Autologous platelets and leukocytes can improve healing of infected high-energy soft tissue injury

Despite advances in surgical techniques and pharmacology, healing of injury-associated soft tissue defects is frequently complicated by infections, which often requires a secondary intervention.Cytokines are important mediators of healing. Application of autologous platelet-rich plasma enriched in growth factors and antimicrobial proteins, known also as platelet–leukocyte rich plasma (PLRP), represents a novel approach to the treatment of soft tissue and bone healing disturbances. This case is the first report on the application of PLRP in an infected high-energy soft tissue injury and shows that the volume and concentration of platelets and leukocytes is adequate to induce healing processes despite concurrent infection.     

富血小板血浆促进骨修复的理论研究与临床实践

目的:归纳总结富血小板血浆的发展、作用机制及目前还存在的问题,为富血小板血浆的临床应用提供参考。资料来源:应用计算机检索Medline1995-01/2005-06关于富血小板血浆对骨修复的作用的相关文献。检索词“platelet-richplasma,bone,re-pair”,同时应用计算机检索万方数据库1998-01/2005-06期间的上述相关文章,限定文章语言种类为中文,检索词“富血小板血浆,骨,修复”。资料选择:选择有关富血小板血浆和骨修复的中外研究文献;未排除非随机对照的研究文献。资料提炼:49篇关于富血小板血浆与骨修复的文献,其中40篇符合标准。排除的9篇文献是因为重复的同一研究。对剩余的40篇文献进行分类整理,予以综述。资料综合:富血小板血浆在1998年首先被应用于临床修复下颌骨缺损,在颌面缺损处植入自体骨与富血小板血浆的复合物,骨密度影像测定发现富血小板血浆组与单用自体骨的对照组相比,其骨成熟度是对照组的1.62～2.61倍。在随后的这些年里,富血小板血浆已经在很多医学领域被用来促进组织修复,其特点:安全,简便,廉价。但目前仍有一些问题有待进一步研究和解决。结论:富血小板血浆包含多种生长因子,且已被证明可促进骨组织和软组织的修复。富血小板血浆经离心自体血而制成,制作简单,安全。由于是自源性的,根本上排除了疾病传播及免疫排斥的可能。     

Examination of the Role of Platelet-Rich Plasma in Meniscal Tears

The role of platelet-rich plasma in meniscal tears in humans has yet to be fully examined in the literature. Meniscal tears remain a prevalent and common orthopedic injury. Numerous methods of treatment for this condition are available, ranging from conservative methods to surgical options. Platelet-rich plasma is a biologic agent that is minimally invasive, can have regenerative properties, and may aid healing for patients. This article offers a current review of the literature examining platelet-rich plasma in meniscal tears and recovery.     

自体富血小板血浆与自体骨移植治疗粉碎性骨折：随机对照随访

背景：实验发现,富血小板血浆＋骨移植修复骨缺损,不仅使新骨形成速度快,而且成骨密度高。目的：观察自体富血小板血浆与自体骨移植治疗粉碎性骨折,观察其疗效。方法：临床随机对照前瞻性队列研究。选取四肢粉碎性骨折及骨缺损患者42例,随机分为2组：实验组20例采用自体富血小板血浆与自体髂骨松质骨混合,植于粉碎性骨折骨缺损处;对照组22例仅行钢板螺钉或髓内钉内固定。术后及治疗后1,3,6,12个月拍摄X射线片检查,比较两组愈合情况、愈合速度,以及功能恢复情况。结果与结论：骨折愈合时间,实验组平均12周,对照组18周,两者比较差异有显著性意义。对照组有2例发生钢板断裂,1例骨不连再次手术,3例骨折延迟愈合;实验组未出现自体输血及其他并发症。结果说明自体富血小板血浆与自体骨移植治疗粉碎性骨折可促进和加速骨愈合。     

State of the art and future perspectives of articular cartilage regeneration: a focus on adipose-derived stem cells and platelet-derived products

Trauma, malposition and age-related degeneration of articular cartilage often result in severe lesions that do not heal spontaneously. Many efforts over the last centuries have been undertaken to support cartilage healing, with approaches ranging from symptomatic treatment to structural cartilage regeneration. Microfracture and matrix-associated autologous chondrocyte transplantation (MACT) can be regarded as one of the most effective techniques available today to treat traumatic cartilage defects. Research is focused on the development of new biomaterials, which are intended to provide optimized physical and biochemical conditions for cell proliferation and cartilage synthesis. New attempts have also been undertaken to replace chondrocytes with cells that are more easily available and cause less donor site morbidity, e.g. adipose derived stem cells (ASC). The number of in vitro studies on adult stem cells has rapidly increased during the last decade, indicating that many variables have yet to be optimized to direct stem cells towards the desired lineage. The present review gives an overview of the difficulties of cartilage repair and current cartilage repair techniques. Moreover, it reviews new fields of cartilage tissue engineering, including stem cells, co-cultures and platelet-rich plasma (PRP).     

Updates in biological therapies for knee injuries: tendons

Tendons are subjected to tendinopathies caused by inflammation, degeneration, and weakening of the tendon, due to overuse and trauma, which may eventually lead to tendon rupture. Recently, there has been increasing interest in biological approaches to augment tissue healing. Tendon healing occurs through a dynamic process with inflammation, cellular proliferation, and tissue remodeling. In this review article, we discuss the more frequently proposed biological therapies for tendon injuries as platelet-rich plasma, mesenchymal stem cells, extracorporeal shockwave, and scaffolds.     

Autologous platelet-rich plasma in the treatment of refractory wounds in cutaneous leukocytoclastic vasculitis complicated with hypertension (grade 2 moderate risk): A case report

IntroductionCutaneous leukocytoclastic vasculitis is an inflammatory variant of vasculitis with a variety of causes that only affects the skin. Its pathological manifestations include neutrophil infiltration and nuclear fragmentation. Clinically, it is characterised by a pleomorphic rash, including erythema, purpuric skin lesions, reticulocytosis, necrosis and ulceration. Once formed, local ulcerations are very difficult to heal.Case presentationA 46-year-old female was diagnosed with cutaneous leukocytoclastic vasculitis. The patient’s legs exhibited ulcers with a black eschar on the surface. The largest wound was 4.5 × 4.0 cm and the deepest wound was 1.7 × 1.8 × 1.0 cm. The ulcers had been present for 6 months and did not exhibit signs of healing. Treatment was commenced with platelet-rich plasma, and the wounds healed within 1 month.ConclusionTopical application of autologous platelet-rich plasma gel exerts beneficial effects in cutaneous leukocytoclastic vasculitis with regard to wound size reduction, and it induces granulation tissue formation. Platelet-rich plasma may represent a safe and cost-effective treatment for managing cutaneous wound healing to reduce the length of the recovery period.     

Current opinion about using the platelet-rich gel in orthopaedics and trauma surgery

The use of growth factors in combination with tissue engineering seems to be the most promising method in the future for the treatment of tissue, bone and cartilage defect. Growth factors are cytokines with regulatory functions for healing in tissues of the musculoskeletal system. These small peptides are synthesised by resident cells at the site of injury such as mesenchymal stem cells and chondrocytes, or by the infiltrating inflammatory process. Platelet-rich plasma (PRP) is a novel osteoinductive therapeutic approach that is increasingly used in treatment of such complications of bone healing processes. The activator for PRP is a mixture of thrombin and calcium chloride. After connecting these substances platelet-rich gel (PRG) is formed and numerous regulatory molecules to the injury site such as PDGF, TGF-, VEGF, IGF, EGF and antimicrobial proteins are released. The aim of this article is presentation of present knowledge about properties and possibilities of using platelet-rich plasma in the treatment of soft tissue and bone healing disturbances.     

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)。治疗2、12周后,观察组的VAS评分均低于对照组(P<0.05)。治疗12周后,观察组的SP、5-HT、PGE2、IL-1β、TNF-α水平均低于对照组(P<0.05)。观察组的并发症总发生率低于对照组(P<0.05)。结论自体富血小板血浆治疗膝骨关节炎患者的效果显著。     

自体脂肪移植在乳房整形美容中的应用

自体脂肪因具备取材方便、治疗效果好等优势而成为整形外科软组织塑形、修复常用的填充材料。随着乳房整形美容需求患者数量的增加,自体脂肪移植在该方面的应用也日益成熟。本文对乳房整形美容中自体脂肪移植的临床应用、并发症和移植安全性等方面的研究进行综述,为自体脂肪移植技术在乳房整形美容领域的进一步实践提供理论基础。     

富血小板血浆复合软骨细胞构建可注射性组织工程化软骨

背景：富血小板血浆中含有大量的生长因子,因此其在骨再生、创伤愈合等方面得到了较多的应用,然而其在组织工程软骨的研究报道较少。 目的：观察富血小板血浆对软骨细胞增殖和分化的影响,以及富血小板血浆复合软骨细胞构建组织工程化软骨的可行性。 方法：检测兔全血、富血小板血浆及激活富血小板血浆中转化生长因子β、胰岛素样生长因子1、血小板源性生长因子BB及表皮生长因子的浓度。将兔软骨细胞在分别含10％,15％,20％,30％富血小板血浆的DMEM培养液中培养7d,CCK-8法检测细胞增殖,QT-PCR检测细胞内II型胶原、蛋白聚糖、Sox-9的表达。在兔皮下注射自体富血小板血浆与软骨细胞复合物,6周后取材进行组织学检测。结果与结论：富血小板血浆中各生长因子浓度高于全血（P〈0．05）,激活富血小板血浆中各生长因子浓度高于富血小板血浆（P〈0．05）。不同浓度富血小板血浆均能促进软骨细胞的增殖,且20％浓度内呈浓度依赖性。20％浓度组促II型胶原表达的能力强于其他浓度组（P〈0．05）,15％浓度组促Sox-9和蛋白聚糖表达的能力强于其他浓度组（P〈0．05）。富血小板血浆一软骨细胞复合物移植后,新生组织呈软骨样并有明显的软骨陷窝,细胞外富含软骨样基质,表明其作为可注射性支架用于软骨组织工程。     

自体血清(血浆)疗法在整形外科和皮肤科诊疗及微创美容医疗和护理中的应用

自体血清(血浆)因能为多种细胞增殖和生长、组织修复和再生等提供较为丰富而完整的营养成分、生物活性物质和细胞生长因子,并能改善和调节细胞生长和代谢的微环境,提供某些必要的促细胞接触和伸展的生物活性因子,以促进和加快细胞迁移、聚集和贴附等独特的生物学特点,加上自体血清(血浆)来源于自体,具有良好的同一性和相融性,且因其毒副作用小、取材方便、应用安全等特点,使其近年来在临床某些疾病治疗和护理中的应用越来越广泛.为了进一步推动和拓展自体血清(血浆)在临床治疗和护理领域中的应用,并为未来设计和创建自体血清(血浆)在临床新的治疗方法和新的护理模式提供参考依据,本文对自体血清(血浆)在整形外科、皮肤科及微创美容和皮肤抗衰老医学中的临床治疗和护理领域的应用进行综述.

Abstract：

With rich nutritious ingredients, bioactive substances and growth factors for cell proliferation and growth, tissue repair and regeneration, autologous serum (plasma) can improve and regulate the micro environment for cell's growth and metabolism and provide some necessary bioactive factors to promote cell migration, aggregation and adhesion. Being autologoua makes the serum (plasma) identical and harmonious. Having slight side effects, autologous serum (plasma) is safe for application. Besides, the resources can be easily obtained. These features enable it to be widely used in clinical treatment and nursing care for some diseases in recent years. In order to further push forward the application of autologous serum (plasma) in clinical treatment and nursing care and provide references for designing new c linical treatment approaches and nursing modela, upon comprehensive and systematic review of relevant literature, this paper summarizes the application of autologous serum (plasma) on clinical treatment and nursing care in plastic surgery, dermatology, minimally invasive beauty and skin anti-aging medicine.     

Tendon healing and platelet-rich plasma therapies

Importance of the field: The therapeutic use of platelet-rich plasma (PRP) is an autologous biotechnology that relies on the local delivery of a wide range of growth factors and cytokines with the aim of enhancing tissue healing. Understanding both tendon healing and PRP therapies is an area of research that is critically important in developing optimal formulations and protocols to achieve the intended therapeutic effects.

Areas covered in this review: We summarise recent information on the mechanisms inherent to the earliest response to tendon injury. We then describe the positive effect of PRP therapies on tendon healing. Research on tendinopathy has produced several biological hypotheses based on histopathological, biochemical and clinical findings showing that cell apoptosis, angiofibroblastic features or abnormal biochemical adaptations underlie the condition.

What the reader will gain: The article provides insights into early healing mechanisms and the influence of PRP therapies on inflammation, cell migration, angiogenesis and the proliferation and synthesis of extracellular matrix. The knowledge gained helps to better understand and optimize tendon therapies.

Take home message: The use of endogenous therapies has a positive effect on experimental tendon healing. However, several obstacles need to be addressed to optimise medical practice in this field.     

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。     

透明质酸注射填充韧带深层联合微针导入自体富血小板血浆对面部年轻化患者皮肤指标及美学评分的影响

目的探讨透明质酸注射填充韧带深层联合微针导入自体富血小板血浆对面部年轻化患者皮肤指标及美学评分的影响。方法选择2018年6月至2020年8月接受面部年轻化的患者90例为研究对象,随机数字表法分组,对照组与观察组各45例,对照组接受透明质酸注射填充韧带深层治疗,观察组在对照组基础上加微针导入自体富血小板血浆,对两组治疗前后皮肤指标、美学评分进行比较。结果两组治疗前的皮肤水分、弹性、油脂、暗斑评分无明显差异(P>0.05),观察组治疗后上述皮肤指标与对照组比较有明显差异(P<0.05);两组治疗前的客观与主观美学评分无明显差异(P>0.05),观察组治疗后美学评分明显较对照组高(P<0.05);观察组不良反应率为4.44%,明显较对照组17.78%低(P<0.05)。结论透明质酸注射填充韧带深层联合微针导入自体富血小板血浆可改善面部年轻化患者皮肤指标,提高美学评分,且不良反应较少,值得推广。     

感染骨灭活原位移植自体富血小板血浆复合骨髓治疗慢性骨髓炎

目的:评价感染骨灭活原位移植自体富血小板血浆复合骨髓治疗慢性骨髓炎的疗效.方法:40只新西兰大白兔,随机分成两组,制成慢性骨髓炎模型.以感染灶最严重处为中心,线锯截取出死骨及感染骨2.0 cm煮沸灭活15 min,原位移植并闭合伤口.实验组术后局部注射制备好的自体富血小板血浆复合骨髓悬液,隔周1次,连续注射3周.对照组注射生理盐水.分别于术后第4、8、12、16周处死5只动物,行X线观察、组织学观察.结果:实验组成骨修复X线评分、组织学评分均高于对照组,两组之间差异有显著性(P<0.05).结论:感染骨灭活原位移植可作为骨支架,自体富血小板血浆复合骨髓,具有抗感染及促进成骨的双重作用,治疗慢性骨髓炎效果良好.     

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.     

富血小板血浆促进骨修复的机制及应用

背景：目前普遍认为富血小板血浆具有促进骨修复的作用,但其具体机制尚未完全阐明,富血小板的最佳应用方式仍不明确。目的：综述近期富血小板血浆促进骨修复机制及应用的研究进展。方法：由第一作者检索1995/2011PubMed与CNKI数据库有关富血小板血浆促进骨修复机制及应用的相关文献,排除与研究目的相关性差及内容陈旧、重复的文献。中文关键词为＂富血小板血浆,生长因子,骨修复＂,英文关键词为＂Platelet-rich plasma,Growth factor,Bone repair＂。共纳入25篇符合标准的文献进行综述。结果与结论：富血小板血浆含有多种高浓度生长因子,普遍的观点认为聚合过程中血小板脱颗粒释放多种生长因子联合作用加速了骨修复的过程。单独应用富血小板血浆对骨修复的治疗效果不如与其他物质复合使用效果明显。     

富血小板血浆促进骨修复的机制及应用

背景:目前普遍认为富血小板血浆具有促进骨修复的作用,但其具体机制尚未完全阐明,富血小板的最佳应用方式仍不明确。目的:综述近期富血小板血浆促进骨修复机制及应用的研究进展。方法:由第一作者检索1995/2011PubMed与CNKI数据库有关富血小板血浆促进骨修复机制及应用的相关文献,排除与研究目的相关性差及内容陈旧、重复的文献。中文关键词为"富血小板血浆,生长因子,骨修复",英文关键词为"Platelet-rich plasma,Growth factor,Bone repair"。共纳入25篇符合标准的文献进行综述。结果与结论:富血小板血浆含有多种高浓度生长因子,普遍的观点认为聚合过程中血小板脱颗粒释放多种生长因子联合作用加速了骨修复的过程。单独应用富血小板血浆对骨修复的治疗效果不如与其他物质复合使用效果明显。     

Platelet-rich plasma for the treatment of burn wounds: A meta-analysis of randomized controlled trials

BackgroundTo evaluate the efficacy and safety of platelet-rich plasma in the treatment of burn wounds through a meta-analysis of randomized controlled trials.MethodsWe conducted a comprehensive study from electronic medical journal databases. The primary outcome was healing rate, and the secondary outcomes were healing time, adverse events, pain score and scar score. The data was analyzed using Review Manager 5.3 and Stata 12. The odds ratio (OR) among different groups was calculated by using 95 % confidence interval (CI).ResultsWe included 8 randomized controlled trials with a total of 539 patients. The results showed that platelet-rich plasma could improve the healing rate of burn wound (OR 4.43, 95 % CI 2.13–9.22). The wound healing time of the platelet-rich plasma treatment group was significantly shorter than that of the conventional treatment group (OR –4.23, 95 % CI ?5.48 to ?2.98), both the superficial burn (OR –3.80, 95 % CI ?4.53 to ?3.07) and the deep burn group (OR –4.65, 95 % CI ?6.90 to ?2.40) had shorter healing time. Otherwise, the incidences of adverse events (OR 0.30, 95 % CI 0.11?0.78), pain score (OR –0.80, 95 % CI ?1.40 to ?0.21) and scar score (OR –0.38, 95 % CI ?0.69 to ?0.07) were all better in the platelet rich plasma treatment group.ConclusionTopical platelet-rich plasma treatment on burn wounds can improve wound healing and reduce the incidence of adverse events. Further research is needed to standardize the preparation and use of platelet-rich plasma and to evaluate the long-term clinical outcome of platelet-rich plasma in the treatment of burn wounds.