Hoʻohana nui ʻia ka Platelet Rich Plasma (PRP) i nā orthopedics, akā aia nō ka hoʻopaʻapaʻa ikaika.No laila, ua alakaʻi ka German "Clinical Tissue Regeneration Working Group" o ka German Orthopedics and Trauma Society i kahi noiʻi e hiki ai i ka ʻae ʻana i ka hiki i kēia manawa therapeutic o PRP.
Manaʻo ʻia nā noi PRP Therapeutic he pono (89%) a ʻoi aku paha ka mea nui i ka wā e hiki mai ana (90%).ʻO nā hōʻailona maʻamau ka maʻi tendon (77%), osteoarthritis (OA) (68%), ʻeha ʻiʻo (57%), a me ka ʻeha cartilage (51%).Ua loaʻa ka ʻae i ka ʻōlelo o 16/31.ʻO ka hoʻohana ʻana i ka PRP i ka osteoarthritis mua o ke kuli (Kellgren Lawrence II) i manaʻo ʻia he mea pono, a me nā maʻi ʻāʻī a me nā maʻi tendon mau loa.No nā maʻi maʻi maʻi (cartilage, tendons), ʻoi aku ka maikaʻi o nā injections (2-4) ma mua o hoʻokahi injections.Eia naʻe, ʻaʻole lawa ka ʻikepili i ka wā ma waena o nā injections.Manaʻo nui ʻia e hoʻohālikelike i ka hoʻomākaukau ʻana, ka noi, ka pinepine, a me ka hoʻoholo ʻana i nā hōʻailona no ka PRP.
Hoʻohana nui ʻia ka Platelet rich plasma (PRP) i ka lāʻau lapaʻau hou, ʻoi aku ka nui o ka lāʻau lapaʻau orthopedic.Ua hōʻike ʻia ka noiʻi ʻepekema kumu he nui nā hopena maikaʻi o ka PRP ma nā ʻōnaehana musculoskeletal he nui, e like me nā chondrocytes, nā tendon cell, a i ʻole nā pūnaewele ʻiʻo, i loko o ka vitro a me ka vivo.Eia nō naʻe, ua kaupalena ʻia ka maikaʻi o nā palapala e kū nei, me ka ʻepekema kumu a me ka noiʻi lapaʻau.No laila, ma ka noiʻi lapaʻau, ʻaʻole maikaʻi ka hopena e like me ka noiʻi ʻepekema kumu.
Nui nā kumu kūpono.ʻO ka mea mua, loaʻa nā ʻano hoʻomākaukau he nui (ʻoi aku ma mua o 25 mau ʻōnaehana kūʻai like ʻole) e loaʻa ai nā kumu ulu i loaʻa i ka platelet, akā ʻo ka huahana PRP hope loa i haku ʻia i kā lākou haku mele like ʻole a me kā lākou hoʻoikaika ʻana.No ka laʻana, hōʻike nā ʻano hana hoʻomākaukau PRP like ʻole i nā hopena like ʻole ma nā chondrocytes hui.Eia kekahi, ma muli o ka hōʻike ʻole ʻia o nā ʻāpana kumu e like me ke ʻano o ke koko (nā koko ʻulaʻula, nā keʻokeʻo keʻokeʻo, a me nā platelets) i hōʻike ʻia i kēlā me kēia haʻawina, pono koke ka hōʻike maʻamau o kēia mau mea.He ʻokoʻa koʻikoʻi ko ka huahana PRP hope loa.ʻO ka mea paʻakikī i ka pilikia, ʻaʻole i hoʻohālikelike ʻia ke ʻano, ka manawa, a me ka nui o nā noi PRP, a ʻaʻole i aʻo piha ʻia i ka noiʻi ʻepekema kumu.Ma kēia manaʻo, ʻike ʻia ka koi no ka hoʻohālikelike ʻana o ka platelet i loaʻa i ka ulu ulu ʻana, e ʻae ai i ka hoʻāʻo ʻepekema kumu maʻamau o nā hopena o nā ʻokoʻa like ʻole e like me ka PRP formulation, PRP injection volume, a me ka manawa injection.Eia kekahi, pono e hoʻohana i nā hoʻohālikelike e wehewehe pono i nā huahana PRP i hoʻohana ʻia.Ua manaʻo kekahi mau mea kākau i nā ʻōnaehana hoʻokaʻawale like ʻole, e like me Mishra (helu platelet, hele mai o nā keʻokeʻo keʻokeʻo, hoʻōla) a me Dohan Ellenfest (helu platelet, helu keʻokeʻo keʻokeʻo, hele mai o fibrinogen), Delong (P latelet helu, nail activation, w ^ ʻO ka helu o ke koko o Haide; ka hoʻokaʻawale ʻana i ka PAW) a me ka Mautner (Ka helu Platelet, ka hele ʻana o nā eukocyte nui, ka loaʻa ʻana o nā ʻāpana koko i kapa ʻia ʻo R, a me ka hoʻohana ʻana i ka hana nail; ka hoʻohālikelike ʻana o PLRA) 。 Magalon et al.ʻO ka papa inoa DEPA i manaʻo ʻia e pili ana i ka hoʻokomo ʻana i ka platelet OSE, ka hana pono, ka palekana o PRP, a me kāna hoʻāla ʻana.Harrison et al.Ua paʻi ʻia kekahi ʻōnaehana hoʻonohonoho holoʻokoʻa, me nā ʻano hana hoʻāla i hoʻohana ʻia, ka nui o ka leo i hoʻohana ʻia, ka hoʻohana ʻana i ke alapine a me nā subcategories i hoʻāla ʻia, ka pae platelet a me nā ʻenehana hoʻomākaukau, a me ka helu awelika holoʻokoʻa a me ka helu (haʻahaʻa kiʻekiʻe) helu keʻokeʻo keʻokeʻo (neutrophils, lymphocytes, a monocytes) no nā platelets, nā ʻāpana koko ʻulaʻula, a me ka hoʻokaʻawale ʻana.ʻO ka hoʻohālikelike hou loa mai Kon et al.Ma muli o ka ʻae ʻana o ka poʻe akamai, ua wehewehe ʻia nā mea koʻikoʻi e like me ka platelet composition (platelet concentration and concentration ratio), ka maʻemaʻe (ke ʻike ʻia o nā ʻulaʻula ʻulaʻula/keʻokeʻo keʻokeʻo), a me ka hoʻāla ʻana (endogenous/exogenous, calcium hoʻohui).
Ua kūkākūkā nuiʻia ka hoʻohanaʻana i nā hōʻailona he nui no ka PRP, e like me ka hōʻikeʻana i ka mālamaʻana i ka maʻi tendon i nā haʻawina hauʻoli e pili ana i nā wahi likeʻole [me nā hopena maikaʻi a me nā hopena maikaʻiʻole].No laila, ʻaʻole hiki ke loaʻa nā hōʻike paʻa mai ka palapala.He mea paʻakikī kēia no ka PRP therapy e hoʻokomo i nā alakaʻi like ʻole.Ma muli o ka nui o nā pilikia i hoʻoponopono ʻole ʻia e pili ana i ka hoʻohana ʻana i ka PRP, ʻo ke kumu kumu o kēia ʻatikala e hōʻike i nā manaʻo o nā poʻe loea mai ka German "Clinical Tissue Regeneration Working Group" o ka German Orthopedics and Trauma Society (DGOU) ma ka hoʻohana a me ka wā e hiki mai ana. o PRP.
Kaʻina hana
ʻO ka German "Clinical Tissue Regeneration Working Group" he 95 mau lālā, ʻo kēlā me kēia mea kūikawā i ka orthopedic orthopedic a me ka hana hou ʻana o ka ʻiʻo (nā kauka lapaʻau āpau a i ʻole nā kauka, ʻaʻohe mea lapaʻau kino a ʻepekema hoʻoikaika kino).ʻO kahi hui hana i haku ʻia he 5 mau kānaka (nānā makapō) ke kuleana no ka hoʻolaha ʻana i ka hoʻokolokolo.Ma hope o ka nānā ʻana i nā palapala e loaʻa nei, ua hoʻomākaukau ka hui hana i nā mea ʻike hiki ke hoʻokomo ʻia i ka puni mua o ka hoʻokolokolo.Ua mālama ʻia ka noiʻi mua ma ʻApelila 2018, e uhi ana i nā nīnau he 13 a me nā ʻano maʻamau o ka noi PRP, me nā nīnau i pani ʻia a wehe ʻia, a me ka paipai ʻana i nā poʻe akamai e noi i nā papahana hou a i ʻole nā hoʻololi.Ma muli o kēia mau pane, ua kūkulu ʻia ka lua o ka noiʻi ʻana a mālama ʻia i Nowemapa 2018, me ka huina o 31 mau nīnau i pani ʻia i 5 mau ʻano like ʻole: nā hōʻailona no ka hōʻeha cartilage a me ka osteoarthritis (OA), nā hōʻailona no ka maʻi tendon, nā hōʻailona no ka ʻeha ʻeha. , noi o PRP, a me nā wahi noiʻi e hiki mai ana.
Ma o kahi noiʻi pūnaewele (Survey Monkey, USA), ua loaʻa kahi ʻaelike e ʻae i ka poʻe pane e helu inā pono e hoʻokomo ʻia ka papahana i nā koi hōʻike haʻahaʻa loa, a e hāʻawi i ʻelima mau ʻāpana pane kūpono ma Likert: 'ʻAe loa';ʻAe;Mai ʻae ʻaʻole hoʻi e kūʻē;ʻAʻole ʻae a ʻae ʻole paha.Ua hoʻokele ʻia ka noiʻi e nā loea ʻekolu e pili ana i ka pono o ke alo, ka ʻike a me ka ʻae ʻia, a ua hoʻololi iki ʻia nā hopena.Ma ka puni mua, he 65 ka nui o ka poe akamai i komo, a ma ka puni elua, he 40 ka nui o ka poe akamai i komo.No ka ʻāpana ʻelua o ka ʻae ʻana, ʻōlelo ʻia kahi wehewehe priori inā ʻoi aku ka nui o ka 75% o ka poʻe pane e ʻae, e hoʻokomo ʻia ka papahana i loko o ka palapala ʻaelike hope, a ʻaʻole i ʻae ʻia ma lalo o 20% o nā mea pane.Ua ʻae ʻo 75% o ka poʻe i komo ʻo ia ka hoʻoholo ʻae ʻōlelo maʻamau, i hoʻohana ʻia i kā mākou noiʻi.
Ka hopena
Ma ka pōʻai mua, ua pane ka 89% o ka poʻe he pono ka noi PRP, a ʻo 90% o ka poʻe e manaʻoʻiʻo e ʻoi aku ka nui o ka PRP i ka wā e hiki mai ana.Ua kamaʻāina ka hapa nui o nā lālā i ka ʻepekema kumu a me ka noiʻi lapaʻau, akā ʻo 58% wale nō o nā lālā e hoʻohana i ka PRP i kā lākou hana i kēlā me kēia lā.ʻO nā kumu maʻamau o ka hoʻohana ʻole ʻana i ka PRP ʻo ia ka nele o kahi kaiapuni kūpono, e like me nā halemai kulanui (41%), pipiʻi (19%), hoʻopau manawa (19%), a i ʻole lawa ʻole nā hōʻike ʻepekema (33%).ʻO nā hōʻailona maʻamau no ka hoʻohana ʻana i ka PRP ʻo ia ka maʻi tendon (77%), OA (68%), ʻeha ʻeha (57%), a me ka ʻeha cartilage (51%), ʻo ia ke kumu no ka lua o ka hoʻokolokolo.Hōʻike ʻia ka hōʻailona no ka hoʻohana intraoperative o PRP me ka 18% hoʻoponopono cartilage a me 32% hoʻoponopono tendon.ʻIke ʻia nā hōʻailona ʻē aʻe ma 14%.ʻO 9% wale nō o nā kānaka i ʻōlelo ʻaʻohe hoʻohana lapaʻau ʻo PRP.Hoʻohana ʻia ka PRP injection i kekahi manawa me ka hyaluronic acid (11%).Ma waho aʻe o ka PRP, ua hoʻokomo pū ka poʻe loea i nā anesthetics kūloko (65%), cortisone (72%), hyaluronic acid (84%), a me Traumel/Zeel (28%).Eia kekahi, ua ʻōlelo nui ka poʻe loea i ka pono o ka noiʻi ʻana i ka noiʻi ʻana i ka PRP (76%) a me ka pono o ka standardization ʻoi aku ka maikaʻi (formulation 70%, indications 56%, time 53%, injection frequency 53%).No ka ʻike kikoʻī e pili ana i ka puni mua, e ʻoluʻolu e nānā i ka appendix.Ua ʻōlelo nui ka poʻe loea e pono ke noiʻi hou aku i ka noiʻi ma ka noi ʻana o PRP (76%), a pono e hoʻokō ʻia ka standardization maikaʻi (ka hoʻokumu ʻana 70%, nā hōʻailona 56%, ka manawa 53%, ka pinepine o ka injection 53%).No ka ʻike kikoʻī e pili ana i ka puni mua, e ʻoluʻolu e nānā i ka appendix.Ua ʻōlelo nui ka poʻe loea e pono ke noiʻi hou aku i ka noiʻi ma ka noi ʻana o PRP (76%), a pono e hoʻokō ʻia ka standardization maikaʻi (ka hoʻokumu ʻana 70%, nā hōʻailona 56%, ka manawa 53%, ka pinepine o ka injection 53%).
Ma muli o kēia mau pane, ʻoi aku ka manaʻo o ka pōʻai ʻelua i ke kumuhana o ka hoihoi nui.Ua loaʻa ka ʻae i ka ʻōlelo o 16/31.Hōʻike pū ia i nā wahi i emi ʻole ka ʻae ʻana, ʻoi aku hoʻi ma ke kahua o nā hōʻailona.ʻAe like ka poʻe (92%) he nui nā ʻokoʻa i nā hōʻailona like ʻole o ka noi PRP (e like me ka OA, ka maʻi tendon, ʻeha ʻeha, a pēlā aku).
[ʻO ka pakuhi oblique bar i hoʻopaʻa ʻia e hōʻike ana i ka māhele ʻana o ka pae i ʻaelike ʻia ma ka pōʻai ʻelua o ka noiʻi (31 nīnau (Q1 - Q31)), e hōʻike pono ana i nā wahi kūʻē.
ʻO ka pā ma ka ʻaoʻao hema o ka Y-axis e hōʻike ana i ke kuʻikahi, aʻo ka pā ma ka ʻaoʻao ʻākau e hōʻike ana i ka ʻaelike.ʻO ka hapa nui o nā kuʻikahi e kū mai ma ke kahua o nā hōʻailona.]
Nā hōʻailona no ka ʻeha cartilage a me ka OA
Aia ka ʻaelike maʻamau (77.5%) hiki ke hoʻohana ʻia ka PRP no ka osteoarthritis mua o ke kuli [Kellgren Lawrence (KL) Level II].No nā ʻeha cartilage liʻiliʻi loa (KL Level I) a me nā pae koʻikoʻi (KL Level III a me IV), ʻaʻohe manaʻo i ka hoʻohana ʻana i ka PRP i ka wā a i ʻole ma hope o ke kaʻina hana hou ʻana o ka cartilage, ʻoiai ʻo 67.5% o ka poʻe akamai i manaʻo he kahua hoʻohiki kēia. .
Nā hōʻailona no ka maʻi ʻeha
Ma ka noiʻi, ua hōʻike ka poʻe loea i ka hapa nui (82.5% a me 80%) he mea pono ka hoʻohana ʻana o PRP i nā maʻi tendon acute a me nā maʻi.I ka hihia o ka hoʻoponopono ʻana i ka rotator cuff, 50% o ka poʻe loea e manaʻoʻiʻo he pono ka hoʻohana ʻana o ka PRP intraoperative, akā ʻo 17.5% o ka poʻe loea e paʻa i ka manaʻo kūʻē.Manaʻo kekahi helu like o ka poʻe akamai (57.5%) he kuleana maikaʻi ka PRP i ka mālama postoperative ma hope o ka hoʻoponopono ʻana i nā tendon.
Hōʻike no ka ʻeha ʻiʻo
Akā ʻaʻole i ʻike ʻia kahi manaʻo ma ka hoʻohana ʻana i ka PRP no ka mālama ʻana i ka ʻeha ʻeha a i ʻole ka maʻi maʻi (e like me ka 75% consensus).
Nā ʻano hana o ka noi PRP
ʻEkolu mau ʻōlelo i hiki ke ʻae ʻia:
(1) Pono nā ʻeha maʻi ma mua o hoʻokahi injection o PRP
(2) ʻAʻole lawa ka ʻike e pili ana i ka manawa kūpono ma waena o nā injections (ʻaʻohe manaʻo i ʻike ʻia ma nā wā wiki)
(3) He mea nui paha ka hoʻololi ʻana o nā ʻano hana PRP like ʻole i ko lākou hopena olaola
Nā Wahi Imi Hou
Pono e hoʻonui maikaʻi ʻia ka hana PRP (95% kūlike) a me kāna noi lapaʻau (e like me ka pinepine o ka injection, ka manawa noi, nā hōʻailona hōʻailona).ʻOiai ma nā wahi e like me ka mālama ʻana i ka OA kahi i hōʻike ʻia ai ka ʻikepili lapaʻau maikaʻi, manaʻoʻiʻo nā lālā loea he pono nui no ka noiʻi ʻepekema a me ka noiʻi lapaʻau.Pili kēia i nā hōʻailona ʻē aʻe.
Kūkākūkā
Hōʻike nā hualoaʻa noiʻi aia nō ka hoʻopaʻapaʻa ākea e pili ana i ka hoʻohana ʻana i ka PRP i nā orthopedics, ʻoiai ma nā hui loea aupuni.Ma loko o 31 mau haʻiʻōlelo, he 16 wale nō i loaʻa i ka manaʻo like.Loaʻa ka manaʻo nui loa ma ke kahua o ka noiʻi e hiki mai ana, e hōʻike ana i ka pono nui e hoʻonui i nā hōʻike ma o ka hana ʻana i nā haʻawina like ʻole e hiki mai ana.Ma kēia ʻano, ʻo ka loiloi koʻikoʻi o nā hōʻike i loaʻa e nā hui hana loea he ala e hoʻonui ai i ka ʻike olakino.
Nā hōʻailona no ka OA a me ka ʻeha cartilage
Wahi a nā moʻolelo o kēia manawa, kūpono paha ka PRP no ka OA mua a me ka maʻalahi.Hōʻike nā hōʻike hou e hiki ke hoʻomaikaʻi i ka intra-articular injection o PRP i nā hōʻailona maʻi me ka nānā ʻole i ke kiʻekiʻe o ka pōʻino o ka cartilage, akā maʻamau ka nele o ka loiloi subgroup maikaʻi e pili ana i ka helu ʻana o Kellgren a me Lawrence.Ma kēiaʻano, ma muli o ka lawaʻole o kaʻikepili i loaʻa,ʻaʻole'ōlelo ka poʻe akamai i ka hoʻohanaʻana i ka PRP no ka pae KL 4. Loaʻa i ka PRP ka mea hiki ke hoʻonui i ka hana o ke kuli, hiki paha ma ka ho'ēmiʻana i nā hopena inflammatory a me ka ho'ēmiʻana i ke kaʻina hana hoʻoponopono degenerative o ka cartilage hui.Loaʻa ka PRP i nā hopena maikaʻi aʻe i nā kāne, ʻōpio, nā mea maʻi me nā pae haʻahaʻa o ka ʻeha cartilage a me ka helu helu kino (BMI).
I ka unuhi ʻana i ka ʻikepili lapaʻau i paʻi ʻia, ʻike ʻia ke ʻano o ka PRP he mea nui.Ma muli o ka hopena cytotoxic i hōʻike ʻia o ka plasma waiwai i nā keʻokeʻo keʻokeʻo ma nā synovial cell in vitro, ʻo LP-PRP ka mea nui no ka noi intra articular.Ma kahi noiʻi ʻepekema kumu hou, ua hoʻohālikelike ʻia nā hopena o ke koko keʻokeʻo keʻokeʻo maikaʻi ʻole (LP) a me ka PRP keʻokeʻo keʻokeʻo waiwai (LR) i ka hoʻomohala ʻana i ka OA i kahi kiʻi ʻiole ma hope o ka meniscectomy.Ua hōʻike ʻo LP-PRP i ka hana ʻoi aku ka maikaʻi ma ka mālama ʻana i ka nui o ka cartilage i hoʻohālikelike ʻia me LR-PRP.Ua ʻike ʻia kahi meta-analysis o nā hoʻāʻo hoʻokele randomized i ʻoi aku ka maikaʻi o nā hopena i hoʻohālikelike ʻia me ka hyaluronic acid (HA), a ua hōʻike ʻia ka hōʻike subgroup he ʻoi aku ka maikaʻi o nā hopena ma mua o LR-PRP.Eia naʻe, ʻaʻohe hoʻohālikelike pololei ma waena o LR - a me LP-PRP, pono e noiʻi hou aku.ʻO ka ʻoiaʻiʻo, ʻo ka haʻawina nui loa e hoʻohālikelike ana iā LR-PRP me HA e hōʻike ana ʻaʻohe hopena ʻino o LR-PRP.Eia hou, ua hōʻike pololei ʻia kahi noiʻi lapaʻau e hoʻohālikelike ana iā LR-PRP a me LP-PRP ʻaʻole i ʻokoʻa nā hopena ma hope o 12 mau mahina.Loaʻa i ka LR-PRP nā molekole pro-inflammatory a me nā kiʻekiʻe kiʻekiʻe o nā kumu ulu, akā loaʻa pū kekahi kiʻekiʻe o nā cytokine anti-inflammatory, e like me nā interleukin-1 receptor antagonists (IL1-Ra).Ua wehewehe ʻia nā haʻawina hou i ke kaʻina hana "inflammatory regeneration" o nā keʻokeʻo keʻokeʻo e huna ana i nā cytokines pro-inflammatory a anti-inflammatory, e hōʻike ana i ka hopena maikaʻi i ka hoʻōla hou ʻana o ka ʻiʻo.Pono nā haʻawina lapaʻau hou me ka hoʻolālā randomized no ka hoʻoholo ʻana i ka hana maikaʻi loa a i ʻole ka hoʻokumu ʻana o PRP a me ka protocol noi kūpono ma OA.
No laila, manaʻo kekahi e ʻoi aku ka maikaʻi o ka HA a me PRP no nā maʻi me ka OA haʻahaʻa a me ka BMI haʻahaʻa.Ua hōʻike ʻia nā loiloi ʻōnaehana hou he ʻoi aku ka maikaʻi o ka PRP ma mua o HA.Eia nō naʻe, ʻo nā wahi hāmama i manaʻo ʻia me ka lokahi ka pono no ka hoʻomākaukau ʻana i ka PRP maʻamau, nā helu noi, a me ka pono no nā hoʻokolohua hoʻokolohua hou aʻe me ka maikaʻi o ka wai.No laila, ʻaʻole maopopo i kēia manawa nā ʻōlelo aʻoaʻo a me nā alakaʻi i ke kākoʻo a kūʻē paha i ka hoʻohana ʻana i ka osteoarthritis kuli.I ka hōʻuluʻuluʻana, ma muli o nā hōʻike o kēia manawa, nā papahana hoʻomākaukau likeʻole e kaupalena i keʻano hoʻololi kiʻekiʻe, a hiki i ka PRP ke alakaʻi i ka hoʻonuiʻana i kaʻeha i ka OA haʻahaʻa.ʻAʻole ʻōlelo ka hui loea i ka hoʻohana ʻana i ka PRP i nā kūlana OA koʻikoʻi.Ua hōʻike ʻia nā haʻawina hou aʻe e kōkua pū ana ʻo PRP i ka hopena placebo, ʻoi aku hoʻi i ka mālama ʻana i ka OA a i ʻole Epicondylitis lateral.ʻO ka PRP injection he ʻāpana wale nō o ka hoʻolālā lapaʻau holoʻokoʻa e hoʻoponopono i nā pilikia koʻikoʻi o OA.Ma waho aʻe o nā mea koʻikoʻi ʻē aʻe e like me ka pohō kaumaha, ka hoʻoponopono ʻana i nā dislocations, ka hoʻomaʻamaʻa ʻana i nā ʻiʻo, a me nā kuli kuli, hiki ke kōkua i ka hoʻēmi ʻana i ka ʻeha a lawe mai i nā hopena maikaʻi aʻe i nā maʻi.
ʻO ke kuleana o ka PRP i ke kāʻei cartilage regenerative kekahi wahi i hoʻopaʻapaʻa nui ʻia.ʻOiai ua hōʻike ka noiʻi ʻepekema kumu i ka hopena maikaʻi i nā chondrocytes, ʻaʻole lawa nā hōʻike hōʻike lapaʻau no ka hoʻohana ʻana i ka PRP i ka wā o ka ʻoki ʻana, ka hana hou ʻana o ka cartilage, a i ʻole nā pae hoʻoponopono, e hōʻike ana i kā mākou ʻike.Eia kekahi, ʻaʻole maopopo ka manawa kūpono no ka mālama ʻana i ka PRP postoperative.Akā ʻae ka hapa nui o ka poʻe loea e hiki i ka PRP ke kōkua i ka hoʻoulu hou ʻana o ka cartilage biological.I ka hōʻuluʻulu ʻana, ʻo nā hopena o kēia manawa o ka hoʻokolokolo koʻikoʻi e hōʻike ana he pono ka loiloi hou ʻana i ka hana kūpono o ka PRP i ke kaʻina cartilage regenerative.
Nā hōʻailona no ka maʻi ʻeha
ʻO ka hoʻohana ʻana i ka PRP no ka mālama ʻana i ka tendinosis he kumuhana hoʻopaʻapaʻa i ka palapala.ʻO ka loiloi o ka noiʻi ʻepekema kumu e hōʻike ana he hopena maikaʻi ka PRP i loko o ka vitro (e like me ka hoʻonui ʻana i ka hoʻonui ʻana o ka tendon cell proliferation, paipai i nā hopena anabolic, e like me ka hoʻonui ʻana i ka hana collagen) a i loko o ka vivo (hoʻonui ʻana i ka ho'ōla tendon).I loko o ka hoʻomaʻamaʻa lāʻau lapaʻau, ua hōʻike ʻia nā haʻawina he nui ka maikaʻi o ka mālama ʻana i ka PRP a ʻaʻohe hopena i nā maʻi ʻokoʻa a me nā maʻi tendon mau loa.No ka laʻana, ua hoʻokūpaʻa ʻia kahi loiloi ʻōnaehana hou i nā hopena hoʻopaʻapaʻa o ka noi PRP i nā ʻeha tendon like ʻole, ʻoi aku ka maikaʻi o ka hopena maikaʻi i nā lesion tendon kuʻekuʻe kuʻekuʻe lateral a me nā lesion tendon patellar, akā ʻaʻole ma nā lesions Achilles a i ʻole rotator cuff lesions.ʻO ka hapa nui o nā moʻolelo RCT kaʻina hana i nele i nā hopena maikaʻi, a ʻaʻohe mau hōʻike paʻa o kāna noi conservative i nā maʻi rotator cuff.No ka Epicondylitis waho, hōʻike ka meta-analysis i kēia manawa he hopena maikaʻi ka corticosteroids, akā ʻoi aku ka maikaʻi o ka hopena lōʻihi o PRP.Ma muli o nā hōʻike o kēia manawa, ua hōʻike ka patellar a me ka lateral elbow tendinosis i ka hoʻomaikaʻi ʻana ma hope o ka mālama ʻana i ka PRP, ʻoiai ʻaʻole e pōmaikaʻi ka tendon Achilles a me ka rotator cuff mai ka noi PRP.No laila, ua hoʻoholo ka manaʻo o ka ESSKA Basic Science Committee i kēia manawa ʻaʻohe manaʻo i ka hoʻohana ʻana i ka PRP no ka mālama ʻana i ka tendinosis.ʻOiai ka hoʻopaʻapaʻa i loko o ka palapala, e like me ka hōʻike ʻia e ka noiʻi hou a me nā loiloi ʻōnaehana, he kuleana maikaʻi ka PRP i ka mālama ʻana i nā maʻi tendon mai nā kumu ʻepekema a me nā hiʻohiʻona lapaʻau.E noʻonoʻo pono i nā hopena ʻaoʻao o ka corticosteroids i ka wā e hoʻohana ai i nā maʻi tendon.Hōʻike nā hopena o kēia noiʻi i ka manaʻo o Kelemania i kēia manawa he hiki ke hoʻohana ʻia ka PRP no ka mālama ʻana i nā maʻi tendon koʻikoʻi a me ka maʻi.
Hōʻike no ka ʻeha ʻiʻo
ʻO ka hoʻopaʻapaʻa ʻoi aku ka hoʻohana ʻana i ka PRP e mālama i nā ʻeha ʻiʻo, ʻo ia kekahi o nā hōʻeha maʻamau i nā haʻuki ʻoihana, e hopena ma kahi o 30% o nā lā kula.Hāʻawi ka PRP i ka hiki ke hoʻomaikaʻi i ka ho'ōla olaola a me ka hoʻolalelale ʻana i nā helu hoʻoikaika kino, i loaʻa ka manaʻo nui i nā makahiki i hala.ʻOiai ʻo 57% o nā pane i hāʻawi ʻia i ka pōʻai mua i helu i ka hōʻeha ʻana i ka ʻiʻo ma ke ʻano he hōʻailona maʻamau no ka hoʻohana ʻana i ka PRP, aia nō ka nele o ka ʻike ʻepekema paʻa.Ua ʻike kekahi mau haʻawina in vitro i nā pono kūpono o ka PRP i ka ʻeha ʻeha.Ua ho'āʻo maikaʻi ʻia ka wikiwiki o ka hana o ka cell satellite, ka hoʻonui ʻana i ke anawaena fibril regenerated, ka hoʻoulu ʻana o ka myogenesis, a me ka hoʻonui ʻana i ka hana o MyoD a me myostatin.ʻIke hou aku e pili ana iā Mazoka et al.Ua ʻike ʻia ka piʻi ʻana o ka nui o nā mea ulu e like me HGF, FGF, a me EGF ma PRP-LP.Tsai et al.hoʻoikaika i kēia mau ʻike.Ma waho aʻe o ka hōʻoia ʻana i ka hoʻonui ʻia ʻana o ka protein protein o cyclin A2, cyclin B1, cdk2 a me PCNA, ua hōʻike ʻia ua hoʻonui ʻia ka ikaika o ka ʻiʻo ʻiʻo iwi a me ka hoʻonui ʻana o ka cell ma o ka hoʻololi ʻana i nā cell mai ka pae G1 a i nā pae S1 a me G2&M.Ua hōʻuluʻulu ʻia kahi loiloi ʻōnaehana hou i ka ʻepekema ʻepekema o kēia manawa penei: (1) Ma ka hapa nui o nā haʻawina, ua hoʻonui ʻia ka mālama ʻana i ka PRP i ka hoʻonui ʻia ʻana o ka ʻiʻo, ka hōʻike kumu ulu (e like me PDGF-A/B a me VEGF), ke kiʻi ʻana o ke koko keʻokeʻo, a me ka angiogenesis i loko o ka ʻiʻo. hoʻohālikelike ʻia me ke ʻano hoʻohālike pūʻulu mana;(2) ʻAʻole kūlike ka ʻenehana hoʻomākaukau PRP i ka noiʻi ʻana i nā palapala ʻepekema kumu;(3) Hōʻike nā hōʻike mai ka noiʻi ʻepekema kumu in vitro a in vivo hiki ke lawelawe ʻo PRP ma ke ʻano he ala lapaʻau maikaʻi e hiki ai ke hoʻolalelale i ke kaʻina hana hoʻōla o nā maʻi ʻiʻo i hoʻohālikelike ʻia me ka pūʻulu hoʻomalu, e pili ana i nā hopena i ʻike ʻia ma ka pae cellular a me ka pae i loko. ka hui lapaʻau.
ʻOiai ua hōʻike ʻia kahi haʻawina retrospective i ka ho'ōla piha ʻana a manaʻo ʻia ʻaʻole i loaʻa ka manawa ma waho o ka pūnaewele i kahi pōmaikaʻi nui, ʻo Bubnov et al.I loko o kahi noiʻi cohort o nā mea pāʻani 30, ua ʻike ʻia ua hoʻemi ʻia ka ʻeha a ua wikiwiki loa ka wikiwiki o ka hoʻihoʻi ʻana mai ka hoʻokūkū.Hamid et al.I loko o kahi ho'āʻo hoʻokele randomized (RCT) e hoʻohālikelike ana i ka infiltration PRP me nā regimen mālama conservative, ʻoi aku ka wikiwiki o ka hoʻihoʻi ʻana mai ka hoʻokūkū.ʻO ka RCT multicenter makapō pālua wale nō i komo i ka hōʻeha hamstring i nā mea pāʻani (n = 80), a ʻaʻole i ʻike ʻia kahi infiltration placebo nui i hoʻohālikelike ʻia me PRP.ʻAʻole i hoʻokūpaʻa ʻia nā loina olaola, nā ʻike preclinical maikaʻi, a me ka ʻike mua ʻana o ka lāʻau lapaʻau me ka PRP injection i ʻōlelo ʻia ma luna nei e ka RCT kiʻekiʻe.ʻO ka manaʻo o kēia manawa ma waena o nā lālā GOTS ua loiloi i nā lāʻau lapaʻau conservative no ka hōʻeha ʻana i ka ʻiʻo a ua hoʻoholo i kēia manawa ʻaʻohe hōʻike maopopo e hiki ke hoʻohana ʻia ka intramuscular injection e mālama i ka hōʻeha ʻeha.Kūlike kēia me kā mākou hopena, a ʻaʻohe manaʻo i ka hoʻohana ʻana i ka PRP i ka mālama ʻana i ka ʻeha ʻeha.Pono ka noiʻi hou aʻe e pili ana i ka nui, ka manawa, a me ka pinepine o ka PRP i ka ʻeha ʻeha.Ke hoʻohālikelike ʻia i ka ʻeha cartilage, i ka ʻeha ʻiʻo, ka hoʻohana ʻana i nā algorithms lapaʻau, ʻoi aku ka PRP, pili paha i ke kiʻekiʻe a me ka lōʻihi o ka ʻeha, e hoʻokaʻawale i waena o ke komo ʻana o ke anawaena o ka ʻiʻo ʻeha a me ka hōʻeha tendon a i ʻole ka ʻeha avulsion.
ʻO ke kahua noi o PRP kekahi o nā wahi i kūkākūkā pinepine ʻia, a ʻo ka nele o ka standardization i kēia manawa kekahi o nā pilikia nui i nā hoʻokolohua lapaʻau.ʻAʻole i ʻike ka hapa nui o ka poʻe loea i ka hoʻonui ʻana i ka hoʻohana ʻana i ka PRP, akā naʻe, ua hōʻike kekahi mau haʻawina e hiki ke hoʻohālikelike ʻia ka hoʻohana hou ʻana o ka hyaluronic acid me ka hoʻohana hoʻokahi o PRP no OA.ʻO ka manaʻo manaʻo he pono ke hāʻawi ʻia i nā injections he nui no nā maʻi maʻi maʻi, a kākoʻo ke kahua OA i kēia manaʻo, kahi i ʻoi aku ka maikaʻi o nā injections ma mua o nā injections hoʻokahi.Ke ʻimi nei ka noiʻi ʻepekema kumu i ka pilina hopena o ka PRP, akā pono e hoʻoneʻe ʻia kēia mau hopena i ka noiʻi lapaʻau.ʻAʻole i hoʻoholo ʻia ka noʻonoʻo maikaʻi loa o ka PRP, a ua hōʻike ʻia ka noiʻi e loaʻa paha nā hopena maikaʻi ʻole i nā kiʻekiʻe kiʻekiʻe.Pēlā nō, pili ka hopena o nā keʻokeʻo keʻokeʻo i ka hōʻailona, a ʻo kekahi mau hōʻailona e koi i ka PRP me nā keʻokeʻo keʻokeʻo maikaʻi ʻole.He kuleana koʻikoʻi ka ʻokoʻa o ka haku mele PRP pākahi i ka hopena o ka PRP.
Nā Wahi Imi Hou
Ua ʻae like ʻia e like me nā puke hou, pono hou ka noiʻi ʻana i ka PRP i ka wā e hiki mai ana.ʻO kekahi o nā pilikia koʻikoʻi ʻo ia ka hoʻohālikelike ʻana o ka PRP e ʻoi aku ka maikaʻi (me 95% kūlike).ʻO kekahi mea hiki ke hoʻokō i kēia pahuhopu ʻo ia ka hōʻuluʻulu ʻana o nā platelets e hoʻokō i nā puke nui, ʻoi aku ka maʻamau.Eia kekahi, ʻaʻole ʻike ʻia nā ʻokoʻa like ʻole no ka hoʻohana ʻana i ka lāʻau lapaʻau, e like me ka nui o nā injections e hoʻohana ʻia, ka manawa ma waena o nā injections, a me ke ʻano o ka PRP.Ma kēia ala wale nō e hiki ai ke alakaʻi i ka noiʻi kiʻekiʻe a loiloi i nā hōʻailona kūpono loa no ka hoʻohana ʻana i ka PRP, ka hana ʻana i ka noiʻi ʻepekema a me ka noiʻi lapaʻau, ʻoi aku ka maikaʻi o nā haʻawina hoʻokele randomized, pono.ʻOiai ua loaʻa ka manaʻo ʻae he kuleana koʻikoʻi paha ka PRP i ka wā e hiki mai ana, me he mea lā ua pono ka noiʻi hoʻokolohua a me nā noiʻi lapaʻau i kēia manawa.
Ka palena
ʻO kekahi palena o ka hoʻāʻo ʻana o kēia noiʻi e hoʻoponopono i ke kumuhana i hoʻopaʻapaʻa nui ʻia o ka noi PRP ʻo ia kona ʻano lāhui.ʻO ka loaʻa ʻana o ka PRP a me nā ʻokoʻa ʻāina i ka hoʻihoʻi hou ʻana e pili ana i nā hopena a me nā ʻano hoʻoponopono.Eia kekahi, ʻaʻole multidisciplinary ka consensus a loaʻa wale nā manaʻo o nā kauka orthopedic.Eia nō naʻe, ʻike ʻia paha kēia he mea maikaʻi no ka mea ʻo ia wale nō ka hui e hoʻokō ikaika ana a mālama i ka lāʻau inikini PRP.Eia kekahi, he ʻano ʻano ʻano ʻano ʻokoʻa ka loiloi i hoʻohālikelike ʻia i ke kaʻina hana Delphi i hoʻokō pono ʻia.ʻO ka pōmaikaʻi he ʻaelike i hoʻokumu ʻia e kahi pūʻulu o nā kauka orthopedic ʻoihana me ka ʻike ʻoihana nui i kā lākou mau ʻoihana mai nā hiʻohiʻona o ka ʻepekema kumu a me ka hana lapaʻau.
Manaʻo
Ma muli o ka ʻae ʻana o ka liʻiliʻi o 75% o nā poʻe loea i komo, e hōʻea i ka ʻae ʻana ma nā wahi aʻe:
ʻO ka ʻeha a me ka ʻeha cartilage: ʻO ka hoʻohana ʻana i ka osteoarthritis kuli haʻahaʻa (ka papa KL II) pono paha
ʻO ka maʻi maʻi tendon: Hiki ke hoʻohana i nā maʻi tendon koʻikoʻi a me ka maʻi
Manaʻo hoʻomaʻamaʻa: No nā ʻeha mau loa (cartilage, tendons), ʻoi aku ka maikaʻi o nā injections lehulehu (2-4) i nā wā āpau ma mua o hoʻokahi injection.
Eia naʻe, ʻaʻole lawa ka ʻikepili i ka manawa ma waena o nā injections hoʻokahi.
Ka noiʻi e hiki mai ana: Manaʻo nui ʻia e hoʻohālikelike i ka hana, hoʻomākaukau, hoʻohana ʻana, alapine, a me nā hōʻailona hōʻailona o PRP.Pono nā noiʻi kumu a me nā noiʻi lapaʻau.
Ka hopena
ʻO ka manaʻo manaʻo nui, aia nā ʻokoʻa i nā hōʻailona like ʻole o ka noi PRP, a aia nō ka nui o ka kānalua i ka hoʻohālikelike ʻana o ka papahana PRP ponoʻī, ʻoi aku hoʻi no nā hōʻailona like ʻole.ʻO ka hoʻohana ʻana i ka PRP i ka osteoarthritis mua o ke kuli (KL grade II) a me nā maʻi tendon koʻikoʻi a me ka maʻi maʻi hiki ke hoʻohana.No nā maʻi maʻi maʻi (cartilage a me ka tendon), ʻoi aku ka maikaʻi o ka manawa o nā injections (2-4) ma mua o nā injections hoʻokahi, akā ʻaʻole lawa ka ʻikepili i ka manawa ma waena o nā injections hoʻokahi.ʻO kahi pilikia nui ke ʻano like ʻole o ka haku mele PRP pākahi, kahi mea nui i ka hana o ka PRP.No laila, pono e ʻoi aku ka maikaʻi o ka hana ʻana o ka PRP, a me nā ʻāpana lapaʻau e like me ka pinepine o ka injection, a me ka manawa ma waena o ka injection a me nā hōʻailona pololei.ʻOiai no ka OA, ka mea i hōʻike ʻia i kēia manawa ke kahua noiʻi maikaʻi loa no ka noi PRP, pono ka noiʻi ʻepekema a me ka noiʻi lapaʻau, a me nā hōʻailona ʻē aʻe.
（Paʻi hou ʻia nā mea o kēia ʻatikala, ʻaʻole mākou e hāʻawi i ka hōʻoiaʻiʻo a i ʻole ka hōʻoia ʻana no ka pololei, hilinaʻi a i ʻole ka piha o nā mea i loko o kēia ʻatikala, a ʻaʻole kuleana no nā manaʻo o kēia ʻatikala, e ʻoluʻolu e hoʻomaopopo.)
Ka manawa hoʻouna: Mei-24-2023