自体富血小板血浆对前交叉韧带重建术后腱骨愈合的影响

目的 观察自体富血小板血浆(APRP)对前交叉韧带(ACL)重建术后腱骨愈合的影响.方法 回顾性分析2017年8月至2020年7月在济宁医学院附属医院接受ACL重建术治疗的86例患者的临床资料,按是否接受PRP治疗分为观察组(n=41)和对照组(n=45).观察组于术中用APRP处理移植肌腱,并在股骨隧道与移植物间注入...     

Advances with platelet rich plasma therapies for tendon regeneration

Introduction: PRPs can be used in the management of tendinopathy if we improve our understanding of pathophysiology and to integrate molecular knowledge about PRP participation in healing mechanisms.

Areas covered: We provide new insights into the pathophysiology of tendinopathy, PRP therapies, and the potential links between both. We discuss the place of PRP in promoting tendon repair within what is currently understood regarding the role of PRP molecules in promoting tendon regeneration.

Expert opinion: Development of PRP treatments is challenging because a typical group of patients with tendinopathy does not exist, as it affects multiple segments of the population. Moreover, the pathophysiology and origin of pain are not elucidated yet. Although some degree of success has been achieved, PRP is not considered standard medical treatment, and it is largely not paid nor reimbursed by insurance companies. However, the arguments for using PRP in tendinopathy are increasing, and its potential to rebalance inflammation merits further research. Moreover, PRP contains tendoinductive factors that can drive the fate of stem cells. Tailoring PRPs to the specific needs of the host tendon has not been possible to date, because unanswered questions remain about the characteristics of tendinopathy within the different stages of progression.     

富血小板血浆协同骨形态发生蛋白4促进骨愈合的效应

背景：研究表明骨形态发生蛋白在骨骼发育中的起到关键性作用;文献报道单独的富血小板血浆在动物或者临床试验中并不具备明显促进移植骨组织愈合的作用。目的：验证富血小板血浆协同骨形态发生蛋白4促骨缺损区的成骨作用。方法：24只新西兰大白兔构建上颌骨骨缺损模型,随机分为4组,每组6只。1空白对照组建模后不做特殊处理。2β-磷酸三钙＋Bio-gide生物膜组为β-磷酸三钙0.1 g＋Bio-gide生物膜1张。3富血小板血浆组为β-磷酸三钙0.1 g＋Bio-gide生物膜1张＋富血小板血浆1 mL。4富血小板血浆＋骨形态发生蛋白4组为β-磷酸三钙0.1 g＋Bio-gide生物膜1张＋富血小板血浆1 mL＋5μg骨形态发生蛋白4。于造模后4,8,12周行大体观察、组织学观察及图像分析各组骨缺损区新生骨生成情况。结果与结论：术后4周,富血小板血浆组、富血小板血浆＋骨形态发生蛋白4组骨缺损区新生骨以及新生血管均多于β-磷酸三钙＋Bio-gide组（P〈0.01）;β-磷酸三钙＋Bio-gide组新成骨多于空白对照组（P〈0.01）。术后4,8,12周,富血小板血浆＋骨形态发生蛋白4组骨缺损区新生骨均多于β-磷酸三钙＋Bio-gide组、富血小板血浆组两组骨缺损区（P〈0.01）,β-磷酸三钙＋Bio-gide组和富血小板血浆组均多于空白对照组（P〈0.01）。结果表明以β-磷酸三钙为支架,富血小板血浆复合骨形态发生蛋白可明显促进骨缺损的愈合。     

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

PurposeThe efficacy of platelet-rich plasma (PRP) in the treatment and healing of chronic tendinopathy through stimulation of cell proliferation and total collagen production has been demonstrated by both in vitro and in vivo studies. The aim of this study is to evaluate the effectiveness of ultrasound (US)-guided autologous PRP injections in patellar and Achilles tendinopathy.Materials and methodsAutologous PRP was injected under US-guidance into the Achilles and patellar tendons (30 Achilles tendons, 28 patellar tendons) in 48 prospectively selected patients (30 males, 18 females, mean age 38 ± 16 years, range 20–61 years). All patients were previously evaluated according to the Victoria Institute of Sport Assessment (VISA) scale, which assessed pain and activity level, and they all underwent US of the tendon before treatment and at follow-up after 20 days and 6 months. Statistical analysis was performed with Chi-square and Wilcoxon tests.Results20 days after PRP injection the patients presented a non-significant improvement of clinical symptoms. At the 6-month follow-up VISA score increased from a mean value of 57–75.5 (p < .01). US evaluation revealed a reduction of hypoechoic areas in 26 tendons (p < .01) associated with a widespread improvement of fibrillar echotexture of the tendon and reduced hypervascularity at power Doppler.ConclusionPRP injection in patellar and Achilles tendinopathy results in a significant and lasting improvement of clinical symptoms and leads to recovery of the tendon matrix potentially helping to prevent degenerative lesions. US-guidance allows PRP injection into the tendon with great accuracy.     

Autologous platelet-rich plasma for wound and osseous healing: A review of the literature and commercially available products

The application of autologous platelets that have been sequestered, concentrated, and mixed with thrombin to create growth factor-concentrated, autologous platelet-rich plasma for application to soft tissue wounds and for osseous healing has been a subject of great interest for much of the past 2 decades. Autologous platelet-rich plasma, which consists of both quantitative and qualitative components, has the greatest potency or ability to produce the desired effect. Manufacturers prepare autologous platelet-rich plasma with the ultimate goal of maximizing its benefits while minimizing potential risks. Unfortunately, the manufacturing processes for autologous platelet-rich plasma are highly variable, and the types of proprietary systems available on the market for soft tissue and osseous applications are numerous. The authors provide here an in-depth review of commercially available systems for delivery of autologous platelet-rich plasma that emphasizes the subtle yet important differences among systems. In addition, a detailed review of the literature regarding the use of autologous platelet-rich plasma in soft tissue and osseous healing is provided. Although findings are not yet conclusive, autologous platelet-rich plasma has been shown to be safe, reproducible, and effective in mimicking the natural processes of soft tissue wound and osseous healing.     

自体富血小板血浆促进美容外科伤口愈合的临床观察

目的观察与评价自体富血小板血浆在美容整形外科中的应用效果。方法选取2006年2月~2010年12月共6名在广州军区广州总医院激光整形美容中心和暨南大学第一附属医院整形烧伤外科接受美容整形手术治疗的患者,其中面部除皱2例,双颞部凹陷自体脂肪充填2例,自体脂肪隆胸1例,乳房提升术1例。术前抽取患者静脉血液20~60 ml,通过离心技术收集富血小板成分的血浆,在一侧术区外用,对侧不做其他特殊处理。结果随访时间1~2年,使用自体富血小板血浆的一侧,创面愈合质量有显著提升,瘢痕减少。结论自体富血小板血浆能显著提高美容整形手术的愈合能力及自体脂肪移植的成活率,且该方法操作简单,可行性强,值得临床推广。     

A biological therapy to osteoarthritis treatment using platelet-rich plasma

Introduction: Osteoarthritis (OA) is a degenerative disease affecting the synovial joint. It is caused by cells exposure to non-physiological stimuli, either mechanical or biochemical, and the loss of bone-cartilage homeostasis. Some of these changes, however, may be reversed by the use of single or combined growth factors, suggesting that the treatment of OA could be addressed using a pool of growth factors.

Areas covered: This review addresses current molecular and biological knowledge and implicates the recapitulation of some developmental processes during endochondral ossification in OA aetiology and pathogenesis. Platelets act as carriers of endogenous morphogens that may modulate cell fate and therefore affect joint tissues structure and function. We shed light on the platelet-rich plasma effects on biological level that might drive the osteoarthritic joint's improvement both in structure and function.

Expert opinion: We present the therapeutic potential of plasma rich in growth factors (PRGF-Endoret), an endogenous biological therapy that might modulate the gene expression of cells such as chondrocytes, synoviocytes, macrophages, and mesenchymal stem cells, and thereby influence an anabolic microenvironment of synovial joint which is conducive to maintaining the homeostatic state of the joint's tissues, and hence reduce pain and improve the joint motion.     

Separation of platelet-rich plasma by modified centrifugal elutriation

The Beckman centrifugal elutriation (CE) system is modified for the separation of platelet-rich plasma (PRP) from human and rabbit blood. The Beckman separation chamber is found inadequate for this purpose, and a new chamber of conical shape has been developed. Optimal flow rate for separating PRP from whole blood with the new chamber of 11.3 ml capacity is 3.5 ml/min while centrifuging at 2500 rpm or 700g. Collection process takes about 4 minutes. This new process is based on the principle of centrifugal counterflow displacement and filtration, and is different from the CE process which is based on counterflow centrifugation and differential elution. About 90% of total platelets are recovered with this new process. The collected samples are free of leucocytes and contained only a few erythrocytes. Platelets collected by either differential centrifugation (DC) or new procedures are found to be similar in morphological characteristics, both being discoidal. Other characteristics such as aggregation response induced by ADP or epinephrine, serotonic-¹⁴C secretion, and survival of autologous platelets in rabbits are also found to be similar. However, ATP release induced by ADP is consistently higher from platelets prepared by our procedure than from those prepared by the DC procedure.     

Evaluation of wound healing in diabetic foot ulcer using platelet-rich plasma gel: A single-arm clinical trial

The aim of the present study was to evaluate the effectiveness of using autologous platelet-rich plasma (PRP) gel for treatment of diabetic foot ulcer (DFU) during the first 4 weeks of the treatment. In this longitudinal and single-arm trial, 100 patients were randomly selected after meeting certain inclusion and exclusion criteria; of these 100 patients, 70 (70%) were enrolled in the trial. After the primary care actions such as wound debridement, the area of each wound was calculated and recorded. The PRP therapy (2 mL/cm² of ulcers) was performed weekly until the healing time for each patient. We used one sample T-test for healing wounds and Bootstrap resampling approach for reporting confidence interval with 1000 Bootstrap samples. The p-value < 0.05 were considered statistically significant. The mean (SD) of DFU duration was 19.71 weeks (4.94) for units sampling. The ratio of subjects who withdrew from the study was calculated to be 2 (2.8%). Average area of 71 ulcers in the mentioned number of cases was calculated to be 6.11 cm² (SD: 4.37). Also, the mean, median (SD) of healing time was 8.7, 8 weeks (SD: 3.93) except for 2 mentioned cases. According to one sample T-test, wound area (cm²), on average, significantly decreased to 51.9% (CI: 46.7–57.1) through the first four weeks of therapy. Furthermore, significant correlation (0.22) was not found between area of ulcers and healing duration (p-value > 0.5). According to the results, PRP could be considered as a candidate treatment for non-healing DFUs as it may prevent future complications such as amputation or death in this pathological phenomenon.     

自体富血小板血浆治疗膝骨关节炎的临床效果

目的 探索自体富血小板血浆治疗膝骨关节炎的临床效果.方法 选择80例膝骨关节炎患者为研究对象,根据单双号随机将其分为对照组和观察组,每组40例.对照组采用关节腔内注射玻璃酸钠法治疗,观察组采用自体富血小板血浆治疗.比较两组的治疗效果.结果 治疗12周后,观察组的Lysholm评分、膝关节活动度优于对照组(P<0.05)...     

富白细胞-血小板血浆凝胶释放的炎性生长因子

背景：目前对富白细胞-血小板血浆凝胶的研究主要集中在生长因子的释放及其促进组织和创面生长的作用机制方面. 目的：通过测定富白细胞-血小板血浆凝胶中释放的白细胞介素1,4,6和血小板源性生长因子BB、转化生长因子β、血管内皮生长因子的水平,观察富白细胞-血小板血浆凝胶超微结构,对其抗菌作用和促进溃疡愈合的作用机制进行进一步探讨. 方法：取健康志愿者空腹静脉血离心、分离得到富白细胞-血小板血浆,再以10∶1的比例加入激活剂后混匀得富白细胞-血小板血浆凝胶.将凝胶保存在DMEM培养基中,分别于培养1,3,7,14,21 d后收集含有渗出液的培养基进行实验. 结果与结论：酶联免疫吸附法检测结果显示,健康志愿者富白细胞-血小板血浆凝胶中各类白细胞所占比例与全血有所不同,淋巴细胞所占比例最大.白细胞介素1在培养0-1 d达到峰值（P 〈0.05）,之后逐渐下降.白细胞介素4各时间段释放量无差异.白细胞介素6的释放量在培养0-1 d,2-3 d和4-7 d保持较高水平,培养8-14 d和15-21 d释放量明显下降（P〈0.05）.血小板源性生长因子BB和转化生长因子β在培养1 d释放量最大（P〈0.05）,之后迅速下降.血管内皮生长因子表现为培养7 d逐渐上升,培养8-21 d缓慢下降.扫描电镜观察可见,凝胶中绝大部分白细胞为淋巴细胞.结果证实,富白细胞-血小板血浆凝胶的促进创面愈合的机制除与血小板源性生长因子 BB、转化生长因子β、血管内皮生长因子的释放有关外,可能与富集更多的淋巴细胞及白细胞介素1,4,6的释放有关.     

富血小板血浆(PRP)联合点阵疗法治疗雄激素源性脱发的临床观察

目的观察富血小板血浆(PRP)联合点阵疗法治疗雄激素源性脱发的疗效及安全性。方法采用随机对照方法,纳入90例男性雄激素源性脱发患者,随机分为联合组、PRP组、非那雄胺组,各30例,非那雄胺组采用口服非那雄胺治疗,PRP组采用PRP外用+口服非那雄胺治疗,联合组采用PRP外用+点阵疗法+口服非那雄胺治疗,观察治疗前后受试者脱发及头皮油腻、瘙痒等症状改善情况评价临床疗效,监测血液、尿液常规及肝肾功能等指标评价安全性。结果经治疗后,联合组有效率93.33%,PRP组76.67%,非那雄胺组66.67%,三组有效率具有显著差异(P <0.05),联合组疗效优于PRP组,优于非那雄胺组;联合组1例、PRP组3例受试者在治疗中出现轻微肌肤刺痛、红斑,予冰敷处理后症状消失;PRP组2例受试者出现少量红色丘疹,原因为肌肤过感,给予抗敏治疗后缓解;三组患者均未出现瘢痕或者感染,血液、尿液常规及肝肾功检测均未出现异常。结论富血小板血浆联合点阵疗法对雄激素源性脱发患者临床疗效显著,安全性高,值得推广应用。     

超声引导下富血小板血浆注射治疗肩袖部分撕裂的临床疗效观察

目的：观察超声引导下富血小板血浆注射治疗肩袖部分撕裂的临床疗效。方法：42例肩袖部分撕裂患者随机分为观察组和对照组各21例,2组各有1例脱落,最终各20例完成研究。观察组给予超声引导下富血小板血浆注射治疗,对照组给予超声引导下玻璃酸钠注射治疗。2组均每周治疗1次,共3次。分别于治疗前、治疗后1、3及6个月,采用视觉模拟评分（VAS）、Constant-Murley评分（CMS）和美国肩肘外科医师评分（ASES）对2组患者的肩关节疼痛及功能情况进行评估,并记录不良事件发生情况。同时,于治疗前和治疗后6个月对所有患者进行超声检查记录撕裂大小以评估肌腱结构完整性。结果：在治疗后1个月,2组的VAS、CMS、ASES评分差异无统计学意义。在治疗后3个月和6个月,观察组的VAS评分较对照组降低、CMS和ASES评分较对照组升高（均P＜0.05）,在治疗后6个月,观察组的撕裂尺寸较对照组降低（均P＜0.05）;在治疗后随访的任何时期,2组患者的VAS均较治疗前降低、CMS和ASES评分均较治疗前升高（均P＜0.05）;观察组的撕裂尺寸较治疗前降低（P＜0.05）,而对照组的改变无统计学意义。结论：超声引导下富血小板血浆注射不仅可显著改善肩袖部分厚度撕裂患者肩关节疼痛和功能,而且减小撕裂尺寸,促进撕裂肌腱组织再生。     

异体骨髓间充质干细胞联合自体PRP促进皮肤慢性溃疡创面愈合的实验研究

目的探讨在皮肤慢性溃疡处注射异体骨髓间充质干细胞（BMSC）和自体富血小板血浆（PRP）对皮肤的再生和重建的作用。方法选择健康6—8周龄SD大鼠17只,取其中1只大鼠,采用全骨髓法体外分离培养BMSC,取传至第3代细胞,移植前48h行DiI荧光标记。剩余16只大鼠麻醉后制作全层皮肤缺损模型,于其背部脊柱两侧制作4个全层皮肤缺损创面并随机分为4组。A组局部注射异体BMSC悬液联合PRP治疗,B组局部单纯注射异体BMSC悬液,C组局部单纯注射PRP治疗,D组局部注射等量生理盐水。治疗7、14d采集标本观察结果。采用大体观察、苏木素一伊红染色、荧光显微镜观察创面愈合情况。结果体外分离培养的BMSC具有成脂、成骨、成神经分化潜能。在治疗后7、14d,A、B、C组创面愈合时间均短于D组,A组愈合时间比B、C组缩短。组织学观察发现A组新生真皮相应时间点的厚度、血管和胶原纤维均明显多于其他3组。结论在皮肤慢性溃疡处联合应用异体BMSC和自体PRP,能加速真皮的修复和重建。     

富血小板血浆复合Bio-Oss/Bio-Gide修复兔牙槽骨临界骨缺损

背景：有研究发现,富血小板血浆可促进骨、软组织损伤修复,但在骨愈合过程中的作用仍存在争议,目前尚无定论。目的：对比观察富血小板血浆复合Bio-Oss/Bio-Gide在兔牙槽骨缺损修复过程中的成骨效果,以探讨富血小板血浆在骨损伤愈合中的作用。方法：选择新西兰大白兔16只,手术建立兔下颌牙槽骨临界骨缺损模型,采取自身对照,随机选择一侧下颌骨以富血小板血浆/Bio-Oss/Bio-Gide修复骨缺损（实验侧）;另外一侧以Bio-Oss/Bio-Gide修复骨缺损（对照侧）。分别于术后2,4,8,12周时各处死4只,通过大体观察、X射线观察、CBCT骨密度测定、组织学切片观察以及新生骨占缺损面积百分比的测定,定性及定量分析牙槽骨缺损区的成骨效果。结果与结论：术后2-12周的X射线、CBCT及组织学切片观察显示,实验侧和对照侧均有不同程度的新骨形成以及植骨材料的降解吸收;12周时,实验侧缺损表面可见连续的皮质骨形成,植骨区新骨形成并趋于成熟,植骨材料降解吸收明显,对照侧修复效果次之。在术后2,4,8,12周各时间点,实验侧骨密度值均低于对照侧（P〈0.05）,实验侧新生骨占面积百分比均大于对照侧（P〈0.05）。说明在兔下颌牙槽骨缺损修复中,富血小板血浆/Bio-Oss/Bio-Gide比Bio-Oss/Bio-Gide具有更好的成骨效果,表明富血小板血浆可促进新骨的形成以及Bio-Oss骨粉的降解吸收。     

富血小板血浆对关节镜治疗膝关节退行性病变患者疗效的影响

目的探讨术中应用富血小板血浆(PRP)对膝关节镜治疗膝关节退行性病变患者术后疼痛、功能恢复和生活质量的影响。方法采用随机对照双盲试验(RCT)设计,将需行关节镜手术的58例膝关节软骨或半月板退行性变患者随机分配至干预组(n=24)或对照组(n=34)。关节镜治疗期间,PRP组关节内注射PRP。评估术前、术后6周、术后6个月和术后12个月时的术后疼痛、功能恢复和生活质量情况。结果 58例患者随访至研究结束(即随访12个月)。PRP组患者术后6个月时疼痛评分明显低于对照组[(0.9±0.1)和(2.3±0.4)分,P=0.008],但术后12个月时无差异[(1.4±0.6)和(1.6±0.8)分,P=0.163]。PRP组患者术后6和12个月Lysholm评分均高于术前[(77.5±19.8)和(41.7±16.5)分,P=0.011;(83.2±18.2)和(41.7±16.5)分,P=0.003]。生活质量SF-36评分显示,PRP组SF-36身体健康评分在术后6周达到峰值,而SF-36心理健康评分术后6周、术后6个月和术后12个月均明显高于对照组,且同样是在术后6周分值最高。结论与单用关节镜相比,术中应用PRP可在术后6和12个月缓解术后疼痛和促进膝关节功能恢复。     

兔富血小板血浆制备及其活性分析

背景：富血小板血浆是目前已知富含多种生长因子并能将其释放的自体提取物,并已应用于骨、软骨组（：织工程再生的研究。目的：通过比较不同方法制备兔富血小板血浆中血小板浓度,并测定其血小板源性生长因子、转化生因子β1水平,探讨富血小板血浆制备方法及影响因素。方法：采用Pet八Jngar0法、Landesberg法、Aghaloo法制备新西兰大耳白兔富血小板血浆。检测3组富血小板血浆中血小板计数,以及3组富血小板血浆活化前后及正常血浆、贫血小板血浆中血小板源性生长因子、转化生因子β1水平。结果与结论：3种方法制备的富血小板血浆中血小板计数、血小板回收率、血小板富集系数差异有非常显著性意义（P〈0．001）,Landesberg法和AghaIoo法均可制备有效浓度的富血小板血浆,且AghaIoo法制备血小板浓度及活性高于Landesbe叼法（P〈0．05）。活化前3组富血小板血浆中血小板源性生长因子、转化生因子β1水平与正常血浆组、贫血小板血浆组比较差异无显著性意义。活化后,Landesberg法和AghaIoo法制备的血小板血浆中血小板源性生长因子、转化生因子β1水平明显高于活化前（P〈0．001）,且AghaIoo法最高（P〈0．05）。富血小板血浆中血小板计数与血小板源性生长因子水平（P＜0．872,P〈0．001）,转化生因子β1水平（P＜0．917,P〈0．001）呈正相关。     

Evaluation of platelet-rich plasma gel potential in acceleration of wound healing duration in patients underwent pilonidal sinus surgery: A randomized controlled parallel clinical trial

Objectives

One of the most important surgical issues applied in the treatment of pilonidal sinus disease is wound healing. The aim of this study was to investigate the possible effect of platelet-rich plasma (PRP) gel on accelerating wound healing in these patients.