj tseem muaj qhov sib txawv ntawm tus kheej.Dab tsi cuam tshuam qhov teeb meem yog tias qhov ntau npaum li cas, lub sijhawm, thiab ntau npaum li cas ntawm PRP daim ntawv thov tsis tau ua qauv, thiab tsis tau kawm tag nrho hauv kev tshawb fawb txog kev tshawb fawb.Hauv qhov no, qhov kev thov rau cov qauv tsim qauv ntawm platelet derived qhov kev loj hlob yog qhov tseeb, uas yuav tso cai rau cov qauv kev tshawb fawb ntawm cov teebmeem ntawm cov kev sib txawv xws li PRP formulation, PRP txhaj ntim, thiab lub sijhawm txhaj tshuaj.Tsis tas li ntawd, kev siv cov kev faib tawm los piav qhia zoo dua PRP cov khoom siv yuav tsum yog qhov yuav tsum tau ua.Qee tus kws sau ntawv tau npaj cov txheej txheem sib txawv, suav nrog Mishra (platelet suav, muaj cov qe ntshav dawb, ua kom) thiab Dohan Ellenfest (platelet suav, suav ntshav dawb, muaj fibrinogen), Delong (P latelet suav, ntsia thawv qhib, w ^ Haide cov ntshav suav; PAW kev faib tawm) thiab Mautner (Platelet suav, muaj cov eukocyte loj, muaj cov qe ntshav R sau npe, thiab siv cov ntsia hlau ua kom; PLRA kev faib tawm) . Magalon li al.Txoj kev npaj DEPA kev faib tawm suav nrog kev txhaj tshuaj platelet OSE, kev ua haujlwm ntau lawm, PRP kev ruaj ntseg, thiab nws qhov ua kom.Harrison et al.Lwm cov txheej txheem kev faib tawm tau raug luam tawm, suav nrog cov txheej txheem ua kom siv, tag nrho cov ntim siv, kev tswj hwm zaus thiab subcategories qhib, platelet concentration thiab npaj cov txheej txheem, nrog rau tag nrho qhov nruab nrab suav thiab ntau yam (tsawg siab) cov qe ntshav dawb suav (neutrophils, lymphocytes, thiab monocytes) rau platelets, qe ntshav liab, thiab kev faib tawm.Qhov kev faib tawm tshiab yog los ntawm Kon et al.Raws li cov kws tshaj lij pom zoo, qhov tseem ceeb tshaj plaws tau piav qhia yog platelet muaj pes tsawg leeg (platelet concentration thiab concentration ratio), purity (muaj cov qe ntshav liab / qe ntshav dawb), thiab ua kom muaj zog (endogenous / exogenous, calcium ntxiv).
Kev siv ntau qhov ntsuas rau PRP tau tham dav dav, xws li qhov tseeb tias kev kho mob ntawm cov leeg nqaij tau piav qhia hauv cov kev tshawb fawb soj ntsuam txog ntau qhov chaw [nrog cov txiaj ntsig zoo thiab tsis zoo sib xws].Yog li ntawd, feem ntau nws tsis yooj yim sua kom tau txais cov pov thawj tseeb los ntawm cov ntaub ntawv.Qhov no kuj ua rau nws nyuaj rau PRP txoj kev kho kom suav nrog ntau yam kev qhia.Vim muaj ntau qhov teeb meem tsis daws teeb meem nyob ib puag ncig kev siv PRP, lub hauv paus ntsiab lus ntawm tsab xov xwm no yog los nthuav tawm cov kev xav ntawm cov kws tshaj lij los ntawm German "Clinical Tissue Regeneration Working Group" ntawm German Orthopedics thiab Trauma Society (DGOU) ntawm kev siv thiab yav tom ntej. ntawm PRP.
Txoj kev
Lub German "Clinical Tissue Regeneration Working Group" yog tsim los ntawm 95 tus tswv cuab, txhua tus tshwj xeeb hauv kev phais orthopedic thiab kho cov nqaij mos (txhua tus kws kho mob lossis kws kho mob, tsis muaj kws kho mob lub cev lossis cov kws tshawb fawb qoj ib ce).Ib pawg neeg ua haujlwm uas muaj 5 tus neeg (qhov muag tsis pom kev) yog lub luag haujlwm los txhawb kev tshawb nrhiav.Tom qab tshuaj xyuas cov ntaub ntawv uas twb muaj lawm, pawg neeg ua haujlwm tau npaj cov ntaub ntawv muaj peev xwm uas tuaj yeem suav nrog hauv thawj qhov kev tshawb nrhiav.Thawj qhov kev tshawb fawb tau ua nyob rau lub Plaub Hlis 2018, suav nrog 13 cov lus nug thiab feem ntau ntawm daim ntawv thov PRP, suav nrog cov lus nug kaw thiab qhib, thiab txhawb cov kws tshaj lij los tawm tswv yim ntxiv lossis hloov kho.Raws li cov lus teb no, ib qho kev tshawb fawb thib ob tau tsim thiab ua nyob rau lub Kaum Ib Hlis 2018, nrog rau tag nrho 31 cov lus nug xaus rau hauv 5 pawg sib txawv: cov lus qhia rau pob txha mos thiab pob txha caj qaum (OA), cov lus qhia rau cov leeg pathology, cov lus qhia rau cov leeg mob. , daim ntawv thov ntawm PRP, thiab cov chaw tshawb fawb yav tom ntej.
Los ntawm kev soj ntsuam online (Survey Monkey, USA), tau txais kev pom zoo los tso cai rau cov neeg teb kom ntsuas seb qhov project yuav tsum suav nrog qhov tsawg kawg nkaus kev qhia yuav tsum tau ua, thiab muab tsib qhov ua tau cov lus teb rau ntawm Likert: 'Zoo pom zoo';Pom zoo;Tsis pom zoo los yog tawm tsam;Tsis pom zoo los yog tsis pom zoo.Qhov kev tshawb fawb tau sim los ntawm peb tus kws tshaj lij ntawm lub ntsej muag siv tau, kev nkag siab thiab kev lees paub, thiab cov txiaj ntsig tau hloov kho me ntsis.Hauv thawj puag ncig, tag nrho ntawm 65 tus kws tshaj lij tau koom nrog, thaum nyob rau hauv qhov thib ob, tag nrho ntawm 40 tus kws tshaj lij tau koom.Rau qhov kev pom zoo thib ob, lub ntsiab lus tseem ceeb hais tias yog tias ntau dua 75% ntawm cov neeg teb pom zoo, qhov project yuav raug suav nrog hauv daim ntawv pom zoo zaum kawg, thiab tsawg dua 20% ntawm cov neeg teb tsis pom zoo.75% ntawm cov neeg koom pom zoo tias nws yog qhov kev txiav txim siab pom zoo tshaj plaws, uas tau siv hauv peb txoj kev tshawb fawb.
Kev tshwm sim
Hauv thawj puag ncig, 89% ntawm cov neeg tau teb tias daim ntawv thov PRP muaj txiaj ntsig, thiab 90% ntawm cov neeg ntseeg tias PRP yuav tseem ceeb dua yav tom ntej.Cov tswv cuab feem ntau tau paub txog kev tshawb fawb thiab kev tshawb fawb soj ntsuam, tab sis tsuas yog 58% ntawm cov tswv cuab siv PRP hauv lawv cov kev xyaum txhua hnub.Feem ntau yog vim li cas tsis siv PRP yog qhov tsis muaj ib puag ncig tsim nyog, xws li tsev kho mob hauv tsev kawm qib siab (41%), kim (19%), siv sijhawm (19%), lossis tsis muaj pov thawj scientific (33%).Cov kev qhia feem ntau rau kev siv PRP yog cov kab mob leeg (77%), OA (68%), cov leeg raug mob (57%), thiab pob txha mos (51%), uas yog lub hauv paus rau kev tshawb nrhiav thib ob.Cov lus qhia rau kev siv PRP tshwm sim ua ke nrog 18% kho pob txha mos thiab 32% kho cov leeg.Lwm qhov qhia tau pom hauv 14%.Tsuas yog 9% ntawm cov neeg tau hais tias PRP tsis siv tshuaj kho mob.PRP txhaj yog qee zaum siv ua ke nrog hyaluronic acid (11%).Ntxiv rau PRP, cov kws tshaj lij kuj tau txhaj tshuaj loog hauv zos (65%), cortisone (72%), hyaluronic acid (84%), thiab Traumel / Zeel (28%).Tsis tas li ntawd, cov kws tshaj lij tau hais txog qhov xav tau kev tshawb fawb soj ntsuam ntau ntxiv ntawm daim ntawv thov PRP (76%) thiab xav tau kev tsim qauv zoo dua (formulation 70%, indications 56%, timeing 53%, injection zaus 53%).Yog xav paub ntxiv txog thawj puag ncig, thov xa mus rau daim ntawv txuas ntxiv.Cov kws tshaj lij tau hais tias yuav tsum muaj kev tshawb fawb soj ntsuam ntau ntxiv ntawm daim ntawv thov PRP (76%), thiab kev ua kom zoo dua qub yuav tsum tau ua tiav (formulation 70%, qhia 56%, sij hawm 53%, txhaj tshuaj zaus 53%).Yog xav paub ntxiv txog thawj puag ncig, thov xa mus rau daim ntawv txuas ntxiv.Cov kws tshaj lij tau hais tias yuav tsum muaj kev tshawb fawb soj ntsuam ntau ntxiv ntawm daim ntawv thov PRP (76%), thiab kev ua kom zoo dua qub yuav tsum tau ua tiav (formulation 70%, qhia 56%, sij hawm 53%, txhaj tshuaj zaus 53%).
Raws li cov lus teb no, qhov thib ob tsom mus rau lub ntsiab lus uas nyiam tshaj plaws.Kev pom zoo tau mus txog hauv nqe lus ntawm 16/31.Nws kuj qhia tau hais tias thaj chaw uas tsis muaj kev pom zoo tsawg dua, tshwj xeeb tshaj yog nyob rau hauv cov lus qhia.Cov neeg feem ntau pom zoo (92%) tias muaj qhov sib txawv tseem ceeb hauv ntau qhov kev qhia ntawm PRP daim ntawv thov (xws li OA, kab mob leeg, mob nqaij, thiab lwm yam).
[Daim ntawv qhia oblique bar sawv cev rau qhov sib faib ntawm qib pom zoo nyob rau hauv qhov kev ntsuam xyuas thib ob (31 nqe lus nug (Q1 - Q31)), uas qhia tau zoo txog qhov tsis pom zoo.
Lub bar nyob rau sab laug ntawm Y-axis qhia txog kev tsis pom zoo, thaum lub bar ntawm sab xis qhia txog kev pom zoo.Feem ntau qhov kev tsis pom zoo tshwm sim hauv thaj chaw ntawm kev qhia.]
Indications rau pob txha mos raug mob thiab OA
Muaj kev pom zoo dav dav (77.5%) tias PRP tuaj yeem siv rau thaum ntxov hauv caug osteoarthritis [Kellgren Lawrence (KL) Qib II].Rau kev raug mob pob txha mos tsawg dua (KL Qib I) thiab theem hnyav dua (KL Qib III thiab IV), tseem tsis tau muaj kev pom zoo rau kev siv PRP thaum lub sij hawm lossis tom qab phais pob txha mos, txawm tias 67.5% ntawm cov kws tshaj lij ntseeg tias qhov no yog qhov kev cog lus. .
Indications rau cov leeg nqaij
Hauv kev tshawb fawb, cov kws tshaj lij tau sawv cev rau feem coob (82.5% thiab 80%) tias kev siv PRP yog qhov tseem ceeb hauv cov kab mob hnyav thiab mob ntev.Nyob rau hauv cov ntaub ntawv ntawm rotator cuff kho, 50% ntawm cov kws txawj ntseeg hais tias intraoperative daim ntawv thov ntawm PRP tej zaum yuav pab tau, tab sis 17.5% ntawm cov kws txawj tuav lub tswv yim sib txawv.Ib tus lej zoo sib xws ntawm cov kws tshaj lij (57.5%) ntseeg tias PRP muaj lub luag haujlwm zoo hauv kev kho mob tom qab phais mob.
Qhia txog kev raug mob ntawm cov leeg
Tab sis tsis muaj kev pom zoo pom zoo ntawm kev siv PRP rau kev kho mob ntawm cov leeg mob lossis mob ntev (xws li ntau dua 75% kev pom zoo).
Cov tswv yim zoo ntawm PRP Daim Ntawv Thov
Muaj peb nqe lus uas tuaj yeem pom zoo raws li:
(1) Cov kab mob ntev yuav tsum tau txhaj tshuaj PRP ntau dua
(2) Cov ntaub ntawv tsis txaus ntawm lub sijhawm zoo tshaj plaws ntawm kev txhaj tshuaj (tsis muaj kev pom zoo pom nyob rau hauv ib lub lim tiam)
(3) Qhov sib txawv ntawm cov qauv PRP sib txawv tuaj yeem ua lub luag haujlwm tseem ceeb hauv lawv cov teebmeem lom neeg
Cov cheeb tsam tshawb fawb yav tom ntej
PRP ntau lawm yuav tsum ua kom zoo dua tus qauv (95% sib xws) thiab nws daim ntawv thov kev kho mob (xws li kev txhaj tshuaj ntau zaus, lub sijhawm thov, kev tshuaj ntsuam xyuas).Txawm hais tias nyob hauv thaj chaw xws li OA kev kho mob uas tau tshaj tawm cov ntaub ntawv kho mob zoo, cov tswv cuab kws tshaj lij ntseeg tias tseem muaj qhov xav tau zoo rau kev tshawb fawb txog kev tshawb fawb thiab kev kho mob ntau dua.Qhov no kuj siv tau rau lwm qhov kev qhia.
Sib tham
Cov txiaj ntsig kev tshawb fawb qhia tau hais tias tseem muaj kev sib cav txog kev siv PRP hauv orthopedics, txawm nyob hauv pab pawg kws tshaj lij hauv tebchaws.Tawm ntawm 31 cov lus hais, tsuas yog 16 tau mus txog qhov kev pom zoo.Muaj qhov kev pom zoo loj tshaj plaws hauv kev tshawb fawb yav tom ntej, qhia txog qhov xav tau muaj zog los tsim cov pov thawj nthuav dav los ntawm kev ua ntau yam kev tshawb fawb yav tom ntej.Hauv qhov no, kev ntsuam xyuas tseem ceeb ntawm cov pov thawj muaj los ntawm cov kws tshaj lij ua haujlwm yog ib txoj hauv kev los txhim kho kev paub txog kev kho mob.
Indications rau OA thiab pob txha raug mob
Raws li cov ntaub ntawv tam sim no, PRP tej zaum yuav haum rau OA thaum ntxov thiab nruab nrab.Cov pov thawj tsis ntev los no qhia tias kev txhaj tshuaj intra-articular ntawm PRP tuaj yeem txhim kho cov tsos mob ntawm tus neeg mob txawm tias qhov kev puas tsuaj ntawm pob txha mos, tab sis feem ntau tsis muaj kev tshuaj xyuas pawg zoo raws li Kellgren thiab Lawrence kev faib tawm.Hauv qhov no, vim muaj cov ntaub ntawv tsis txaus, cov kws tshaj lij tam sim no tsis pom zoo siv PRP rau KL qib 4. PRP kuj tseem muaj peev xwm txhim kho lub hauv caug ua haujlwm, muaj peev xwm los ntawm kev txo qis cov tshuaj tiv thaiv kab mob thiab ua rau cov txheej txheem degenerative remodeling ntawm pob txha pob txha.PRP feem ntau ua tiav cov txiaj ntsig zoo hauv cov txiv neej, hluas, cov neeg mob uas muaj cov pob txha mos thiab lub cev qhov ntsuas (BMI).
Thaum txhais cov ntaub ntawv kho mob luam tawm, qhov sib xyaw ntawm PRP zoo li yog qhov tseem ceeb.Vim muaj cov nyhuv cytotoxic ntawm plasma nplua nuj nyob rau hauv cov qe ntshav dawb ntawm synovial hlwb hauv vitro, LP-PRP feem ntau pom zoo rau daim ntawv thov intra articular.Hauv kev tshawb fawb tsis ntev los no, cov teebmeem ntawm cov qe ntshav dawb (LP) thiab cov qe ntshav dawb nplua nuj (LR) PRP ntawm kev loj hlob ntawm OA tau muab piv rau tus qauv nas tom qab meniscectomy.LP-PRP tau pom qhov ua tau zoo tshaj plaws hauv kev khaws cov pob txha pob txha piv rau LR-PRP.Kev tshawb xyuas meta-kev soj ntsuam tsis ntev los no ntawm randomized tswj kev sim tau pom tias PRP tau txais txiaj ntsig zoo dua piv rau hyaluronic acid (HA), thiab kev soj ntsuam pab pawg tau pom tias LP-PRP tau txais txiaj ntsig zoo dua li LR-PRP.Txawm li cas los xij, tsis muaj qhov sib piv ncaj qha ntawm LR - thiab LP-PRP, ua rau kev tshawb fawb ntxiv.Qhov tseeb, txoj kev tshawb fawb loj tshaj plaws piv rau LR-PRP nrog HA qhia tau hais tias LR-PRP tsis muaj qhov tsis zoo.Tsis tas li ntawd, kev tshawb fawb soj ntsuam sib piv LR-PRP thiab LP-PRP ncaj qha tsis pom qhov sib txawv hauv cov txiaj ntsig tom qab 12 lub hlis.LR-PRP muaj ntau dua pro-inflammatory molecules thiab ntau dua ntawm kev loj hlob yam tseem ceeb, tab sis kuj muaj ntau dua concentrations ntawm anti-inflammatory cytokines, xws li interleukin-1 receptor antagonists (IL1-Ra).Cov kev tshawb fawb tsis ntev los no tau piav qhia txog cov txheej txheem "inflammatory regeneration" ntawm cov qe ntshav dawb secreting pro-inflammatory thiab anti-inflammatory cytokines, uas qhia tau hais tias muaj kev cuam tshuam zoo rau cov ntaub so ntswg regeneration.Cov kev tshawb fawb soj ntsuam ntxiv nrog rau cov qauv tsim qauv tsim nyog yog tsim nyog los txiav txim siab qhov kev tsim khoom zoo tshaj plaws los yog PRP formulation muaj pes tsawg leeg thiab cov ntawv thov zoo tshaj plaws hauv OA.
Yog li, qee qhov qhia tias HA thiab PRP yuav yog txoj hauv kev zoo tshaj plaws rau cov neeg mob uas muaj OA me me thiab BMI qis.Cov kev ntsuam xyuas tsis ntev los no tau pom tias PRP muaj cov txiaj ntsig kho tau zoo dua piv rau HA.Txawm li cas los xij, cov ntsiab lus qhib kev sib koom ua ke suav nrog qhov xav tau rau kev npaj PRP tus qauv, daim ntawv thov tus nqi, thiab qhov xav tau rau kev sim tshuaj ntsuam xyuas ntxiv nrog cov dej zoo.Yog li, tam sim no cov lus pom zoo thiab cov lus qhia feem ntau tsis tuaj yeem txhawb lossis tawm tsam kev siv lub hauv caug osteoarthritis.Hauv cov ntsiab lus, raws li cov pov thawj tam sim no, cov txheej txheem npaj sib txawv txwv tsis pub muaj kev hloov pauv siab, thiab PRP tuaj yeem ua rau muaj kev txhim kho mob me me mus rau nruab nrab OA.Pawg kws tshaj lij tsis pom zoo siv PRP hauv OA qhov xwm txheej hnyav.Cov kev tshawb fawb tsis ntev los no tau pom tias PRP kuj tseem txhawb nqa cov txiaj ntsig ntawm cov placebo, tshwj xeeb tshaj yog hauv kev kho OA lossis lateral Epicondylitis.Kev txhaj tshuaj PRP tsuas yog ib feem ntawm kev kho mob tag nrho los daws cov teeb meem lom neeg ntawm OA.Ntxiv nrog rau lwm yam tseem ceeb xws li kev poob phaus, kho qhov dislocations, kev cob qhia cov leeg nqaij, thiab lub hauv caug pads, nws tuaj yeem pab txo qhov mob thiab ua rau muaj txiaj ntsig zoo rau cov neeg mob.
Lub luag haujlwm ntawm PRP hauv kev phais pob txha mos yog lwm qhov kev sib cav dav dav.Txawm hais tias cov kev tshawb fawb tseem ceeb tau pom tias muaj kev cuam tshuam zoo rau chondrocytes, cov ntaub ntawv pov thawj kev kho mob rau kev siv PRP thaum lub sij hawm phais, pob txha mos rov tsim dua tshiab, lossis cov theem kev kho mob tseem tsis txaus, qhia txog peb qhov kev tshawb pom.Tsis tas li ntawd, lub sijhawm zoo rau kev kho mob tom qab PRP tseem tsis paub meej.Tab sis feem ntau cov kws tshaj lij pom zoo tias PRP tuaj yeem pab txhawb kev tsim cov pob txha mos.Hauv cov ntsiab lus, cov txiaj ntsig tam sim no ntawm kev txiav txim siab tseem ceeb qhia tau tias kev ntsuam xyuas ntxiv ntawm PRP lub luag haujlwm tseem ceeb hauv kev phais pob txha mos yog tsim nyog.
Indications rau cov leeg nqaij
Kev siv PRP rau kev kho mob tendinosis yog ib lub ntsiab lus tsis sib haum xeeb hauv cov ntaub ntawv.Kev tshuaj xyuas ntawm cov kev tshawb fawb tseem ceeb qhia tau hais tias PRP muaj cov txiaj ntsig zoo hauv vitro (xws li ua kom cov leeg nqaij ntawm tes proliferation, txhawb cov teebmeem anabolic, xws li nce collagen ntau lawm) thiab hauv vivo (nce tendon kho).Hauv kev xyaum kho mob, ntau cov kev tshawb fawb tau pom tias kev kho PRP muaj qhov zoo thiab tsis muaj kev cuam tshuam rau ntau yam kab mob hnyav thiab mob ntev.Piv txwv li, kev tshuaj xyuas tsis ntev los no tau hais txog cov txiaj ntsig tsis sib haum xeeb ntawm PRP daim ntawv thov nyob rau hauv cov kab mob sib txawv, feem ntau muaj kev cuam tshuam zoo rau ntawm lub luj tshib sab nraub qaum thiab patellar tendon lesions, tab sis tsis yog ntawm Achilles tendon lossis rotator cuff lesions.Feem ntau ntawm cov ntaub ntawv phais RCT tsis muaj txiaj ntsig zoo, thiab tseem tsis muaj pov thawj tseeb ntawm nws daim ntawv thov kev saib xyuas hauv cov kab mob rotator cuff.Rau sab nraud Epicondylitis, qhov kev tshuaj ntsuam meta tam sim no qhia tau hais tias corticosteroids muaj cov txiaj ntsig zoo rau lub sijhawm luv luv, tab sis lub sijhawm ntev ntawm PRP zoo dua.Raws li cov pov thawj tam sim no, patellar thiab lateral luj tshib tendinosis tau pom tias muaj kev txhim kho tom qab kev kho PRP, thaum Achilles tendon thiab rotator cuff tsis zoo li tau txais txiaj ntsig los ntawm PRP daim ntawv thov.Yog li, qhov kev pom zoo tsis ntev los no los ntawm ESSKA Basic Science Committee tau xaus lus tias tam sim no tsis muaj kev pom zoo rau kev siv PRP rau kev kho mob tendinosis.Txawm hais tias muaj kev tsis sib haum xeeb hauv cov ntaub ntawv, raws li tau pom los ntawm kev tshawb fawb tsis ntev los no thiab kev ntsuam xyuas zoo, PRP muaj lub luag haujlwm zoo hauv kev kho cov kab mob leeg los ntawm ob qho tib si kev tshawb fawb thiab kev soj ntsuam.Tshwj xeeb tshaj yog xav txog cov kev mob tshwm sim ntawm corticosteroids thaum siv cov kab mob leeg.Cov txiaj ntsig ntawm qhov kev tshawb fawb no qhia tias lub teb chaws Yelemees qhov kev pom tam sim no yog PRP tuaj yeem siv los kho cov kab mob sib kis thiab mob ntev.
Qhia txog kev raug mob ntawm cov leeg
Ntau qhov kev tsis sib haum xeeb yog kev siv PRP los kho cov leeg nqaij, uas yog ib qho kev raug mob ntau tshaj plaws hauv kev ua kis las, uas ua rau kwv yees li 30% ntawm cov hnub tawm haujlwm.PRP muab txoj hauv kev los txhim kho kev kho mob lom neeg thiab ua kom rov qab ua kom lub cev muaj zog, uas tau txais kev saib xyuas ntau ntxiv hauv ob peb xyoos dhau los.Txawm hais tias 57% ntawm cov lus teb tau muab nyob rau hauv thawj puag ncig tau teev cov leeg nqaij raug mob raws li qhov qhia tau zoo tshaj plaws rau kev siv PRP, tseem tsis muaj kev tshawb fawb keeb kwm yav dhau los.Ntau qhov kev tshawb fawb hauv vitro tau pom cov txiaj ntsig zoo ntawm PRP hauv cov leeg nqaij.Kev ua kom nrawm ntawm satellite xov tooj ntawm tes, nce hauv txoj kab uas hla ntawm fibril, stimulation ntawm myogenesis, thiab nce kev ua haujlwm ntawm MyoD thiab myostatin tau kuaj pom zoo.Cov ntaub ntawv ntxiv txog Mazoka et al.Kev nce ntxiv ntawm cov ntsiab lus ntawm kev loj hlob xws li HGF, FGF, thiab EGF tau pom hauv PRP-LP.Tsai et al.hais txog cov kev tshawb pom no.Ntxiv nrog rau kev ua pov thawj ntawm cov protein ntau ntxiv ntawm cyclin A2, cyclin B1, cdk2 thiab PCNA, nws tau ua pov thawj tias cov leeg nqaij pob txha muaj zog thiab cell proliferation tau nce los ntawm kev hloov cov hlwb los ntawm G1 theem mus rau S1 thiab G2&M theem.Kev tshuaj xyuas tsis ntev los no tau sau tseg cov keeb kwm kev tshawb fawb tam sim no raws li hauv qab no: (1) Hauv ntau cov kev tshawb fawb, PRP kev kho mob tau nce cov leeg ntawm tes, kev loj hlob ntawm kev nthuav qhia (xws li PDGF-A / B thiab VEGF), kev nrhiav cov qe ntshav dawb, thiab angiogenesis hauv cov leeg. piv rau pawg tswj cov qauv;(2) PRP npaj thev naus laus zis tseem tsis sib xws hauv kev tshawb fawb ntawm cov ntaub ntawv tshawb fawb yooj yim;(3) Cov ntaub ntawv pov thawj los ntawm kev tshawb fawb txog kev tshawb fawb hauv vitro thiab hauv vivo qhia tias PRP tuaj yeem ua txoj kev kho mob zoo uas tuaj yeem ua kom cov txheej txheem kho mob ntawm cov leeg nqaij piv rau pawg tswj hwm, raws li kev pom zoo ntawm cov cellular thiab cov ntaub so ntswg hauv qib. pawg kho mob.
Txawm hais tias kev tshawb fawb rov qab piav qhia txog kev kho kom zoo thiab txiav txim siab tias lub sijhawm tawm ntawm qhov chaw tsis muaj qhov zoo dua, Bubnov li al.Hauv kev tshawb fawb ntawm 30 tus neeg ncaws pob, nws tau pom tias qhov mob tau txo qis thiab qhov ceev ntawm kev rov qab los ntawm kev sib tw tau nrawm heev.Hamid et al.Hauv kev sim ntsuas randomized (RCT) piv rau PRP infiltration nrog kev saib xyuas kev noj qab haus huv, tau piav qhia sai dua los ntawm kev sib tw.Qhov tsuas yog ob chav dig muag multicenter RCT suav nrog hamstring raug mob hauv cov neeg ncaws pob (n = 80), thiab tsis muaj cov placebo infiltration tseem ceeb tau pom zoo piv rau PRP.Cov ntsiab lus cog lus lom neeg, kev tshawb pom zoo preclinical, thiab kev ua tiav kev kho mob thaum ntxov nrog PRP txhaj tshuaj tau hais los saum toj no tsis tau lees paub los ntawm qib siab RCT tsis ntev los no.Qhov kev pom zoo tam sim no ntawm GOTS cov tswv cuab tau soj ntsuam cov kev kho mob rau cov leeg nqaij thiab xaus lus tias tam sim no tsis muaj pov thawj tseeb tias kev txhaj tshuaj intramuscular tuaj yeem siv los kho cov leeg mob.Qhov no yog raws li peb cov txiaj ntsig, thiab tsis muaj kev pom zoo rau kev siv PRP hauv kev kho mob ntawm cov leeg nqaij.Kev tshawb fawb ntxiv yog xav tau ceev nrooj ntawm koob tshuaj, sijhawm, thiab zaus ntawm PRP hauv cov leeg nqaij.Piv nrog rau cov pob txha mos raug mob, nyob rau hauv cov leeg mob, kev siv cov txheej txheem kev kho mob, tshwj xeeb tshaj yog PRP, tej zaum yuav muaj feem xyuam rau qib thiab lub sij hawm ntawm qhov raug mob, qhov txawv ntawm qhov kev koom tes ntawm cov leeg raug mob txoj kab uas hla thiab cov leeg raug mob los yog avulsion raug mob.
Daim ntawv thov teb ntawm PRP yog ib qho ntawm cov kev sib tham nquag tshaj plaws, thiab qhov tsis muaj kev tsim qauv tam sim no yog ib qho teeb meem tseem ceeb hauv kev sim tshuaj.Feem ntau cov kws tshaj lij tsis tau pom muaj kev nce ntxiv hauv kev siv PRP, txawm li cas los xij, qee qhov kev tshawb fawb tau pom tias kev siv ntxiv ntawm hyaluronic acid tuaj yeem muab piv rau ib qho kev siv PRP rau OA.Qhov kev pom zoo yog tias ntau qhov kev txhaj tshuaj yuav tsum tau muab rau cov kab mob ntev, thiab OA teb txhawb cov lus pom zoo no, qhov twg ntau qhov kev txhaj tshuaj zoo dua li kev txhaj tshuaj ib zaug.Kev tshawb fawb txog kev tshawb fawb tseem ceeb yog tshawb nrhiav kev sib raug zoo ntawm koob tshuaj PRP, tab sis cov txiaj ntsig no tseem yuav tsum tau xa mus rau kev tshawb fawb soj ntsuam.Qhov zoo tshaj plaws concentration ntawm PRP tseem tsis tau txiav txim siab, thiab kev tshawb fawb tau pom tias cov concentration ntau dua yuav muaj qhov tsis zoo.Ib yam li ntawd, qhov cuam tshuam ntawm cov qe ntshav dawb nyob ntawm qhov qhia, thiab qee qhov kev qhia xav tau PRP nrog cov qe ntshav dawb tsis zoo.Qhov sib txawv ntawm tus kheej PRP muaj pes tsawg leeg ua lub luag haujlwm tseem ceeb hauv kev cuam tshuam ntawm PRP.
Cov cheeb tsam tshawb fawb yav tom ntej
Nws yog ib qho kev pom zoo tias raws li kev tshaj tawm tsis ntev los no, kev tshawb fawb ntxiv ntawm PRP yog qhov tsim nyog rau yav tom ntej.Ib qho ntawm cov teeb meem tseem ceeb yog PRP formulations yuav tsum zoo dua tus qauv (nrog 95% sib xws).Ib qho kev ua tau zoo ntawm kev ua tiav lub hom phiaj no yuav yog kev sib sau ntawm cov platelets kom ua tiav cov ntim loj, uas yog tus qauv ntau dua.Tsis tas li ntawd, ntau yam tsis paub txog kev siv tshuaj kho mob tsis paub, xws li yuav tsum tau siv ntau npaum li cas txhaj tshuaj, lub sijhawm ntawm kev txhaj tshuaj, thiab ntau npaum li cas ntawm PRP.Tsuas yog nyob rau hauv txoj kev no nws tuaj yeem ua tau los ua kev tshawb fawb qib siab thiab ntsuas qhov ntsuas twg yog qhov tsim nyog tshaj plaws rau kev siv PRP, ua cov kev tshawb fawb txog kev tshawb fawb thiab kev kho mob, zoo dua randomized tswj kev tshawb fawb, tsim nyog.Txawm hais tias kev pom zoo tau mus txog tias PRP tuaj yeem ua lub luag haujlwm tseem ceeb hauv lub neej yav tom ntej, nws zoo li xav tau kev sim thiab tshuaj ntsuam xyuas ntxiv tam sim no.
Txoj kev cia siab
Ib qho kev txwv ntawm qhov kev tshawb fawb no sim los hais txog lub ntsiab lus sib cav dav dav ntawm PRP daim ntawv thov yog nws cov yam ntxwv ntawm haiv neeg.Qhov muaj ntawm PRP thiab lub teb chaws qhov sib txawv ntawm kev them nyiaj rov qab tuaj yeem cuam tshuam cov txiaj ntsig thiab kev tswj hwm.Tsis tas li ntawd, kev pom zoo tsis yog kev qhuab qhia ntau yam thiab tsuas yog suav nrog kev xav ntawm cov kws kho mob orthopedic.Txawm li cas los xij, qhov no kuj tseem pom tau tias yog qhov zoo dua vim tias nws tsuas yog pab pawg siv zog thiab saib xyuas PRP kev txhaj tshuaj.Tsis tas li ntawd, qhov kev tshawb fawb tau ua muaj cov txheej txheem sib txawv zoo piv rau cov txheej txheem Delphi nruj heev.Qhov kom zoo dua yog qhov kev pom zoo tsim los ntawm ib pab pawg kws kho mob orthopedic nrog kev paub dav dav hauv lawv cov haujlwm los ntawm kev xav ntawm kev tshawb fawb thiab kev kho mob.
Kev pom zoo
Raws li kev pom zoo ntawm tsawg kawg 75% ntawm cov kws tshaj lij koom nrog, ncav cuag qhov kev pom zoo ntawm cov ntsiab lus hauv qab no:
OA thiab pob txha raug mob: Daim ntawv thov ntawm lub hauv caug osteoarthritis (KL II qib) yuav pab tau
Tendon pathology: Daim ntawv thov ntawm cov kab mob hnyav thiab mob ntev yuav pab tau
Cov tswv yim tswv yim: Rau cov kab mob ntev (mob pob txha, leeg), ntau qhov kev txhaj tshuaj (2-4) ntawm ib ntus yog qhov xav tau ntau dua li kev txhaj tshuaj ib zaug.
Txawm li cas los xij, muaj cov ntaub ntawv tsis txaus ntawm lub sijhawm luv ntawm kev txhaj tshuaj ib zaug.
Kev tshawb fawb yav tom ntej: Nws raug pom zoo kom ua qauv tsim, npaj, thov, zaus, thiab qhia ntau yam ntawm PRP.Kev tshawb fawb tseem ceeb thiab kho mob ntxiv yog tsim nyog.
Xaus
Qhov kev pom zoo dav dav yog tias muaj qhov sib txawv ntawm ntau qhov kev qhia ntawm PRP daim ntawv thov, thiab tseem muaj qhov tsis txaus ntseeg tseem ceeb hauv kev tsim qauv ntawm PRP txoj haujlwm nws tus kheej, tshwj xeeb tshaj yog rau cov cim sib txawv.Daim ntawv thov ntawm PRP nyob rau hauv lub hauv caug osteoarthritis thaum ntxov (KL qib II) thiab cov kab mob hnyav thiab mob ntev yuav pab tau.Rau qhov mob ntev (pob txha mos thiab cov leeg nqaij), ntu ntu ntau qhov kev txhaj tshuaj (2-4) yog qhov xav tau ntau dua li kev txhaj tshuaj ib zaug, tab sis muaj cov ntaub ntawv tsis txaus ntawm lub sijhawm luv ntawm kev txhaj tshuaj ib zaug.Ib qho teeb meem loj yog qhov sib txawv ntawm tus kheej PRP muaj pes tsawg leeg, uas ua lub luag haujlwm tseem ceeb hauv lub luag haujlwm ntawm PRP.Yog li ntawd, kev tsim cov PRP yuav tsum ua kom zoo dua tus qauv, nrog rau cov kev kuaj mob xws li kev txhaj tshuaj ntau zaus, thiab lub sijhawm ntawm kev txhaj tshuaj thiab cov lus qhia tseeb.Txawm hais tias OA, uas tam sim no sawv cev rau kev tshawb fawb zoo tshaj plaws rau PRP daim ntawv thov, xav tau kev tshawb fawb txog kev tshawb fawb thiab kev kho mob ntau dua, nrog rau lwm cov lus qhia.
(Cov ntsiab lus ntawm tsab xov xwm no tau luam tawm dua, thiab peb tsis muab ib qho kev qhia lossis kev lees paub rau qhov raug, kev ntseeg tau lossis ua tiav ntawm cov ntsiab lus muaj nyob rau hauv tsab xov xwm no, thiab tsis muaj lub luag haujlwm rau cov kev xav ntawm tsab xov xwm no, thov nkag siab.)
Post lub sij hawm: May-24-2023