Platelet rich plasma (PRP) amagwiritsidwa ntchito kwambiri m'mafupa, koma pakadali mkangano woopsa.Choncho, a German "Clinical Tissue Regeneration Working Group" a German Orthopedics and Trauma Society adachita kafukufuku kuti agwirizane ndi zomwe zilipo panopa za PRP.
Mapulogalamu ochiritsira a PRP amaonedwa kuti ndi othandiza (89%) ndipo angakhale ofunika kwambiri m'tsogolomu (90%).Zizindikiro zodziwika bwino ndi matenda a tendon (77%), osteoarthritis (OA) (68%), kuvulala kwa minofu (57%), ndi kuvulala kwa cartilage (51%).Chigwirizano chinafikiridwa m'mawu a 16/31.Kugwiritsiridwa ntchito kwa PRP kumayambiriro kwa mawondo osteoarthritis (Kellgren Lawrence II) kumaonedwa kuti kungakhale kothandiza, komanso matenda aakulu ndi aakulu a tendon.Kwa zotupa zosatha (cartilage, tendons), jakisoni angapo (2-4) ndioyenera kuposa jekeseni imodzi.Komabe, palibe deta yokwanira pa nthawi yapakati pakati pa jakisoni.Zimalimbikitsidwa kuti zikhazikitse kukonzekera, kugwiritsa ntchito, mafupipafupi, ndi kutsimikiza kwa zizindikiro za PRP.
Platelet rich plasma (PRP) imagwiritsidwa ntchito kwambiri pamankhwala obwezeretsanso, makamaka mumankhwala amasewera a mafupa.Kafukufuku woyambirira wa sayansi wasonyeza kuti PRP ili ndi zotsatira zabwino zambiri pa maselo ambiri a musculoskeletal system, monga chondrocytes, maselo a tendon, kapena maselo a minofu, onse mu vitro ndi mu vivo.Komabe, ubwino wa mabuku omwe alipo akadali ochepa, kuphatikizapo sayansi yofunikira komanso kafukufuku wachipatala.Chifukwa chake, pakufufuza kwachipatala, zotsatira zake sizabwino ngati kafukufuku woyambira wasayansi.
Pali zifukwa zambiri.Choyamba, njira zingapo zokonzekera (pakali pano pamitundu yosiyanasiyana ya 25 yomwe ikupezeka pamalonda) ilipo kuti ipeze zinthu zomwe zimachokera ku platelet, koma chomaliza cha PRP chimapangidwa ndi zolemba zawo zosawerengeka komanso khama lawo.Mwachitsanzo, njira zosiyanasiyana zokonzekera PRP zimasonyeza zotsatira zosiyana pa ma chondrocyte olowa.Kuphatikiza apo, chifukwa chakuti zinthu zofunika kwambiri monga momwe magazi amapangidwira (maselo ofiira a magazi, maselo oyera a magazi, ndi mapulateleti) sizinafotokozedwebe m’kafukufuku uliwonse, kupereka lipoti lokhazikika la zinthu zimenezi n’kofunika kwambiri.Chogulitsa chomaliza cha PRP chilinso ndi kusiyana kwakukulu kwapayekha.Chomwe chimasokoneza vutoli ndikuti mlingo, nthawi, ndi kuchuluka kwa ntchito za PRP sizinakhazikitsidwe, ndipo sizinaphunzire mokwanira mu kafukufuku wofunikira wa sayansi.Pachifukwa ichi, kufunikira kwa mapangidwe okhazikika a platelet derived growth factor ikuwonekera, zomwe zidzalola kuyesa kovomerezeka kwa sayansi kwa zotsatira za magawo osiyanasiyana monga kupanga PRP, kuchuluka kwa jekeseni wa PRP, ndi nthawi ya jekeseni.Kuphatikiza apo, kugwiritsa ntchito magulu kuti afotokoze bwino zinthu za PRP zomwe zimagwiritsidwa ntchito ziyenera kukhala zovomerezeka.Olemba ena apereka njira zosiyanasiyana zamagawo, kuphatikiza Mishra (kuwerengera kwa mapulateleti, kupezeka kwa maselo oyera amagazi, kuyambitsa) ndi Dohan Ellenfest (kuwerengera kwa mapulateleti, kuchuluka kwa maselo oyera amagazi, kupezeka kwa fibrinogen), Delong (P latelet count, activation ya misomali, w ^ Kuwerengera kwa maselo a magazi a Haide; gulu la PAW) ndi Mautner (Kuwerengera kwa Platelet, kukhalapo kwa eukocyte yaikulu, kukhalapo kwa maselo a magazi a R olembedwa, ndi kugwiritsa ntchito misomali; gulu la PLRA) . Magalon et al.Gulu la DEPA lomwe likufunsidwa limaphatikizapo jekeseni wa platelet OSE, kupanga bwino, chitetezo cha PRP, ndi kuyambitsa kwake.Harrison et al.Dongosolo linanso lodziwika bwino lamagulu linasindikizidwa, kuphatikiza njira zoyatsira zomwe zimagwiritsidwa ntchito, kuchuluka kwa voliyumu yogwiritsidwa ntchito, ma frequency olamulira ndi magawo ang'onoang'ono, njira zamapulateleti ndi njira zokonzekera, komanso mawerengero apakati ndi kuchuluka kwa maselo oyera amwazi (neutrophils, lymphocytes, ndi monocytes) a mapulateleti, maselo ofiira a magazi, ndi magulu.Gulu laposachedwa likuchokera ku Kon et al.Kutengera kuvomerezana kwa akatswiri, zinthu zofunika kwambiri zimafotokozedwa ngati mapangidwe a mapulateleti (kuchuluka kwa mapulateleti ndi chiŵerengero cha ndende), chiyero (kukhalapo kwa maselo ofiira a magazi / maselo oyera a magazi), ndi kuyambitsa (endogenous / exogenous, calcium supplement).
Kugwiritsiridwa ntchito kwa zizindikiro zambiri za PRP zakhala zikukambidwa kwambiri, monga kuti chithandizo cha matenda a tendon chafotokozedwa m'maphunziro a zachipatala okhudza malo osiyanasiyana [ndi zotsatira zabwino ndi zoipa].Choncho, nthawi zambiri zimakhala zosatheka kupeza umboni wotsimikizirika kuchokera m'mabuku.Izi zimapangitsanso kukhala kovuta kuti chithandizo cha PRP chiphatikizidwe ndi malangizo osiyanasiyana.Chifukwa cha zovuta zambiri zomwe sizinathetsedwe zokhudzana ndi kugwiritsa ntchito PRP, mfundo yaikulu ya nkhaniyi ndikuwonetsa maganizo a akatswiri ochokera ku German "Clinical Tissue Regeneration Working Group" ya German Orthopedics and Trauma Society (DGOU) pa ntchito ndi tsogolo. pa PRP.
Njira
Gulu lachijeremani la "Clinical Tissue Regeneration Working Group" la Germany limapangidwa ndi mamembala a 95, omwe ali okhazikika pa opaleshoni ya mafupa ndi kusinthika kwa minofu (madokotala onse kapena madokotala, palibe ochiritsa thupi kapena asayansi ochita masewera olimbitsa thupi).Gulu logwira ntchito lopangidwa ndi anthu a 5 (kubwereza kwakhungu) ndiloyenera kulimbikitsa kufufuza.Pambuyo poyang'ana zolemba zomwe zilipo kale, gulu logwira ntchito linakonza zinthu zomwe zingatheke zomwe zingaphatikizidwe mu kafukufuku woyamba.Kafukufuku woyamba adachitika mu Epulo 2018, akufunsa mafunso a 13 ndi mbali zonse za pulogalamu ya PRP, kuphatikiza mafunso otsekedwa ndi otseguka, ndikulimbikitsa akatswiri kuti apereke malingaliro owonjezera kapena zosintha.Kutengera mayankho awa, kafukufuku wachiwiri adapangidwa ndikuchitidwa mu Novembala 2018, ndi mafunso okwana 31 otsekedwa m'magulu 5 osiyanasiyana: zisonyezo za kuvulala kwa cartilage ndi osteoarthritis (OA), zisonyezo za matenda a tendon, zisonyezo za kuvulala kwa minofu. , kugwiritsa ntchito PRP, ndi malo ofufuzira amtsogolo.
Kupyolera mu kafukufuku wa pa intaneti (Survey Monkey, USA), mgwirizano unafikiridwa kuti alole omwe anafunsidwa kuti awone ngati polojekitiyi ikuyenera kuphatikizidwa ndi zofunikira zochepa za malipoti, ndi kupereka masikelo asanu omwe angathe kuyankha pa Likert: 'Kuvomereza Kwambiri';Gwirizanani;Osavomereza kapena kutsutsa;Sindikugwirizana nazo kapena kutsutsa mwamphamvu.Kafukufukuyu adayesedwa ndi akatswiri atatu okhudzana ndi nkhope, kumvetsetsa ndi kuvomereza, ndipo zotsatira zake zinasinthidwa pang'ono.Mugawo loyamba, akatswiri okwana 65 adatenga nawo gawo, pomwe mugawo lachiwiri, akatswiri 40 adatenga nawo gawo.Pachigawo chachiwiri cha mgwirizano, kutanthauzira kwapadera kumanena kuti ngati oposa 75% a ofunsidwa amavomereza, polojekitiyi idzaphatikizidwa mu chikalata chomaliza cha mgwirizano, ndipo osachepera 20% omwe adafunsidwa sagwirizana.75% ya omwe adatenga nawo mbali amavomereza kuti ndilo lingaliro lodziwika bwino, lomwe linagwiritsidwa ntchito mu kafukufuku wathu.
Zotsatira
Pachigawo choyamba, 89% ya anthu adayankha kuti ntchito ya PRP ndiyothandiza, ndipo 90% ya anthu amakhulupirira kuti PRP idzakhala yofunika kwambiri m'tsogolomu.Mamembala ambiri amadziwa bwino za sayansi ndi kafukufuku wachipatala, koma 58% yokha ya mamembala amagwiritsa ntchito PRP pazochitika zawo za tsiku ndi tsiku.Zifukwa zodziwika bwino zosagwiritsa ntchito PRP ndi kusowa kwa malo oyenerera, monga zipatala za yunivesite (41%), zodula (19%), zowononga nthawi (19%), kapena umboni wosakwanira wa sayansi (33%).Zizindikiro zodziwika bwino za kugwiritsa ntchito PRP ndi matenda a tendon (77%), OA (68%), kuvulala kwa minofu (57%), ndi kuvulala kwa cartilage (51%), yomwe ndiyo maziko a kafukufuku wachiwiri.Chizindikiro chogwiritsira ntchito PRP chikuwonekera pamodzi ndi 18% kukonza kanyumba ndi 32% kukonza tendon.Zizindikiro zina zimawonedwa mu 14%.9% yokha ya anthu adanena kuti PRP ilibe chithandizo chamankhwala.Jekeseni wa PRP nthawi zina amagwiritsidwa ntchito limodzi ndi hyaluronic acid (11%).Kuphatikiza pa PRP, akatswiri adalowetsanso mankhwala oletsa ululu wamba (65%), cortisone (72%), hyaluronic acid (84%), ndi Traumel / Zeel (28%).Kuphatikiza apo, akatswiri adafotokoza mokulira kufunika kofufuza zambiri zachipatala pakugwiritsa ntchito PRP (76%) komanso kufunikira kokhazikika bwino (kupanga 70%, zisonyezo 56%, nthawi 53%, pafupipafupi jekeseni 53%).Kuti mudziwe zambiri pa kuzungulira koyamba, chonde onani zowonjezera.Akatswiri ananena mochulukira kuti kafukufuku wambiri wazachipatala amafunikira pakugwiritsa ntchito PRP (76%), ndipo kukhazikika bwino kuyenera kukwaniritsidwa (kupanga 70%, zisonyezo 56%, nthawi 53%, pafupipafupi jekeseni 53%).Kuti mudziwe zambiri pa kuzungulira koyamba, chonde onani zowonjezera.Akatswiri ananena mochulukira kuti kafukufuku wambiri wazachipatala amafunikira pakugwiritsa ntchito PRP (76%), ndipo kukhazikika bwino kuyenera kukwaniritsidwa (kupanga 70%, zisonyezo 56%, nthawi 53%, pafupipafupi jekeseni 53%).
Kutengera mayankho awa, kuzungulira kwachiwiri kumayang'ana kwambiri pamutu womwe uli ndi chidwi kwambiri.Chigwirizano chinafikiridwa m'mawu a 16/31.Ikuwonetsanso madera omwe pali mgwirizano wocheperako, makamaka pankhani yazizindikiro.Anthu ambiri amavomereza (92%) kuti pali kusiyana kwakukulu kwa zizindikiro zosiyanasiyana za ntchito ya PRP (monga OA, matenda a tendon, kuvulala kwa minofu, etc.).
[Tchati ya mipiringidzo yosanjikizana imayimira kugawika kwa magawo omwe adagwirizana nawo mugawo lachiwiri la kafukufuku (mafunso 31 (Q1 - Q31)), zomwe zikuwonetsa madera omwe amasemphana maganizo.
Bar kumanzere kwa Y-axis imasonyeza kusagwirizana, pamene bala kumanja kumasonyeza mgwirizano.Kusagwirizana kwakukulu kumabuka m'gawo lazizindikiro.]
Zizindikiro za kuvulala kwa cartilage ndi OA
Pali mgwirizano wamba (77.5%) kuti PRP ingagwiritsidwe ntchito pa matenda osteoarthritis oyambirira [Kellgren Lawrence (KL) Level II].Kwa kuvulala kochepa kwambiri kwa cartilage (KL Level I) ndi magawo ovuta kwambiri (KL Level III ndi IV), palibe mgwirizano pakugwiritsa ntchito PRP panthawi kapena pambuyo pa opaleshoni yokonzanso khungu la cartilage, ngakhale 67.5% ya akatswiri amakhulupirira kuti iyi ndi gawo lodalirika. .
Zizindikiro za zotupa za tendon
Mu kafukufukuyu, akatswiri adayimira ambiri (82.5% ndi 80%) kuti kugwiritsa ntchito PRP ndi kothandiza pa matenda oopsa komanso osatha.Pankhani ya kukonza makapu ozungulira, 50% ya akatswiri amakhulupirira kuti kugwiritsa ntchito PRP kwa intraoperative kungakhale kothandiza, koma 17.5% ya akatswiri amakhala ndi lingaliro losiyana.Chiwerengero chofanana cha akatswiri (57.5%) amakhulupirira kuti PRP ili ndi ntchito yabwino pa chithandizo chamankhwala pambuyo pokonza tendon.
Chizindikiro cha kuvulala kwa minofu
Koma palibe mgwirizano womwe unapezeka pakugwiritsa ntchito PRP pofuna kuchiza kuvulala kwakukulu kapena kosatha kwa minofu (monga kupitirira 75% kuvomereza).
Zothandiza za PRP Application
Pali ziganizo zitatu zomwe zingagwirizane:
(1) Zotupa zosatha zimafuna jekeseni yoposa imodzi ya PRP
(2) Chidziwitso chosakwanira pa nthawi yoyenera pakati pa jakisoni (palibe mgwirizano womwe umapezeka pakapita sabata)
(3) Kusiyanasiyana kwa mitundu yosiyanasiyana ya PRP kungathandize kwambiri pazochitika zawo zamoyo
Malo Ofufuza Zamtsogolo
Kupanga kwa PRP kuyenera kukhala kovomerezeka bwino (95% kusasinthasintha) ndi ntchito yake yachipatala (monga mafupipafupi a jekeseni, nthawi yogwiritsira ntchito, zizindikiro zachipatala).Ngakhale m'malo monga chithandizo cha OA komwe akuti kuli chidziwitso chabwino chachipatala, akatswiri amakhulupirira kuti pakufunikabe kafukufuku wofunikira kwambiri wasayansi ndi zamankhwala.Izi zikugwiranso ntchito pazizindikiro zina.
Kambiranani
Zotsatira zafukufuku zikuwonetsa kuti padakali kutsutsana kwakukulu pakugwiritsa ntchito PRP mu mafupa a mafupa, ngakhale m'magulu a akatswiri a dziko.Pa zolankhula 31, 16 okha ndi omwe adagwirizana.Pali mgwirizano waukulu kwambiri pankhani ya kafukufuku wamtsogolo, zomwe zikuwonetsa kufunikira kwakukulu kopanga umboni wokulirapo pochita maphunziro osiyanasiyana amtsogolo.Pachifukwa ichi, kuunika kofunikira kwa umboni womwe ulipo ndi magulu ogwira ntchito akatswiri ndi njira yowonjezera chidziwitso chachipatala.
Zizindikiro za OA ndi kuvulala kwa cartilage
Malingana ndi zolemba zamakono, PRP ikhoza kukhala yoyenera kwa OA oyambirira komanso ochepa.Umboni waposachedwapa umasonyeza kuti jekeseni wa intra-articular wa PRP ukhoza kupititsa patsogolo zizindikiro za odwala mosasamala kanthu za kuwonongeka kwa cartilage, koma nthawi zambiri pamakhala kusowa kwa kusanthula kwamagulu ang'onoang'ono malinga ndi Kellgren ndi Lawrence.Pachifukwa ichi, chifukwa cha deta yosakwanira yomwe ilipo, akatswiri pakali pano samalimbikitsa kugwiritsa ntchito PRP kwa KL mlingo wa 4. PRP imakhalanso ndi mwayi wopititsa patsogolo ntchito ya mawondo a mawondo, mwinamwake mwa kuchepetsa zochitika zotupa ndi kuchepetsa kuchepetsa kukonzanso kowonongeka kwa cartilage.PRP imakhala ndi zotsatira zabwino kwa amuna, achinyamata, odwala omwe ali ndi kuwonongeka kwa cartilage ndi body mass index (BMI).
Pomasulira deta yosindikizidwa yachipatala, kupangidwa kwa PRP kumawoneka ngati chinthu chofunika kwambiri.Chifukwa cha kuwonetseredwa kwa cytotoxic mphamvu ya plasma yodzaza ndi maselo oyera a magazi pa synovial cell in vitro, LP-PRP imalimbikitsidwa makamaka kuti igwiritsidwe ntchito m'mitsempha.Pakafukufuku waposachedwapa wa sayansi, zotsatira za maselo oyera a magazi (LP) ndi maselo oyera a magazi olemera (LR) PRP pa chitukuko cha OA anafanizidwa mu chitsanzo cha mbewa pambuyo pa meniscectomy.LP-PRP inawonetsa kuchita bwino kwambiri pakusunga voliyumu ya cartilage poyerekeza ndi LR-PRP.Kusanthula kwaposachedwapa kwa mayesero oyendetsedwa mwachisawawa kunapeza kuti PRP inali ndi zotsatira zabwino poyerekeza ndi hyaluronic acid (HA), ndipo kusanthula kagulu kakang'ono kunasonyeza kuti LP-PRP inali ndi zotsatira zabwino kuposa LR-PRP.Komabe, panalibe kuyerekezera kwachindunji pakati pa LR - ndi LP-PRP, kupanga kafukufuku wina wofunikira.M'malo mwake, kafukufuku wamkulu kwambiri woyerekeza LR-PRP ndi HA akuwonetsa kuti LR-PRP ilibe zotsatira zoyipa.Kuonjezera apo, kafukufuku wachipatala poyerekeza LR-PRP ndi LP-PRP mwachindunji sanasonyeze kusiyana kwachipatala pa zotsatira pambuyo pa miyezi 12.LR-PRP ili ndi mamolekyu owonjezera omwe amachititsa kuti thupi likhale lopweteka komanso kukula kwa zinthu zomwe zimakula, komanso zimakhala ndi ma anti-inflammatory cytokines, monga interleukin-1 receptor antagonists (IL1-Ra).Kafukufuku waposachedwapa walongosola njira ya "kubwezeretsanso" kwa maselo oyera a magazi omwe amachititsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda.Maphunziro owonjezera azachipatala okhala ndi mapangidwe oyembekezeredwa mwachisawawa ndi ofunikira kuti adziwe momwe angapangire kapena mawonekedwe a PRP komanso njira yoyenera yogwiritsira ntchito mu OA.
Choncho, ena amanena kuti HA ndi PRP zikhoza kukhala njira zabwino zothandizira odwala omwe ali ndi OA yochepa komanso BMI yochepa.Kuwunika kwaposachedwa kwawonetsa kuti PRP ili ndi zotsatira zabwino zochiritsira poyerekeza ndi HA.Komabe, mfundo zotseguka zomwe zaperekedwa mogwirizana zikuphatikizapo kufunikira kokonzekera kokhazikika kwa PRP, mitengo yogwiritsira ntchito, komanso kufunikira kwa mayesero ena azachipatala omwe ali ndi madzi apamwamba.Choncho, pakali pano malingaliro ndi malangizo ovomerezeka nthawi zambiri samagwirizana kapena kutsutsa kugwiritsa ntchito mawondo osteoarthritis.Mwachidule, potengera umboni wamakono, njira zokonzekera zosiyana zimachepetsa kusinthasintha kwakukulu kwa njira, ndipo PRP ingayambitse kupweteka kwa OA yofatsa mpaka yochepetsetsa.Gulu la akatswiri silimalimbikitsa kugwiritsa ntchito PRP muzochitika zovuta za OA.Kafukufuku waposachedwapa wasonyeza kuti PRP imathandizanso kuti pakhale zotsatira za placebo, makamaka pochiza OA kapena lateral Epicondylitis.Jekeseni wa PRP ukhoza kukhala gawo limodzi la njira zonse zothandizira kuthana ndi zovuta zamoyo za OA.Kuwonjezera pa zinthu zina zofunika monga kuchepa kwa thupi, kukonza kusokonezeka, kuphunzitsa minofu, ndi mawondo a mawondo, zingathandize kuchepetsa ululu ndikubweretsa zotsatira zabwino kwa odwala.
Udindo wa PRP mu opareshoni ya regenerative cartilage ndi malo ena omwe amatsutsana kwambiri.Ngakhale kuti kafukufuku wofunikira wa sayansi wasonyeza zotsatira zabwino pa chondrocytes, umboni wachipatala wogwiritsira ntchito PRP panthawi ya opaleshoni, opaleshoni ya kukonzanso kwa cartilage, kapena magawo okonzanso akadali osakwanira, kusonyeza zomwe tapeza.Kuonjezera apo, nthawi yabwino yothandizira chithandizo cha PRP pambuyo pa opaleshoni sichidziwikabe.Koma akatswiri ambiri amavomereza kuti PRP ingathandize kulimbikitsa kusinthika kwa cartilage.Mwachidule, zotsatira zaposachedwa za chigamulo chovuta zimasonyeza kuti kuwunika kwina kwa ntchito yomwe PRP ingathe kuchita pa opaleshoni yokonzanso cartilage ndiyofunika.
Zizindikiro za zotupa za tendon
Kugwiritsa ntchito PRP pochiza tendinosis ndi nkhani yotsutsana m'mabuku.Kupenda kafukufuku wofunikira wa sayansi kumasonyeza kuti PRP ili ndi zotsatira zabwino mu vitro (monga kuwonjezeka kwa tendon cell proliferation, kulimbikitsa zotsatira za anabolic, monga kuwonjezeka kwa collagen kupanga) ndi mu vivo (kuwonjezeka kwa machiritso a tendon).Muzochita zachipatala, kafukufuku wambiri wasonyeza kuti chithandizo cha PRP chili ndi zabwino komanso zopanda zotsatira pa matenda osiyanasiyana ovuta komanso osatha.Mwachitsanzo, kafukufuku waposachedwapa anatsindika zotsatira zotsutsana za ntchito ya PRP m'magulu osiyanasiyana a tendon, makamaka kukhala ndi zotsatira zabwino pa zilonda zam'mphepete mwa mphuno ndi zilonda za patellar tendon, koma osati pa Achilles tendon kapena rotator cuff zilonda.Zolemba zambiri za opaleshoni ya RCT zilibe zotsatira zopindulitsa, ndipo palibe umboni wotsimikizirika wa ntchito yake yosamalitsa mu matenda a rotator cuff.Kwa Epicondylitis yakunja, kafukufuku wamakono wa meta amasonyeza kuti corticosteroids imakhala ndi zotsatira zabwino za nthawi yochepa, koma zotsatira za nthawi yaitali za PRP ndizopambana.Malingana ndi umboni wamakono, tendinosis ya patellar ndi lateral elbow tendinosis yawonetsa kusintha pambuyo pa chithandizo cha PRP, pamene tendon Achilles ndi rotator cuff sizikuwoneka kuti zimapindula ndi ntchito ya PRP.Choncho, mgwirizano waposachedwa ndi Komiti Yoyamba ya Sayansi ya ESSKA inatsimikizira kuti pakali pano palibe mgwirizano wogwiritsa ntchito PRP pofuna kuchiza tendinosis.Ngakhale kuti pali kutsutsana m'mabuku, monga momwe kafukufuku waposachedwapa ndi kuwunikira mwadongosolo, PRP ili ndi ntchito yabwino pochiza matenda a tendon kuchokera kuzinthu zonse za sayansi ndi zamankhwala.Makamaka poganizira zomwe zingachitike ndi corticosteroids mukamagwiritsa ntchito matenda a tendon.Zotsatira za kafukufukuyu zikuwonetsa kuti malingaliro a Germany panopa ndikuti PRP ingagwiritsidwe ntchito pochiza matenda opweteka komanso osatha.
Chizindikiro cha kuvulala kwa minofu
Chotsutsana kwambiri ndi kugwiritsa ntchito PRP pofuna kuchiza kuvulala kwa minofu, yomwe ndi imodzi mwa zovulala zofala kwambiri m'masewera a akatswiri, zomwe zimapangitsa pafupifupi 30% ya masiku akumunda.PRP imapereka mwayi wopititsa patsogolo machiritso achilengedwe komanso kufulumizitsa masewera olimbitsa thupi, omwe alandira chidwi chowonjezeka m'zaka zingapo zapitazi.Ngakhale kuti 57% ya mayankho omwe adaperekedwa pamzere woyamba adatchula kuvulala kwa minofu monga chisonyezero chofala kwambiri cha kugwiritsa ntchito PRP, padakali kusowa kwa sayansi yolimba.Maphunziro angapo a mu vitro awona ubwino wa PRP mu kuvulala kwa minofu.Kuchulukitsa kwa ma cell a satelayiti, kuwonjezeka kwa m'mimba mwa fibril, kukondoweza kwa myogenesis, ndi kuchuluka kwa ntchito za MyoD ndi myostatin zonse zayesedwa bwino.Zambiri za Mazoka et al.Kuwonjezeka kwa kuchuluka kwa zinthu zakukula monga HGF, FGF, ndi EGF kunawonedwa mu PRP-LP.Tsai et al.adatsindika zomwe apeza.Kuwonjezera pa kutsimikizira kuwonjezereka kwa mapuloteni a cyclin A2, cyclin B1, cdk2 ndi PCNA, zimatsimikiziridwa kuti mphamvu ya maselo a chigoba ndi kufalikira kwa maselo kumawonjezeka ndi kusamutsa maselo kuchokera ku G1 kupita ku S1 ndi G2 & M magawo.Ndemanga yaposachedwapa inafotokozera mwachidule za sayansi yamakono motere: (1) M'maphunziro ambiri, chithandizo cha PRP chinachulukitsa kuchuluka kwa maselo a minofu, kukula kwa chinthu (monga PDGF-A / B ndi VEGF), kulembera maselo oyera a magazi, ndi angiogenesis mu minofu. poyerekeza ndi chitsanzo cha gulu lolamulira;(2) Tekinoloje yokonzekera PRP ikadali yosagwirizana ndi kafukufuku wa zolemba zoyambirira za sayansi;(3) Umboni wochokera ku kafukufuku woyambira wa sayansi mu vitro ndi mu vivo umasonyeza kuti PRP ikhoza kukhala njira yochiritsira yothandiza yomwe ingathe kufulumizitsa machiritso a zilonda za minofu poyerekeza ndi gulu lolamulira, malingana ndi zotsatira zomwe zawonedwa pa ma cell ndi minofu. gulu lachipatala.
Ngakhale kuti kafukufuku wobwerezabwereza adalongosola machiritso athunthu ndipo amawona kuti nthawi yopanda malo inalibe phindu lalikulu, Bubnov et al.Pa kafukufuku wamagulu a othamanga a 30, adawona kuti ululu unachepetsedwa ndipo kufulumira kuchira kuchokera ku mpikisano kunafulumira kwambiri.Hamid ndi al.M'mayesero olamulidwa mwachisawawa (RCT) poyerekeza kulowetsedwa kwa PRP ndi machitidwe ochiritsira ochiritsira, kuchira mofulumira kwambiri ku mpikisano kunafotokozedwa.RCT yokhayo yamitundu yambiri yakhungu yomwe imaphatikizapo kuvulala kwa hamstring mwa othamanga (n = 80), ndipo palibe kulowetsedwa kwakukulu kwa placebo komwe kunawonedwa poyerekeza ndi PRP.Mfundo zoyembekeza zamoyo, zopeza zabwino za preclinical, komanso zochitika zopambana zachipatala ndi jekeseni wa PRP zomwe tazitchula pamwambapa sizinatsimikizidwe ndi RCT yapamwamba yaposachedwa.Kugwirizana komwe kulipo pakati pa mamembala a GOTS adayesa njira zochiritsira zochiritsira zovulaza minofu ndipo adatsimikiza kuti pakali pano palibe umboni woonekeratu wakuti jekeseni wa intramuscular angagwiritsidwe ntchito pochiza kuvulala kwa minofu.Izi zikugwirizana ndi zotsatira zathu, ndipo palibe mgwirizano pa kugwiritsa ntchito PRP pochiza kuvulala kwa minofu.Kufufuza kwina kumafunika mwamsanga pa mlingo, nthawi, ndi mafupipafupi a PRP mu kuvulala kwa minofu.Poyerekeza ndi kuvulala kwa cartilage, mu kuvulala kwa minofu, kugwiritsa ntchito njira zothandizira mankhwala, makamaka PRP, zingakhale zogwirizana ndi msinkhu ndi nthawi ya kuvulala, kusiyanitsa pakati pa kukhudzidwa kwa minofu yovulazidwa m'mimba mwake ndi zotheka kuvulala kwa tendon kapena kuvulala.
Ntchito yogwiritsira ntchito PRP ndi imodzi mwa madera omwe amakambidwa kawirikawiri, ndipo kusowa koyimitsidwa pakali pano ndi chimodzi mwazinthu zazikulu mu mayesero a zachipatala.Akatswiri ambiri sanawone kuwonjezeka kulikonse kwa kugwiritsa ntchito PRP, komabe, kafukufuku wina wasonyeza kuti kugwiritsa ntchito kowonjezera kwa hyaluronic acid kungafanane ndi kugwiritsidwa ntchito kamodzi kwa PRP kwa OA.Chigwirizano ndi chakuti jakisoni angapo ayenera kuperekedwa kwa matenda osachiritsika, ndipo gawo la OA limachirikiza lingaliroli, pomwe jakisoni angapo amakhala amphamvu kuposa jakisoni amodzi.Kafukufuku woyambirira wa sayansi akufufuza ubale wa PRP ndi mlingo, koma zotsatirazi ziyenera kusamutsidwira ku kafukufuku wachipatala.Kuchuluka kwabwino kwa PRP sikunadziwikebe, ndipo kafukufuku wasonyeza kuti kukwera kwakukulu kungakhale ndi zotsatira zoipa.Mofananamo, zotsatira za maselo oyera a magazi zimadalira chizindikiro, ndipo zizindikiro zina zimafuna PRP ndi maselo oyera a magazi.Kusiyanasiyana kwa kapangidwe kake ka PRP kamakhala ndi gawo lofunikira pakukhudzidwa kwa PRP.
Malo Ofufuza Zamtsogolo
Zimavomerezedwa kuti malinga ndi zofalitsa zaposachedwapa, kufufuza kwina pa PRP ndikofunikira m'tsogolomu.Chimodzi mwazinthu zazikulu ndikuti mapangidwe a PRP ayenera kukhala okhazikika bwino (ndi 95% kusasinthasintha).Chinthu chimodzi chotheka kuti mukwaniritse cholingachi chingakhale kuphatikizika kwa mapulateleti kuti akwaniritse milingo yayikulu, yomwe imakhala yokhazikika.Kuphatikiza apo, magawo osiyanasiyana ogwiritsira ntchito kuchipatala sakudziwika, monga ma jakisoni angati, nthawi pakati pa jakisoni, ndi mlingo wa PRP.Ndi njira iyi yokha yomwe zingatheke kuchita kafukufuku wapamwamba ndikuwunika zomwe zikuwonetsa zomwe zili zoyenera kugwiritsa ntchito PRP, kupanga kafukufuku wofunikira wa sayansi ndi zachipatala, makamaka maphunziro oyendetsedwa mwachisawawa, ofunikira.Ngakhale kuti kuvomerezana kwafikiridwa kuti PRP ikhoza kukhala ndi gawo lofunika kwambiri m'tsogolomu, zikuwoneka kuti kafukufuku wambiri woyesera ndi wachipatala akufunika tsopano.
Kukhala ndi malire
Cholepheretsa chimodzi cha kafukufukuyu poyesa kuthana ndi mutu womwe anthu ambiri amatsutsana nawo pakugwiritsa ntchito PRP ndi mawonekedwe ake amtundu.Kupezeka kwa PRP ndi kusiyana kwa dziko pakubwezeredwa kungakhudze zotsatira ndi zowongolera.Kuphatikiza apo, kuvomerezana sikuli kosiyanasiyana ndipo kumangophatikiza malingaliro a madokotala a mafupa.Komabe, izi zitha kuwoneka ngati zopindulitsa chifukwa ndi gulu lokhalo lomwe likugwiritsa ntchito ndi kuyang'anira chithandizo cha jakisoni wa PRP.Kuphatikiza apo, kafukufuku wopangidwa ali ndi njira yosiyana yofananira ndi njira ya Delphi yomwe idachitidwa mosamalitsa.Ubwino wake ndi mgwirizano wopangidwa ndi gulu la madokotala odziwa mafupa omwe ali ndi chidziwitso chochuluka chaukatswiri m'magawo awo malinga ndi sayansi yoyambira ndi machitidwe azachipatala.
Malangizo
Kutengera kuvomereza kwa osachepera 75% a akatswiri omwe atenga nawo mbali, agwirizane pazifukwa izi:
OA ndi kuvulala kwa cartilage: Kugwiritsa ntchito mafupa osteoarthritis ofatsa (kalasi ya KL II) kungakhale kothandiza.
Tendon pathology: Kugwiritsa ntchito matenda oopsa komanso osatha a tendon kungakhale kothandiza
Lingaliro lothandiza: Kwa zotupa zosatha (chichereŵechereŵe, tendon), jakisoni angapo (2-4) pakapita nthawi ndi bwino kuposa jekeseni imodzi.
Komabe, palibe deta yokwanira pa nthawi yapakati pakati pa jakisoni imodzi.
Kafukufuku wamtsogolo: Zimalimbikitsidwa kuti zikhazikitse kupanga, kukonzekera, kugwiritsa ntchito, mafupipafupi, ndi mitundu yowonetsera ya PRP.Kufufuza kwina kofunikira komanso kwachipatala ndikofunikira.
Mapeto
Chigwirizano chodziwika bwino ndi chakuti pali kusiyana kwa zizindikiro zosiyanasiyana za ntchito ya PRP, ndipo pakalibe kusatsimikizika kwakukulu pakuyimitsidwa kwa pulogalamu ya PRP palokha, makamaka pazowonetsa zosiyanasiyana.Kugwiritsiridwa ntchito kwa PRP kumayambiriro kwa mawondo osteoarthritis (KL grade II) ndi matenda opweteka komanso osachiritsika a tendon angakhale othandiza.Kwa zotupa zanthawi zonse (za cartilage ndi tendon), jakisoni wanthawi yayitali (2-4) ndikofunikira kuposa jakisoni imodzi, koma palibe chidziwitso chokwanira pa nthawi yapakati pa jakisoni imodzi.Nkhani yaikulu ndi kusiyanasiyana kwa gulu la PRP, lomwe limagwira ntchito yofunika kwambiri pa ntchito ya PRP.Choncho, kupanga PRP kuyenera kukhala kovomerezeka bwino, komanso zizindikiro zachipatala monga maulendo a jekeseni, ndi nthawi pakati pa jekeseni ndi zizindikiro zolondola.Ngakhale OA, yomwe pakadali pano ikuyimira gawo labwino kwambiri lofufuzira pakugwiritsa ntchito PRP, kafukufuku wofunikira kwambiri wasayansi ndi zamankhwala akufunika, komanso zisonyezo zina zomwe zaperekedwa.
(Zomwe zili m'nkhaniyi zidasindikizidwanso, ndipo sitikupereka chitsimikizo chotsimikizika kapena chotsimikizika pakulondola, kudalirika kapena kukwanira kwa zomwe zili m'nkhaniyi, ndipo sitili ndi udindo pamalingaliro ankhaniyi, chonde mvetsetsani.）
Nthawi yotumiza: May-24-2023