富血小板血浆在跟腱损伤修复中的应用
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摘要
背景:富血小板血浆疗法为跟腱损伤的愈合与修复提供了新的方向,其应用已成为近年来国内外研究的热点,表现出了良好的应用前景。目的:对近些年来国内外富血小板血浆疗法的作用机制以及治疗跟腱病的应用现状及研究进展进行综述。方法:通过计算机检索中国期刊全文数据库(CNKI)、万方数据库和PubMed数据库2009年1月至2018年9月的相关文章,以"富血小板血浆、肌腱病、跟腱炎、跟腱断裂、生长因子",英文检索词为"platelet-rich plasma (PRP),tendinopathy,Achilles tendinitis,Achilles tendon rupture,growth factor",选取与富血小板血浆疗法、跟腱病的愈合与修复相关的文章,并进行总结、整理与分析。结果与结论:文章对已纳入的45篇文献进行分析,结果表明生长因子的浓度是治疗跟腱损伤的关键,虽然与传统的保守治疗和单纯的手术治疗相比,富血小板血浆疗法在对跟腱病治疗的影像学表现、功能相关评分以及生活质量上均表现出了良好的优势,但是富血小板血浆疗法在跟腱损伤上的应用从制备、浓度、注射方式均无统一标准,目前富血小板血浆疗法仍缺乏明确严谨的临床指南作为依据。
BACKGROUND: Platelet-rich plasma therapy provides a new direction for the healing and repair of Achilles tendon injury. Its application has become a hot topic in recent years at home and abroad, showing a good application prospect.OBJECTIVE: To review the mechanism of action of platelet-rich plasma therapy at home and abroad and the current status and research progress of the treatment of Achilles tendinopathy.METHODS: A computer-based retrieval of CNKI, WanFang, and PubMed databases was performed for related articles published from January 2009 to September 2018. The keywords were "platelet-rich plasma(PRP), tendinopathy, Achilles tendinitis, Achilles tendon rupture,growth factor" in Chinese and English, respectively. The articles related to platelet-rich plasma therapy, healing and repair of Achilles tendinopathy, for summary and result analysis.RESULTS AND CONCLUSION: Forty-five eligible articles were included for analysis. The concentration of growth factors is the key to the treatment of Achilles tendon injury. Compared with conservative treatment and simple surgery, platelet-rich plasma therapy holds better imaging performance, functional scoring and quality of life. However, there is no uniform standard for preparation, concentration and injection method of platelet-rich plasma therapy in Achilles tendon injury. Platelet-rich plasma therapy still lacks clear and rigorous clinical guidelines.
BACKGROUND: Platelet-rich plasma therapy provides a new direction for the healing and repair of Achilles tendon injury. Its application has become a hot topic in recent years at home and abroad, showing a good application prospect.OBJECTIVE: To review the mechanism of action of platelet-rich plasma therapy at home and abroad and the current status and research progress of the treatment of Achilles tendinopathy.METHODS: A computer-based retrieval of CNKI, WanFang, and PubMed databases was performed for related articles published from January 2009 to September 2018. The keywords were "platelet-rich plasma(PRP), tendinopathy, Achilles tendinitis, Achilles tendon rupture,growth factor" in Chinese and English, respectively. The articles related to platelet-rich plasma therapy, healing and repair of Achilles tendinopathy, for summary and result analysis.RESULTS AND CONCLUSION: Forty-five eligible articles were included for analysis. The concentration of growth factors is the key to the treatment of Achilles tendon injury. Compared with conservative treatment and simple surgery, platelet-rich plasma therapy holds better imaging performance, functional scoring and quality of life. However, there is no uniform standard for preparation, concentration and injection method of platelet-rich plasma therapy in Achilles tendon injury. Platelet-rich plasma therapy still lacks clear and rigorous clinical guidelines.
引文
[1]Wang J,周义钦.肌腱干细胞研究新进展[J].国际骨科学杂志,2015,36(3):163-167.
[2]Wu F,Nerlich M,Docheva D.Tendon injuries:basic science and new repair proposals.EFORT Open Rev.2017;2(7):332-342.
[3]Rodeo SA,Nguyen JT,Cavanaugh JT,et al.Clinical and Ultrasonographic Evaluations of the Shoulders of Elite Swimmers,Am J Sports Med.2016;44(12):3214-3221.
[4]Buda R,Castagnini F,Pagliazzi G,et al.Treatment algorithm for chronic achilles tendon lesions review of the literature and proposal of a new classification.J Am Podiatr Med Assoc.2017;107(2):144-149.
[5]Harke H,Tanger D,Furst-Denzer S,et al.Effect of a preoperative separation of platelets on the postoperative blood loss subsequent to extracorporeal circulation in open heart surgery.Anaesthesist.1977;26(2):64-71.
[6]潘红娟,王雅丽,吕爽,等.富血小板血浆制备方法稳定性的研究[J].中国实验诊断学,2016,20(6):1008-1010.
[7]Dhillon M,Patel S,Shetty V,et al.Orthobiologics and platelet rich plasma,Indian J Orthop.2014;48(1):1-9.
[8]Ayatollahi A,Hosseini H,Shahdi M,et al.Platelet-rich plasma by single spin process in male pattern androgenetic alopecia:is it an effective treatment?Indian Dermatol Online J.2017;8(6):460-464.
[9]Ehrenfest DMD,Andia I,Zumstein MA,et al.Classification of platelet concentrates(Platelet-Rich Plasma-PRP,Platelet-Rich Fibrin-PRF)for topical and infiltrative use in orthopedic and sports medicine:current consensus,clinical implications and perspectives.Muscles Ligaments Tendons J.2014;4(1):3-9.
[10]福嘉欣,王树森.自体富血小板血浆治疗骨关节与运动损伤疾病的机制与应用[J].中国组织工程研究,2017,21(30):4908-4914.
[11]Moran J,Sun S,Khababa I,et al.A randomized trial comparing gentamicin/citrate and heparin locks for central venous catheters in maintenance hemodialysis patients.Am J Kidney Dis.2012;59(1):102-107.
[12]Nurden AT,Nurden P,Sanchez M,et al.Platelets and wound healing.Front Biosci.2008;13:3532-3548.
[13]Drago L,Bortolin M,Vassena C,et al.Plasma components and platelet activation are essential for the antimicrobial properties of autologous platelet-rich plasma:an in vitro study.PLoS One.20149(9):e107813.
[14]吕汝举,刘美静.富血小板血浆(富血小板血浆)治疗技术及应用[J].中国医疗器械信息,2013,19(10):50-55.
[15]Brass L.Understanding and evaluating platelet function.Hematology Am Soc Hematol Educ Program.2010;2010(1):387-396.
[16]潘红娟.富血小板血浆制备技术的优化及其组分的检测[D].长春:吉林大学,2017.
[17]Younesi M,Knapik DM,Cumsky J,et al.Effects of PDGF-BBdelivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon,in vivo.Acta Biomater.2017;63:200-209.
[18]Lichtman MK,Otero-Vinas M,Falanga V.Transforming growth factor beta(TGF-β)isoforms in wound healing and fibrosis.Wound Repair Regen,2016;4(2):215-222.
[19]Ruhrberg C.Growing and shaping the vascular tree:multiple roles for VEGF.Bioessays.2003;5(11):1052-1060.
[20]Fujioka-Kobayashi M,Miron RJ,Hernandez M,et al.Optimized platelet rich fibrin with the low speed concept:growth factor release,biocompatibility and cellular response.J Periodontol.2016;8(1):1-17.
[21]Zhou Y,Zhang J,Wu H,et al.The differential effects of leukocyte-containing and pure platelet-rich plasma(PRP)on tendon stem/progenitor cells-implications of PRP application for the clinical treatment of tendon injuries.Stem Cell Res Ther.2015;6(1):173.
[22]Young A,Mcnaught CE.The physiology of wound healing.Surgery(Oxford).2011;9(10):475-479.
[23]Boswell SG,Schnabel LV,Mohammed HO,et al.Increasing platelet concentrations in leukocyte-reduced platelet-rich plasma decrease collagen gene synthesis in tendons.Am J Sports Med.2014;42(1):42-49.
[24]Dovi JV,He LK,DiPietro LA.Accelerated wound closure in neutrophil-depleted mice.J Leukoc Biol.2003;73(4):448-455.
[25]Dragoo JL,Braun HJ,Durham JL,et al.Comparison of the acute inflammatory response of two commercial platelet-rich plasma systems in healthy rabbit tendons.Am J Sports Med.2012;40(6):1274-1281.
[26]Dohan DM,Choukroun J,Diss A,et al.Platelet-rich fibrin(PRF):asecond-generation platelet concentrate.Part I:Technological concepts and evolution.Am J Sports Med.2006;101(3):e37-e44.;
[27]Choukroun J,Diss A,Simonpieri A,et al.Platelet-rich fibrin(PRF):a second-generation platelet concentrate.Part IV:clinical effects on tissue healing.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2006;101(3):e56-e60.
[28]Dohan DM,Choukroun J,Diss A,et al.Platelet-rich fibrin(PRF):a second-generation platelet concentrate.Part II:platelet-related biologic features.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2006;101(3):e45-e50.
[29]Mishra A,Woodall J,Vieira A.Treatment of tendon and muscle using platelet-rich plasma.Clin Sports Med.2009;28(1):113-125.
[30]刘步云,咸杰,孙育良,等.局部注射自体富血小板血浆联合运动疗法和局部注射曲安奈德治疗跟腱病的临床疗效对比[J].四川医学,2017,38(5):10-13.
[31]Filardo G,Kon E,Matteo BD,et al.Platelet-rich plasma injections for the treatment of refractory achilles tendinopathy:results at 4years.Blood Transfus.2014;12(4):1-8.
[32]Guelfi M,Pantalone A,Vanni D,et al.Long-term beneficial effects of platelet-rich plasma for non-insertional Achilles tendinopathy,Foot Ankle Surg.2015;21(3):178-181.
[33]Marni W,Terry D,Heather B,et al.A pilot study evaluating the effectiveness of platelet-rich plasma therapy for treating degenerative tendinopathies:a randomized control trial with synchronous observational cohort.PLoS One.2016;11(2):e0147842.
[34]Harmon KG,Rao AL.The use of platelet-rich plasma in the nonsurgical management of sports injuries:hype or hope?Hematol Am Soc Hematol Educ Program.2013;2013(1):620-626.
[35]Vos RJD,Windt J,Weir A.Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy:a systematic review.Br J Sports Med.2014;48(12):952-956.
[36]Carli AD,Lanzetti R,Ciompi A,et al.Can platelet-rich plasma have a role in Achilles tendon surgical repair?Knee Surg Sports Traumatol Arthrosc.2015;24(7):2231-2237.
[37]Lyras DN,Kazakos K,Verettas D,et al.The influence of platelet-rich plasma on angiogenesis during the early phase of tendon healing.Foot Ankle Int.2009;30(11):1101-1106.
[38]熊小龙,伍亮,相大勇,等.富血小板血浆对大鼠跟腱断裂早期愈合的影响[J].中国修复重建外科杂志,2012,26(4):466-471.
[39]伍亮,熊小龙,相大勇,等.TGF-β1和VEGF在富血小板血浆治疗跟腱断裂模型中的表达及意义[J].中华临床医师杂志(电子版),2013,7(4):1639-1645.
[40]Alsousou J,Thompson M,Harrison P,et al.Effect of platelet-rich plasma on healing tissues in acute ruptured achilles tendon:a human immunohistochemistry study.Lancet.2015;385:S19.
[41]Jian Z,Xiaolian M,Zhongmin S,et al.A prospective study of platelet-rich plasma as biological augmentation for acute achilles tendon rupture repair.Biomed Res Int.2016;2016:1-8.
[42]Pietro G,Barbara DA,Annarita A,et al.Use of platelet rich plasma and hyaluronic acid in the treatment of complications of achilles tendon reconstruction.World J Plast Surg.2016;5(2):124-132.
[43]Lei H,Gui L,Xiao R.The effect of anticoagulants on the quality and biological efficacy of platelet-rich plasma.Clin Biochem,2009;42(13-14):1452-1460.
[44]Harrison S,Vavken P,Kevy S,et al.Platelet activation by collagen provides sustained release of anabolic cytokines.T Am J Sports Med.2011;39(4):729-734.
[45]罗涛,李放,张宁.不同抗凝剂和激活剂联合应用对富血小板血浆凝胶释放生长因子影响的比较[J].中国组织工程研究,2012,16(16):2893-2897.
[2]Wu F,Nerlich M,Docheva D.Tendon injuries:basic science and new repair proposals.EFORT Open Rev.2017;2(7):332-342.
[3]Rodeo SA,Nguyen JT,Cavanaugh JT,et al.Clinical and Ultrasonographic Evaluations of the Shoulders of Elite Swimmers,Am J Sports Med.2016;44(12):3214-3221.
[4]Buda R,Castagnini F,Pagliazzi G,et al.Treatment algorithm for chronic achilles tendon lesions review of the literature and proposal of a new classification.J Am Podiatr Med Assoc.2017;107(2):144-149.
[5]Harke H,Tanger D,Furst-Denzer S,et al.Effect of a preoperative separation of platelets on the postoperative blood loss subsequent to extracorporeal circulation in open heart surgery.Anaesthesist.1977;26(2):64-71.
[6]潘红娟,王雅丽,吕爽,等.富血小板血浆制备方法稳定性的研究[J].中国实验诊断学,2016,20(6):1008-1010.
[7]Dhillon M,Patel S,Shetty V,et al.Orthobiologics and platelet rich plasma,Indian J Orthop.2014;48(1):1-9.
[8]Ayatollahi A,Hosseini H,Shahdi M,et al.Platelet-rich plasma by single spin process in male pattern androgenetic alopecia:is it an effective treatment?Indian Dermatol Online J.2017;8(6):460-464.
[9]Ehrenfest DMD,Andia I,Zumstein MA,et al.Classification of platelet concentrates(Platelet-Rich Plasma-PRP,Platelet-Rich Fibrin-PRF)for topical and infiltrative use in orthopedic and sports medicine:current consensus,clinical implications and perspectives.Muscles Ligaments Tendons J.2014;4(1):3-9.
[10]福嘉欣,王树森.自体富血小板血浆治疗骨关节与运动损伤疾病的机制与应用[J].中国组织工程研究,2017,21(30):4908-4914.
[11]Moran J,Sun S,Khababa I,et al.A randomized trial comparing gentamicin/citrate and heparin locks for central venous catheters in maintenance hemodialysis patients.Am J Kidney Dis.2012;59(1):102-107.
[12]Nurden AT,Nurden P,Sanchez M,et al.Platelets and wound healing.Front Biosci.2008;13:3532-3548.
[13]Drago L,Bortolin M,Vassena C,et al.Plasma components and platelet activation are essential for the antimicrobial properties of autologous platelet-rich plasma:an in vitro study.PLoS One.20149(9):e107813.
[14]吕汝举,刘美静.富血小板血浆(富血小板血浆)治疗技术及应用[J].中国医疗器械信息,2013,19(10):50-55.
[15]Brass L.Understanding and evaluating platelet function.Hematology Am Soc Hematol Educ Program.2010;2010(1):387-396.
[16]潘红娟.富血小板血浆制备技术的优化及其组分的检测[D].长春:吉林大学,2017.
[17]Younesi M,Knapik DM,Cumsky J,et al.Effects of PDGF-BBdelivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon,in vivo.Acta Biomater.2017;63:200-209.
[18]Lichtman MK,Otero-Vinas M,Falanga V.Transforming growth factor beta(TGF-β)isoforms in wound healing and fibrosis.Wound Repair Regen,2016;4(2):215-222.
[19]Ruhrberg C.Growing and shaping the vascular tree:multiple roles for VEGF.Bioessays.2003;5(11):1052-1060.
[20]Fujioka-Kobayashi M,Miron RJ,Hernandez M,et al.Optimized platelet rich fibrin with the low speed concept:growth factor release,biocompatibility and cellular response.J Periodontol.2016;8(1):1-17.
[21]Zhou Y,Zhang J,Wu H,et al.The differential effects of leukocyte-containing and pure platelet-rich plasma(PRP)on tendon stem/progenitor cells-implications of PRP application for the clinical treatment of tendon injuries.Stem Cell Res Ther.2015;6(1):173.
[22]Young A,Mcnaught CE.The physiology of wound healing.Surgery(Oxford).2011;9(10):475-479.
[23]Boswell SG,Schnabel LV,Mohammed HO,et al.Increasing platelet concentrations in leukocyte-reduced platelet-rich plasma decrease collagen gene synthesis in tendons.Am J Sports Med.2014;42(1):42-49.
[24]Dovi JV,He LK,DiPietro LA.Accelerated wound closure in neutrophil-depleted mice.J Leukoc Biol.2003;73(4):448-455.
[25]Dragoo JL,Braun HJ,Durham JL,et al.Comparison of the acute inflammatory response of two commercial platelet-rich plasma systems in healthy rabbit tendons.Am J Sports Med.2012;40(6):1274-1281.
[26]Dohan DM,Choukroun J,Diss A,et al.Platelet-rich fibrin(PRF):asecond-generation platelet concentrate.Part I:Technological concepts and evolution.Am J Sports Med.2006;101(3):e37-e44.;
[27]Choukroun J,Diss A,Simonpieri A,et al.Platelet-rich fibrin(PRF):a second-generation platelet concentrate.Part IV:clinical effects on tissue healing.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2006;101(3):e56-e60.
[28]Dohan DM,Choukroun J,Diss A,et al.Platelet-rich fibrin(PRF):a second-generation platelet concentrate.Part II:platelet-related biologic features.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2006;101(3):e45-e50.
[29]Mishra A,Woodall J,Vieira A.Treatment of tendon and muscle using platelet-rich plasma.Clin Sports Med.2009;28(1):113-125.
[30]刘步云,咸杰,孙育良,等.局部注射自体富血小板血浆联合运动疗法和局部注射曲安奈德治疗跟腱病的临床疗效对比[J].四川医学,2017,38(5):10-13.
[31]Filardo G,Kon E,Matteo BD,et al.Platelet-rich plasma injections for the treatment of refractory achilles tendinopathy:results at 4years.Blood Transfus.2014;12(4):1-8.
[32]Guelfi M,Pantalone A,Vanni D,et al.Long-term beneficial effects of platelet-rich plasma for non-insertional Achilles tendinopathy,Foot Ankle Surg.2015;21(3):178-181.
[33]Marni W,Terry D,Heather B,et al.A pilot study evaluating the effectiveness of platelet-rich plasma therapy for treating degenerative tendinopathies:a randomized control trial with synchronous observational cohort.PLoS One.2016;11(2):e0147842.
[34]Harmon KG,Rao AL.The use of platelet-rich plasma in the nonsurgical management of sports injuries:hype or hope?Hematol Am Soc Hematol Educ Program.2013;2013(1):620-626.
[35]Vos RJD,Windt J,Weir A.Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy:a systematic review.Br J Sports Med.2014;48(12):952-956.
[36]Carli AD,Lanzetti R,Ciompi A,et al.Can platelet-rich plasma have a role in Achilles tendon surgical repair?Knee Surg Sports Traumatol Arthrosc.2015;24(7):2231-2237.
[37]Lyras DN,Kazakos K,Verettas D,et al.The influence of platelet-rich plasma on angiogenesis during the early phase of tendon healing.Foot Ankle Int.2009;30(11):1101-1106.
[38]熊小龙,伍亮,相大勇,等.富血小板血浆对大鼠跟腱断裂早期愈合的影响[J].中国修复重建外科杂志,2012,26(4):466-471.
[39]伍亮,熊小龙,相大勇,等.TGF-β1和VEGF在富血小板血浆治疗跟腱断裂模型中的表达及意义[J].中华临床医师杂志(电子版),2013,7(4):1639-1645.
[40]Alsousou J,Thompson M,Harrison P,et al.Effect of platelet-rich plasma on healing tissues in acute ruptured achilles tendon:a human immunohistochemistry study.Lancet.2015;385:S19.
[41]Jian Z,Xiaolian M,Zhongmin S,et al.A prospective study of platelet-rich plasma as biological augmentation for acute achilles tendon rupture repair.Biomed Res Int.2016;2016:1-8.
[42]Pietro G,Barbara DA,Annarita A,et al.Use of platelet rich plasma and hyaluronic acid in the treatment of complications of achilles tendon reconstruction.World J Plast Surg.2016;5(2):124-132.
[43]Lei H,Gui L,Xiao R.The effect of anticoagulants on the quality and biological efficacy of platelet-rich plasma.Clin Biochem,2009;42(13-14):1452-1460.
[44]Harrison S,Vavken P,Kevy S,et al.Platelet activation by collagen provides sustained release of anabolic cytokines.T Am J Sports Med.2011;39(4):729-734.
[45]罗涛,李放,张宁.不同抗凝剂和激活剂联合应用对富血小板血浆凝胶释放生长因子影响的比较[J].中国组织工程研究,2012,16(16):2893-2897.