Platelet rich plasma (PRP) ana amfani da shi sosai a likitan kasusuwa, amma har yanzu akwai muhawara mai zafi.Saboda haka, Haikalin "na Jamusawa na Jamusawa na Jamusawa" na Jamusanci na Jamusanci da rauni sun yi bincike don isa ga yarjejeniya ta warkewa na yanzu.
Ana ɗaukar aikace-aikacen PRP na warkewa da amfani (89%) kuma yana iya zama mafi mahimmanci a nan gaba (90%).Alamun da aka fi sani shine cutar tendon (77%), osteoarthritis (OA) (68%), raunin tsoka (57%), da raunin guringuntsi (51%).An cimma yarjejeniya a cikin sanarwar 16/31.Ana ɗaukar aikace-aikacen PRP a farkon osteoarthritis na gwiwa (Kellgren Lawrence II) mai yuwuwa mai amfani, da kuma cututtukan jijiyoyi masu ƙarfi da na yau da kullun.Don raunuka na yau da kullun (garin guringuntsi, tendons), allura da yawa (2-4) sun fi dacewa fiye da allura guda ɗaya.Koyaya, babu isassun bayanai akan tazarar lokaci tsakanin allura.Ana ba da shawarar sosai don daidaita shirye-shiryen, aikace-aikace, mita, da ƙayyadaddun alamomi don PRP.
Platelet rich plasma (PRP) ana amfani dashi sosai a cikin maganin farfadowa, musamman a cikin magungunan wasanni na orthopedic.Binciken kimiyya na asali ya nuna cewa PRP yana da tasiri mai yawa a kan yawancin kwayoyin halitta na musculoskeletal, irin su chondrocytes, ƙwayoyin jijiya, ko ƙwayoyin tsoka, duka a cikin vitro da in vivo.Koyaya, ingancin wallafe-wallafen da ake da su har yanzu yana iyakance, gami da kimiyya na asali da bincike na asibiti.Sabili da haka, a cikin bincike na asibiti, tasirin ba shi da kyau kamar binciken kimiyya na asali.
Akwai dalilai da yawa masu yiwuwa.Da fari dai, hanyoyin shirye-shirye da yawa (a halin yanzu sama da tsarin kasuwanci daban-daban 25) sun wanzu don samun abubuwan haɓakar platelet, amma samfurin PRP na ƙarshe ya ƙunshi nau'ikan abubuwan haɗin gwiwa da kuma ƙoƙarinsu mai ban sha'awa.Alal misali, hanyoyin shirye-shiryen PRP daban-daban suna nuna tasiri daban-daban akan chondrocytes na haɗin gwiwa.Bugu da ƙari, saboda gaskiyar cewa ainihin ma'auni irin su tsarin jini (jajayen jini, farin jini, da platelets) ba a ba da rahoto ba a cikin kowane binciken, ana buƙatar daidaitaccen rahoto na waɗannan abubuwan cikin gaggawa.Samfurin PRP na ƙarshe kuma yana da mahimman bambance-bambancen mutum.Abin da ke damun matsalar shi ne cewa ba a daidaita adadin, lokaci, da adadin aikace-aikacen PRP ba, kuma ba a yi cikakken nazari a cikin binciken kimiyya na asali ba.Dangane da wannan, buƙatar daidaitattun ƙirar ƙira na nau'in haɓakar haɓakar platelet ya bayyana, wanda zai ba da damar daidaitaccen gwajin kimiyya na asali na tasirin sigogi daban-daban kamar ƙirar PRP, ƙarar allurar PRP, da lokacin allura.Bugu da ƙari, yin amfani da rarrabuwa don mafi kyawun kwatanta samfuran PRP da aka yi amfani da su ya zama dole.Wasu mawallafa sun ba da shawarar tsarin rarraba daban-daban, ciki har da Mishra (ƙididdigar platelet, kasancewar fararen jini, kunnawa) da Dohan Ellenfest (ƙididdigar platelet, adadin jinin jini, gaban fibrinogen), Delong (ƙididdigar laletlet, kunna ƙusa, w ^ Haide cell count; PAW classification) da kuma Mautner (Platelet count, gaban manyan eukocyte, gaban R labeled Kwayoyin jini, da kuma amfani da ƙusa kunnawa; PLRA classification) .. Magalon et al.Ƙididdigar DEPA da aka tsara ta ƙunshi allurar platelet OSE, ingancin samarwa, tsaro na PRP, da kunna shi.Harrison et al.An buga wani ingantaccen tsarin rarrabuwa, gami da hanyoyin kunnawa da aka yi amfani da su, jimlar ƙarar da aka yi amfani da su, mitar gudanarwa da rukunan da aka kunna, tattarawar platelet da dabarun shirye-shirye, gami da matsakaicin matsakaicin ƙididdiga da kewayon (ƙananan) adadin fararen ƙwayoyin jini (neutrophils, lymphocytes, da sauransu). monocytes) don platelets, jajayen jini, da rarrabuwa.Sabuwar rarrabuwa ta fito daga Kon et al.Dangane da yarjejeniya da ƙwararre, an bayyana mafi mahimmancin abubuwan da aka tsara azaman kayan aikin Platelet (sel na farin ciki), da kuma kunnawa (Engenous / Enogenous, exogenous / exogenous / exogenous / exogenous / exogenous / exobenous / exogenous / exogenous / exogenous / exogenous / exogenous / exobenous / exogenous / exobenous / exobenous / exobenous / exogenous / exogenous / exobenous / exogenous / exogenous / exogenous / exobenous / exogenous, kari.
Yin amfani da alamun da yawa don PRP an tattauna su sosai, irin su gaskiyar cewa an kwatanta maganin cututtukan tendon a cikin nazarin asibiti game da wurare daban-daban [tare da sakamako mai kyau da kuma mummunan sakamako na lokaci guda].Saboda haka, sau da yawa ba shi yiwuwa a sami tabbataccen shaida daga wallafe-wallafe.Wannan kuma yana da wahala a haɗa maganin PRP a cikin jagororin daban-daban.Sakamakon yawancin batutuwan da ba a warware su ba, ainihin ka'idar nazarin wannan labarin shine don nuna ra'ayoyin na Jamusawa da rauni (DGOU) akan amfani da makomar na PRP.
Hanya
Kungiyar "Clinical Tissue Regeneration Working Working Group" ta Jamus ta ƙunshi mambobi 95, kowannensu ya ƙware a aikin tiyata na orthopedic da sabunta nama (duk likitocin likita ko likitoci, babu masu kwantar da hankali na jiki ko masana kimiyyar motsa jiki).Ƙungiyar aiki da ta ƙunshi mutane 5 (bita na makafi) ita ke da alhakin haɓaka binciken.Bayan nazarin wallafe-wallafen da ake da su, ƙungiyar aiki ta shirya abubuwan da za a iya haɗawa a cikin zagaye na farko na bincike.An gudanar da binciken farko a watan Afrilun 2018, wanda ya ƙunshi tambayoyi 13 da kuma al'amuran gabaɗaya na aikace-aikacen PRP, gami da rufaffiyar tambayoyi da buɗe ido, da ƙarfafa masana su ba da shawarar ƙarin ayyuka ko gyare-gyare.Dangane da waɗannan amsoshi, an haɓaka zagaye na biyu na binciken kuma an gudanar da shi a cikin Nuwamba 2018, tare da jimlar 31 rufaffiyar tambayoyi a cikin nau'ikan 5 daban-daban: alamomi don raunin guringuntsi da osteoarthritis (OA), alamomi don cututtukan tendon, alamun rauni na tsoka. , aikace-aikacen PRP, da wuraren bincike na gaba.
Ta hanyar binciken yanar gizo (Biri Survey, Amurka), an cimma yarjejeniya don ba masu amsa damar tantance ko aikin ya kamata a sanya shi cikin mafi ƙarancin buƙatun rahoto, da kuma samar da ma'auni guda biyar da za a iya amsawa akan Likert: 'Tabbas yarda';Yarda;Ba yarda ko adawa ba;Ban yarda ba ko kuma da tsananin rashin yarda.Kwararru uku ne suka gudanar da binciken a kan ingancin fuska, fahimta da karbuwa, kuma an dan gyara sakamakon.A zagayen farko, jimillar masana 65 ne suka shiga, yayin da a zagaye na biyu, kwararru 40 ne suka halarta.Don zagaye na biyu na yarjejeniya, ma'anar priori ta bayyana cewa idan fiye da kashi 75% na masu amsa sun yarda, za a shigar da aikin a cikin takardar yarjejeniya ta ƙarshe, kuma ƙasa da kashi 20% na masu amsa ba su yarda ba.75% na mahalarta sun yarda cewa shine mafi yawan ƙayyadaddun shawarar yarjejeniya, wanda aka yi amfani da shi a cikin bincikenmu.
Sakamako
A zagaye na farko, 89% na mutane sun amsa cewa aikace-aikacen PRP na da amfani, kuma 90% na mutane sun yi imanin cewa PRP za ta fi muhimmanci a nan gaba.Yawancin membobin sun saba da ilimin kimiyya na asali da bincike na asibiti, amma kawai 58% na membobin suna amfani da PRP a cikin ayyukan yau da kullun.Dalilan da suka fi dacewa na rashin amfani da PRP sune rashin yanayin da ya dace, kamar asibitocin jami'a (41%), tsada (19%), cin lokaci (19%), ko rashin isasshen shaidar kimiyya (33%).Abubuwan da aka fi sani da amfani da PRP sune cututtukan tendon (77%), OA (68%), raunin tsoka (57%), da raunin guringuntsi (51%), wanda shine tushen binciken zagaye na biyu.Alamar yin amfani da intraoperative na PRP yana bayyana tare da 18% gyaran guringuntsi da 32% gyaran tendon.Ana ganin sauran alamun a cikin 14%.Kawai 9% na mutane sun bayyana cewa PRP ba shi da amfani na asibiti.Ana amfani da allurar PRP wani lokaci tare da hyaluronic acid (11%).Baya ga PRP, ƙwararrun sun kuma yi allurar maganin sa barci na gida (65%), cortisone (72%), hyaluronic acid (84%), da Traumel/Zeel (28%).Bugu da ƙari, ƙwararrun ƙwararrun sun bayyana buƙatar ƙarin bincike na asibiti akan aikace-aikacen PRP (76%) da kuma buƙatar ingantaccen daidaituwa (tsarin 70%, alamomi 56%, lokacin 53%, mitar allura 53%).Don cikakkun bayanai kan zagaye na farko, da fatan za a duba karin bayani.Masana sun bayyana da yawa cewa ana buƙatar ƙarin bincike na asibiti akan aikace-aikacen PRP (76%), kuma dole ne a sami ingantacciyar daidaituwa (ƙirar 70%, alamun 56%, lokacin 53%, mitar allura 53%).Don cikakkun bayanai kan zagaye na farko, da fatan za a duba karin bayani.Masana sun bayyana da yawa cewa ana buƙatar ƙarin bincike na asibiti akan aikace-aikacen PRP (76%), kuma dole ne a sami ingantacciyar daidaituwa (ƙirar 70%, alamun 56%, lokacin 53%, mitar allura 53%).
Dangane da waɗannan amsoshin, zagaye na biyu ya fi mai da hankali kan batun da ya fi jan hankali.An cimma yarjejeniya a cikin sanarwar 16/31.Har ila yau, yana nuna wuraren da ba a cika samun yarjejeniya ba, musamman a fagen alamu.Jama'a gabaɗaya sun yarda (92%) cewa akwai manyan bambance-bambance a cikin alamomi daban-daban na aikace-aikacen PRP (kamar OA, cututtukan jijiya, rauni na tsoka, da sauransu).
[Tsarin madaidaicin madaidaicin madaidaicin yana wakiltar yanki na matakin da aka yarda a zagaye na biyu na binciken (tambayoyi 31 (Q1 - Q31)), wanda ke nuna fagagen rashin jituwa.
Bar a gefen hagu na Y-axis yana nuna rashin jituwa, yayin da mashaya a gefen dama yana nuna yarjejeniya.Yawancin rashin jituwa suna tasowa a fagen alamu.]
Alamomi don raunin guringuntsi da OA
Akwai yarjejeniya ta gaba ɗaya (77.5%) cewa ana iya amfani da PRP don farkon gwiwa osteoarthritis [Kellgren Lawrence (KL) Level II].Don ƙananan raunuka na guringuntsi (KL Level I) da matakai masu tsanani (KL Level III da IV), babu wata yarjejeniya ta amfani da PRP a lokacin ko bayan tiyata na farfadowa na guringuntsi, kodayake 67.5% na masana sun yi imanin wannan filin ne mai ban sha'awa. .
Alamomi ga raunukan jijiyoyi
A cikin binciken, masana sun wakilci mafi rinjaye (82.5% da 80%) cewa amfani da PRP yana da amfani a cikin cututtuka masu tsanani da kuma na kullum.Game da gyaran gyare-gyare na rotator cuff, 50% na masana sun yi imanin cewa aikace-aikacen PRP na ciki na iya zama da amfani, amma 17.5% na masana suna da ra'ayi akasin haka.Irin wannan adadin masana (57.5%) sun yi imanin cewa PRP yana da tasiri mai kyau a cikin jiyya na baya bayan gyaran kafa.
Alamar rauni na tsoka
Amma ba a sami yarjejeniya kan amfani da PRP don maganin raunin tsoka mai tsanani ko na kullum (kamar fiye da 75% yarjejeniya).
Halayen Ayyuka na Aikace-aikacen PRP
Akwai maganganu guda uku da za a yi ijma'i a kansu:
(1) Launuka na yau da kullun suna buƙatar allura fiye da ɗaya na PRP
(2) Rashin isassun bayanai akan mafi kyawun tazarar lokaci tsakanin allura (ba a sami yarjejeniya akan tazarar mako-mako ba)
(3) Bambance-bambancen nau'ikan tsarin PRP daban-daban na iya taka muhimmiyar rawa a cikin tasirin ilimin halittar su
Yankunan Bincike na gaba
Samar da PRP dole ne ya zama mafi daidaituwa (95% daidaito) da aikace-aikacen asibiti (irin su mitar allura, lokacin aikace-aikacen, alamun asibiti).Ko da a wurare irin su OA magani inda aka bayar da rahoton cewa akwai kyakkyawan bayanan asibiti, ƙwararrun membobin sun yi imanin cewa har yanzu akwai buƙatar ƙarin bincike na kimiyya da na asibiti.Wannan kuma ya shafi sauran alamomi.
Tattaunawa
Sakamakon binciken ya nuna cewa har yanzu ana ci gaba da muhawara game da aikace-aikacen PRP a cikin likitan kasusuwa, har ma a cikin kungiyoyin kwararru na kasa.A cikin jawabai 31, 16 ne kawai suka cimma matsaya guda.Akwai mafi girman yarjejeniya a fagen bincike na gaba, yana nuna buƙatu mai ƙarfi don samar da faɗaɗa shaida ta hanyar gudanar da bincike daban-daban na gaba.Dangane da wannan, ƙima mai mahimmanci na shaidar da ke akwai ta ƙungiyoyin ma'aikata na ƙwararrun hanya ce ta haɓaka ilimin likitanci.
Alamun OA da raunin guringuntsi
Dangane da wallafe-wallafen yanzu, PRP na iya dacewa da farkon da matsakaicin OA.Shaidu na baya-bayan nan sun nuna cewa allurar intra-articular na PRP na iya inganta alamun haƙuri ba tare da la'akari da girman lalacewar guringuntsi ba, amma yawanci ana samun ƙarancin ƙima mai kyau na rukunin rukunin da ke kan Kellgren da rarrabuwar Lawrence.Dangane da wannan, saboda rashin isasshen bayanai, masana a halin yanzu ba su bayar da shawarar yin amfani da PRP don matakin KL na 4. PRP kuma yana da damar inganta aikin haɗin gwiwa na gwiwa, mai yiwuwa ta hanyar rage ƙananan ƙwayoyin cuta da kuma jinkirta tsarin gyaran gyare-gyare na degenerative na guringuntsi na haɗin gwiwa.PRP yawanci yana samun sakamako mafi kyau a cikin maza, matasa, marasa lafiya tare da ƙananan matakan lalacewa na guringuntsi da ƙididdigar jiki (BMI).
Lokacin fassara bayanan asibiti da aka buga, abun da ke ciki na PRP alama ya zama mahimmin siga.Sakamakon tasirin cytotoxic da aka nuna na plasma mai wadatar farin jini akan sel synovial in vitro, LP-PRP galibi ana ba da shawarar don aikace-aikacen intra articular.A cikin binciken kimiyya na asali na kwanan nan, sakamakon mummunan kwayar jinin jini (LP) da kuma wadataccen farin jini (LR) PRP akan ci gaban OA an kwatanta su a cikin samfurin linzamin kwamfuta bayan meniscectomy.LP-PRP ya nuna kyakkyawan aiki a cikin adana ƙarar guringuntsi idan aka kwatanta da LR-PRP.Wani bincike na kwanan nan na gwaje-gwajen da aka sarrafa bazuwar ya gano cewa PRP yana da sakamako mafi kyau idan aka kwatanta da hyaluronic acid (HA), kuma bincike na rukuni ya nuna cewa LP-PRP yana da sakamako mafi kyau fiye da LR-PRP.Koyaya, babu kwatanta kai tsaye tsakanin LR - da LP-PRP, yin ƙarin bincike ya zama dole.A gaskiya ma, babban binciken da aka kwatanta LR-PRP tare da HA ya nuna cewa LR-PRP ba shi da wani tasiri.Bugu da ƙari, nazarin asibiti wanda ya kwatanta LR-PRP da LP-PRP kai tsaye ya nuna babu bambance-bambancen asibiti a sakamakon bayan watanni 12.LR-PRP yana ƙunshe da ƙarin ƙwayoyin ƙwayoyin cuta masu kumburi da haɓakar abubuwan haɓaka, amma kuma ya ƙunshi babban adadin cytokines anti-inflammatory, irin su interleukin-1 antagonists (IL1-Ra).Nazarin na baya-bayan nan sun bayyana tsarin "sabuntawa mai kumburi" tsarin farin jini wanda ke ɓoye pro-mai kumburi da cytokines mai kumburi, yana nuna tasiri mai kyau akan farfadowa na nama.Ƙarin karatu na asibiti tare da ƙira mai ƙima yana da mahimmanci don ƙayyade mafi kyawun samarwa ko abun da aka tsara na PRP da ƙa'idar aiki mai kyau a cikin OA.
Saboda haka, wasu suna ba da shawarar cewa HA da PRP na iya zama hanyoyin magani mafi kyau ga marasa lafiya tare da ƙananan OA da ƙananan BMI.Ƙididdigar ƙididdiga na baya-bayan nan sun nuna cewa PRP yana da mafi kyawun maganin warkewa idan aka kwatanta da HA.Koyaya, buɗaɗɗen wuraren da aka gabatar baki ɗaya sun haɗa da buƙatar daidaitattun shirye-shiryen PRP, ƙimar aikace-aikacen, da buƙatar ƙarin gwajin gwaji na asibiti tare da ingancin ruwa.Sabili da haka, a halin yanzu shawarwarin hukuma da jagororin ba su da cikas wajen tallafawa ko adawa da yin amfani da osteoarthritis na gwiwa.A taƙaice, bisa ga shaida na yanzu, shirye-shiryen shirye-shirye daban-daban suna iyakance babban bambancin hanyoyin, kuma PRP na iya haifar da ci gaba mai zafi a cikin OA mai sauƙi zuwa matsakaici.Ƙungiyar ƙwararrun ba ta ba da shawarar yin amfani da PRP a cikin yanayi mai tsanani na OA ba.Binciken da aka yi kwanan nan ya nuna cewa PRP kuma yana ba da gudummawa ga tasirin placebo, musamman a cikin maganin OA ko Epicondylitis na gefe.Allurar PRP na iya zama wani ɓangare na dabarun jiyya gabaɗaya don magance matsalolin ilimin halitta na OA.Bugu da ƙari, wasu muhimman abubuwa irin su asarar nauyi, gyaran gyare-gyare, horo na tsoka, da kuma gwiwoyi na gwiwa, zai iya taimakawa wajen rage ciwo kuma ya kawo sakamako mafi kyau ga marasa lafiya.
Matsayin PRP a cikin aikin tiyata na gyaran guringuntsi wani yanki ne da ake muhawara sosai.Kodayake bincike na kimiyya na asali ya nuna tasiri mai kyau a kan chondrocytes, shaidar asibiti don amfani da PRP a lokacin tiyata, aikin gyaran gyaran ƙwayar guringuntsi, ko matakan gyarawa har yanzu bai isa ba, yana nuna bincikenmu.Bugu da ƙari, mafi kyawun lokaci don maganin PRP bayan tiyata har yanzu ba shi da tabbas.Amma yawancin masana sun yarda cewa PRP na iya taimakawa wajen inganta farfadowar guringuntsi.A taƙaice, sakamakon halin yanzu na hukunci mai mahimmanci ya nuna cewa ƙarin kimantawa game da yuwuwar rawar da PRP ke takawa a cikin aikin tiyata na gyaran guringuntsi ya zama dole.
Alamomi ga raunukan jijiyoyi
Yin amfani da PRP don maganin tendinosis abu ne mai rikitarwa a cikin wallafe-wallafe.Binciken bincike na kimiyya na asali ya nuna cewa PRP yana da tasiri mai kyau a cikin vitro (kamar haɓaka ƙwayar ƙwayar ƙwayar ƙwayar cuta, inganta tasirin anabolic, irin su haɓaka samar da collagen) da kuma a cikin vivo (ƙaramar warkar da tendon).A cikin aikin asibiti, yawancin bincike sun nuna cewa maganin PRP yana da kyau kuma ba shi da tasiri a kan cututtuka daban-daban da kuma na kullum.Misali, wani bita na yau da kullun na yau da kullun ya jaddada sakamakon rikice-rikice na aikace-aikacen PRP a cikin raunuka daban-daban na jijiyoyi, galibi suna da tasiri mai kyau akan raunin jijiyoyi na gefe da kuma raunuka na patellar, amma ba akan raunin Achilles ko rotator cuff raunuka ba.Mafi yawan rubuce-rubucen RCT na tiyata ba su da tasiri mai amfani, kuma har yanzu babu wani tabbataccen shaida na aikace-aikacen sa na mazan jiya a cikin cututtukan rotator cuff.Don Epicondylitis na waje, meta-bincike na yanzu yana nuna cewa corticosteroids suna da tasiri mai kyau na ɗan gajeren lokaci, amma tasirin PRP na dogon lokaci ya fi girma.Bisa ga shaida na yanzu, patellar da tendinosis na gefe sun nuna ingantawa bayan jiyya na PRP, yayin da ƙwayar Achilles da rotator cuff ba su da amfani daga aikace-aikacen PRP.Sabili da haka, yarjejeniya ta kwanan nan ta Kwamitin Kimiyya na ESSKA ya kammala cewa a halin yanzu babu wata yarjejeniya game da amfani da PRP don maganin tendinosis.Duk da jayayya a cikin wallafe-wallafen, kamar yadda aka nuna ta hanyar bincike na baya-bayan nan da kuma kimantawa na yau da kullum, PRP yana da tasiri mai kyau wajen magance cututtuka na tendon daga dukkanin ilimin kimiyya da na asibiti.Musamman la'akari da yuwuwar tasirin corticosteroids yayin amfani da cututtukan tendon.Sakamakon wannan binciken ya nuna cewa, ra'ayin Jamus a halin yanzu shi ne cewa za a iya amfani da PRP don magance cututtuka masu tsanani da kuma na kullum.
Alamar rauni na tsoka
Ƙarin rikice-rikice shine amfani da PRP don magance raunin tsoka, wanda shine daya daga cikin raunin da ya fi dacewa a cikin wasanni masu sana'a, wanda ya haifar da kusan 30% na kwanakin filin wasa.PRP tana ba da damar inganta warkar da ilimin halitta da haɓaka ƙimar motsa jiki, wanda ya sami ƙarin kulawa a cikin 'yan shekarun da suka gabata.Kodayake 57% na amsoshin da aka bayar a zagaye na farko da aka jera raunin tsoka a matsayin alamar da aka fi sani da amfani da PRP, har yanzu akwai rashin ingantaccen ilimin kimiyya.Yawancin nazarin in vitro sun lura da yiwuwar amfanin PRP a cikin rauni na tsoka.Haɓaka ayyukan tantanin halitta na tauraron dan adam, haɓaka haɓakar diamita na fibril, haɓakar myogenesis, da haɓaka ayyukan MyoD da myostatin duk an gwada su da kyau.Ƙarin bayani game da Mazoka et al.An haɓaka haɓaka abubuwan haɓaka kamar HGF, FGF, da EGF a cikin PRP-LP.Tsai et al.ya jaddada wadannan binciken.Bugu da ƙari don tabbatar da ƙarar furotin na cyclin A2, cyclin B1, cdk2 da PCNA, an tabbatar da cewa ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ta karu ta hanyar canja wurin sel daga lokaci na G1 zuwa S1 da G2 & M.Wani bita na yau da kullum ya taƙaita ilimin kimiyya na yanzu kamar haka: (1) A mafi yawan nazarin, maganin PRP ya karu da haɓakar ƙwayar tsoka, bayyanar haɓakar haɓaka (irin su PDGF-A / B da VEGF), daukar nauyin fararen jini, da angiogenesis a cikin tsoka. idan aka kwatanta da samfurin ƙungiyar kulawa;(2) Fasahar shirye-shiryen PRP har yanzu ba ta dace ba a cikin binciken wallafe-wallafen kimiyya na asali;(3) Shaida daga bincike na kimiyya na asali a cikin vitro da in vivo sun nuna cewa PRP na iya zama hanyar magani mai mahimmanci wanda zai iya hanzarta tsarin warkar da raunuka na tsoka idan aka kwatanta da ƙungiyar kulawa, dangane da abubuwan da aka lura a cikin salon salula da kuma matakan nama a ciki. kungiyar jiyya.
Kodayake binciken da aka yi a baya ya bayyana cikakken warkarwa kuma yayi la'akari da cewa lokacin kashewa ba shi da fa'ida mai mahimmanci, Bubnov et al.A cikin nazarin ƙungiyar 'yan wasa na 30, an lura cewa an rage jin zafi kuma an kara saurin dawowa daga gasar.Hamid et al.A cikin gwajin da bazuwar sarrafawa (RCT) kwatanta kutsawar PRP tare da tsarin kulawa na ra'ayin mazan jiya, an bayyana murmurewa cikin sauri daga gasa.RCT mai makanta guda biyu kawai ya haɗa da raunin hamstring a cikin 'yan wasa (n = 80), kuma ba a lura da infiltration mai mahimmanci na placebo idan aka kwatanta da PRP.Ka'idodin nazarin halittu masu ban sha'awa, tabbataccen bincike na asali, da kuma samun nasarar ƙwarewar farko na asibiti tare da allurar PRP da aka ambata a sama ba a tabbatar da su ta hanyar RCT mai girma na kwanan nan ba.Yarjejeniya ta yanzu tsakanin membobin GOTS sun kimanta hanyoyin kwantar da hankali na ra'ayin mazan jiya don raunin tsoka kuma sun kammala cewa a halin yanzu babu wata hujja bayyananniya cewa za a iya amfani da allurar intramuscular don magance raunin tsoka.Wannan ya dace da sakamakonmu, kuma babu wata yarjejeniya game da amfani da PRP a cikin maganin raunin tsoka.Ana buƙatar ƙarin bincike cikin gaggawa akan kashi, lokaci, da kuma yawan PRP a cikin rauni na tsoka.Idan aka kwatanta da rauni na guringuntsi, a cikin rauni na tsoka, yin amfani da algorithms na magani, musamman PRP, na iya zama alaƙa da matakin da tsawon lokacin rauni, bambanta tsakanin shigar da diamita na tsoka da aka ji rauni da kuma yiwuwar rauni na tendon ko rauni.
Filin aikace-aikacen PRP yana ɗaya daga cikin wuraren da aka tattauna akai-akai, kuma rashin daidaituwa a halin yanzu shine ɗayan manyan batutuwa a cikin gwaji na asibiti.Yawancin masana ba su ga wani karuwa a cikin amfani da PRP ba, duk da haka, wasu nazarin sun nuna cewa ƙarin amfani da hyaluronic acid za a iya kwatanta shi da amfani guda ɗaya na PRP don OA.Yarjejeniyar ita ce, ya kamata a ba da allurai da yawa don cututtuka na yau da kullum, kuma filin OA ya goyi bayan wannan shawarar, inda allura da yawa sun fi tasiri fiye da allura guda ɗaya.Binciken kimiyya na asali yana bincika alaƙar tasirin kashi na PRP, amma waɗannan sakamakon har yanzu suna buƙatar canjawa wuri zuwa bincike na asibiti.Ba a ƙaddamar da mafi kyawun ƙaddamarwa na PRP ba tukuna, kuma bincike ya nuna cewa mafi girma da yawa na iya samun mummunan tasiri.Hakazalika, tasirin fararen jinin jini ya dogara da alamar, kuma wasu alamun suna buƙatar PRP tare da ƙananan fararen jini.Bambance-bambancen nau'ikan PRP guda ɗaya yana taka muhimmiyar rawa a cikin tasirin PRP.
Yankunan Bincike na gaba
An yarda gaba ɗaya cewa bisa ga wallafe-wallafen kwanan nan, ƙarin bincike kan PRP ya zama dole a nan gaba.Ɗaya daga cikin manyan batutuwa shine cewa dole ne a daidaita tsarin PRP mafi kyau (tare da 95% daidaito).Wani abu mai yuwuwa na cimma wannan buri na iya zama tarawar platelet don cimma babban juzu'i, wanda ya fi daidaita.Bugu da ƙari, nau'o'i daban-daban don aikace-aikacen asibiti ba a san su ba, kamar yawan alluran da ya kamata a yi amfani da su, lokaci tsakanin allura, da adadin PRP.Ta wannan hanyar ne kawai zai iya yiwuwa a gudanar da bincike mai zurfi da kuma kimanta abin da alamun da suka fi dacewa don amfani da PRP, yin bincike na kimiyya na asali da na asibiti, wanda zai fi dacewa da nazarin binciken da bazuwar, ya zama dole.Kodayake an cimma yarjejeniya cewa PRP na iya taka muhimmiyar rawa a nan gaba, da alama ana buƙatar ƙarin gwaji da bincike na asibiti a yanzu.
Iyaka
Iyaka ɗaya mai yuwuwa na yunƙurin wannan binciken na magance batun da ake ta muhawara a kai na aikace-aikacen PRP shine halayensa na kabilanci.Samar da PRP da bambance-bambancen ƙasa a cikin biyan kuɗi na iya shafar sakamako da sassa na tsari.Bugu da ƙari, ijma'i ba iri-iri ba ne kuma kawai ya haɗa da ra'ayoyin likitocin orthopedic.Duk da haka, ana iya ganin wannan a matsayin fa'ida saboda ita ce ƙungiyar kawai ke aiwatarwa da kuma kula da maganin allurar PRP.Bugu da ƙari, binciken da aka gudanar yana da nau'i daban-daban na tsari idan aka kwatanta da tsarin Delphi mai tsanani.Fa'idar ita ce yarjejeniya da ƙungiyar kwararrun likitocin orthopedic suka kafa tare da ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrunsu daga mahangar kimiyya na asali da aikin asibiti.
Shawara
Dangane da ijma’in akalla kashi 75% na masana, a cimma matsaya kan abubuwa masu zuwa:
Raunin OA da guringuntsi: Yin amfani da ƙananan osteoarthritis na gwiwa (KL II grade) na iya zama da amfani.
Kwayoyin cuta na Tendon: Aikace-aikacen cututtuka masu tsanani da na jijiyoyi na iya zama da amfani
Shawarwari mai aiki: Ga raunuka na yau da kullun (garin guringuntsi, tendons), allura da yawa (2-4) a tsaka-tsaki sun fi dacewa fiye da allura guda ɗaya.
Koyaya, babu isasshen bayanai akan tazarar lokaci tsakanin allura guda ɗaya.
Binciken gaba: Ana ba da shawarar sosai don daidaita samarwa, shirye-shirye, aikace-aikace, mita, da kewayon nuni na PRP.Ƙarin bincike na asali da na asibiti ya zama dole.
Kammalawa
Babban yarjejeniya shine cewa akwai bambance-bambance a cikin alamomi daban-daban na aikace-aikacen PRP, kuma har yanzu akwai rashin tabbas game da daidaita tsarin PRP da kansa, musamman ga alamu daban-daban.Aikace-aikacen PRP a farkon osteoarthritis na gwiwa (KL grade II) da kuma cututtukan jijiya mai tsanani na iya zama da amfani.Don raunuka na yau da kullun (cartilage da tendon), tazara da yawa allurai (2-4) ya fi dacewa fiye da allura guda ɗaya, amma babu isasshen bayanai akan tazarar lokaci tsakanin allura guda ɗaya.Babban al'amari shine sauye-sauyen tsarin PRP guda ɗaya, wanda ke taka muhimmiyar rawa a matsayin PRP.Sabili da haka, samar da PRP dole ne ya zama mafi daidaituwa, da kuma sigogi na asibiti kamar mitar allura, da lokaci tsakanin allura da ingantattun alamomi.Ko da na OA, wanda a halin yanzu yana wakiltar mafi kyawun filin bincike don aikace-aikacen PRP, ana buƙatar ƙarin bincike na kimiyya da na asibiti, da kuma sauran alamun da aka tsara.
(Ana sake buga abubuwan da ke cikin wannan labarin, kuma ba mu bayar da garantin bayyananne ko bayyananniyar garanti don daidaito, amintacce ko cikar abubuwan da ke cikin wannan labarin ba, kuma ba mu da alhakin ra'ayoyin wannan labarin, da fatan za a fahimta.)
Lokacin aikawa: Mayu-24-2023