富血小板血浆的临床应用

富血小板血浆(platelet-rich plasma,PRP)是血小板浓度高于基础水平时,从自体血液中提取血小板及血浆的浓聚物,激活后可以释放大量生长因子等促进组织修复和再生的生物活性物质,目前已成为再生医学的重要治疗手段。研究表明,由于PRP对许多疾病都有积极的治疗作用,因而被广泛应用于整形美容外科、骨科、口腔科、眼科等学科。现对PRP的生物学特性、制备方法及临床应用作一综述。     

富血小板血浆治疗骨折的研究进展

富血小板血浆（platelet-rich plasma, PRP）是通过离心、血细胞单采等方式从动物或人全血中提取的富含高浓度血小板的血浆，由于来源于自体血液不产生免疫排斥，是目前应用前景优良的再生医学治疗药物之一，其临床治疗价值与干细胞相当。自Anitua于1999年发现PRP能显著促进骨组织修复以来，PRP由于其自身优良的性能，在骨科疾患中得到广泛应用。本文将分别从PRP影响骨愈合作用机制、促进骨愈合应用及研究进展、展望等方面综述应用PRP治疗骨折的研究进展。     

自体富血小板血浆提取液对周围神经再生的作用

周围神经损伤后促进轴突再生使其尽快致靶在其功能恢复中至关重要，也是临床上迫切需要解决的问题。富血小板血浆（PRP）提取液是全血的提取物，富含多种生长因子，我们研究发现能明显促进周围神经再生，其作用优于单一的神经生长因子（NGF），且制作简便，有望应用于临床。     

富血小板血浆引导骨再生在上颌美学区单牙种植修复中的应用研究

目的:研究富血小板血浆引导骨再生在上颌美学区单牙种植修复中的应用效果。方法:选择2013年1月-2017年1月行上颌美学区单牙种植修复的225例患者为研究对象,根据是否混有富血小板血浆将其分为观察组与对照组,分别给予富血小板血浆引导骨再生、无混有富血小板血浆干预,评价各组种植修复的成功率、骨吸收、红色美学指数(PES)、白色美学指数(WES)及主观满意度情况。结果:两组均成功种植修复,两组骨吸收、WES评分比较无明显差异(P0.05);观察组种植修复即刻、修复后6个月、12个月PES评分及种植修复后12个月附着高度、整体美观评分均显著高于对照组,差异有统计学意义(P0.05)。结论:富血小板血浆引导骨再生效果明显,能有效促进骨再生及修复,且美学效果良好。     

创伤后富血小板血浆治疗研究进展

富血小板血浆能有效地促进骨髓基质干细胞和成骨细胞的增殖、分化,明显促进骨缺损愈合;能在软组织创伤中刺激软组织再生,加速伤口愈合,对跟腱、角膜、泪腺等损伤具有积极的修复作用;能明显促进周围神经损伤的再生。它完全来源于自体,避免了疾病传染及免疫排斥反应,且制作简单,对组织损伤小,其含有的各种生长因子之间具有最佳的浓度配比,因此在临床上具有良好的应用前景。富血小板血浆在经进一步研究后,有望为临床提供安全、可行的创伤治疗方法。     

富含血小板血浆在足踝外科领域的临床应用

正富含血小板血浆(platelet-rich plasma,PRP)作为一种新的生物血液制剂,迄今已经在医疗领域范围内得到了广泛的使用[1],由于其抗感染及组织再生能力,主要应用于促进软组织和骨组织的再生以及治疗骨折的并发症,如感染、骨不连的治疗。PRP是从全血中提取出来的血小板浓缩液,其血小板浓度是正常血浆的8倍,这些血小板中含有α颗粒,可释放用于组织修复的生长因子,包括转化生长因子β(Trans-     

富血小板血浆应用于早期非创伤性股骨头坏死的研究进展

通过广泛查阅国内外数据库,对近年来富血小板血浆(PRP)应用于非创伤性股骨头坏死保髋治疗的现状及进展的相关文献进行分析和总结,发现富血小板血浆可显著促进骨缺损的修复,并在体外对骨髓基质干细胞的增殖与分化有明显的促进作用。富血小板血浆已广泛应用于科研,尤其在软骨损伤修复、骨折不愈合/骨不连等难治性疾病的治疗中显示出较好的疗效。富血小板血浆在软骨损伤修复、骨折不愈合/骨不连修复等与非创伤性股骨头坏死的病理修复过程较为接近,其对早期非创伤性股骨头坏死的治疗具有一定的应用前景。因此本文将就PRP在基础与临床中的应用及尚存在的一些问题和争议进行综述。     

富血小板血浆促进骨修复的研究进展

本文介绍了富血小板血浆修复骨组织的特点,并与目前骨组织工程学修复方法作了比较,讨论了富血小板血浆的制作方法及其促进骨组织修复的机制,提出了富血小板血浆修复骨组织目前还存在的问题。     

细胞治疗策略促进牵张成骨的研究进展

目的综述细胞治疗策略在促进牵张成骨(distraction osteogenesis,DO)方面的研究进展。方法广泛查阅近年来国内外关于细胞治疗策略促进DO、缩短治疗周期的研究文献,对常用方法进行分析总结。结果常用的促进骨再生的细胞治疗策略有细胞注射治疗、细胞-外源性载体支架复合物/可注射组织工程骨、微组织或多细胞聚集体技术、细胞基因治疗,各有优缺点。除自体BMSCs与富血小板血浆复合注射的方法有临床应用报道外,其他方法仍处于基础研究阶段。结论细胞治疗策略在骨再生、促进DO及缩短其治疗周期等方面具有广阔前景,应用于临床前需严谨设计临床前试验来评价其安全性并规范应用方法。     

富血小板血浆在脊柱外科的应用

富血小板血浆因富含多种生长因子,有利于机体组织修复,具有广阔的临床应用前景。许多研究提示富血小板血浆具有促进修复退变椎间盘的作用,但在提高脊柱融合效果方面的研究结论分歧较大,这可能与富血小板血浆制作方法差异较大有关。该文就富血小板血浆在脊柱外科的应用研究现状作一综述。     

富血小板血浆与骨再生

急性臂丛神经炎是一种少见病,但人们往往认识不足,在早期,易被误诊为神经根型颈椎病或胸廓出口综合征。为了提高对本病的认识,降低误诊和漏诊率,本文就急性臂丛神经炎的诊断、鉴别诊断与治疗进行综述。1诊断名词与病因急性臂丛神经炎,病因尚未明了,但却有典型的临床特征。最初由Parsonage等[1]和Turner等[2]报道为肩胛带综合征和麻痹性臂丛神经炎,后被称之为:Parsonage-Turner综合征。其他诊断名词有:急性臂丛神经炎,神经源性肌萎缩,术后原发性臂丛神经炎等[3,4]。     

富血小板血浆在骨科的研究概况

【摘要】〓富血小板血浆(platelet-rich plasma,PRP)是最近十年研究热门的一个课题,它是一种具有促进组织损伤修复作用的自体来源血浆制品,其所含有的超生理浓度血小板和多种生长因子是发挥作用的主要物质。目前,PRP已在口腔、美容整形、普通外科、骨科及运动医学等临床领域开展应用,其中骨科研究是现阶段数量最多的。一些与骨科相关的体外细胞学实验、体内动物实验和临床研究的结果表明PRP能有效地促进骨及软组织修复,对骨科疾病的治疗效果好,但也有文献报道相反的结论或称目前临床证据不足以评价。因此,PRP在骨科的研究还有许多问题亟待解决,需要开展更多的研究进行探索。     

Translational research for injectable tissue-engineered bone regeneration using mesenchymal stem cells and platelet-rich plasma: from basic research to clinical case study

Translational research involves application of basic scientific discoveries into clinically germane findings and, simultaneously, the generation of scientific questions based on clinical observations. At first, as basic research we investigated tissue-engineered bone regeneration using mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) in a dog mandible model. We also confirmed the correlation between osseointegration in dental implants and the injectable bone. Bone defects made with a trephine bar were implanted with graft materials as follows: PRP, dog MSCs (dMSCs) and PRP, autogenous particulate cancellous bone and marrow (PCBM), and control (defect only). Two months later, dental implants were installed. According to the histological and histomorphometric observations at 2 months after implants, the amount of bone-implant contact at the bone-implant interface was significantly different between the PRP, PCBM, dMSCs/ PRP, native bone, and control groups. Significant differences were also found between the dMSCs/PRP, native bone, and control groups in bone density. These findings indicate that the use of a mixture of dMSCs/ PRP will provide good results in implant treatment compared with that achieved by autogenous PCBM. We then applied this injectable tissue-engineered bone to onlay plasty in the posterior maxilla or mandible in three human patients. Injectable tissue-engineered bone was grafted and, simultaneously, 2-3 threaded titanium implants were inserted into the defect area. The results of this investigation indicated that injectable tissue-engineered bone used for the plasty area with simultaneous implant placement provided stable and predictable results in terms of implant success. We regenerated bone with minimal invasiveness and good plasticity, which could provide a clinical alternative to autogenous bone grafts. This might be a good case of translational research from basic research to clinical application.     

Synergistic effects of HBO and PRP improve bone regeneration with autologous bone grafting

Bone defects remain a challenge for patients and orthopaedic surgeons. Autologous transfer of cancellous bone grafts remains the standard of care. However, in recent years various osteoinductive substitute materials, such as platelet rich plasma (PRP) and hyperbaric oxygen therapy (HBO) have been shown to improve bone healing. This study evaluates the effects of a combined application of PRP and HBO with autologous bone grafting in an animal model.In 48 New Zealand White rabbits bone defects at the radius were filled with autologous bone harvested at the iliac crest. This was combined with application of autologous PRP and/or HBO treatment for the duration of this study. After 3 and 6 weeks histomorphometric, immunohistochemical and radiologic evaluations were performed.All animals tolerated the treatment well. Improved bone regeneration was shown in all groups at 6 weeks compared to 3 weeks. Additional application of PRP and HBO resulted in an increase in new bone formation and increased neovascularization at 3 and 6 weeks. There was no statistical significant difference between PRP and HBO application in these regards. A combinatory use of PRP and HBO resulted in an increased bone regeneration and neovascularization compared to all other groups.This study provides evidence for an improvement of bone regeneration with the combinatory application of PRP and HBO to autologous cancellous bone grafts in a model of weight bearing bone defects in rabbits. Also synergistic effects of these two measures on angiogenesis were evident.     

Effect of platelet concentration in platelet-rich plasma on peri-implant bone regeneration

This study analyzed the effect of the platelet count in platelet-rich plasma (PRP) on bone regeneration in vivo. Twenty male New Zealand white rabbits were used. PRP was produced using the Platelet Concentrate Collection System (PCCS) (3i, Miami, FL, USA). After inducing ketamine-xylazine anaesthesia, a self-tapping titanium screw (Branemark MK III TiUnite, 3.75 x 7 mm) was inserted in each distal femur; the femurs were randomized so that one side was treated with PRP while the other (control) was not. Intravital fluorochrome staining was performed on days 1, 7 (1.5 ml of 2% doxycycline/kg bodyweight), 14 (6% xylenol orange, 1.5 ml/kg), and 21 (1% calcein green, 5 ml/kg). Animals were euthanized on day 28 (n = 20). Specimens were prepared for histomorphological evaluation according to Donath and Breuner [J. Oral Pathol. 11 (1982) 318]. Comparing the bone regeneration (fluorochrome staining) in the 4-week implants (n = 19), the only significant difference (sign test, P = 0.004) was seen with intermediate platelet concentrations (n = 9,503,000-1,729,000 platelets/microl PRP). There were no differences in the bone/implant contact rates between the test and the control side among the three groups. The platelet concentration required for a positive PRP effect on bone regeneration seems to span a very limited range. Advantageous biological effects seem to occur when PRP with a platelet concentration of approximately 1,000,000/microl is used. At lower concentrations, the effect is suboptimal, while higher concentrations might have a paradoxically inhibitory effect. On the other hand, the effect of this type of platelet concentrate was not beneficial to accelerate the osseointegration of enosseous dental implants.     

复合富血小板血浆新型可注射组织工程骨体内成骨研究

目的 以新型可注射生物材料壳聚糖β-磷酸三钙为支架,负载骨髓间充质干细胞(MSCs)与富血小板血浆(PRP)构建成新型可注射组织工程骨,观察其体内成骨效应.方法 采用中国青山羊双侧胫骨平台下腔穴型骨缺损模型.30只中国青山羊随机分为五组:空白组:骨缺损部不植入任何组织工程材料;单纯材料组:单纯植入组织工程材料壳聚糖β-磷酸三钙;PRP组:植入单纯复合PRP组织工程材料:MSCs组:植入单纯复合MSCs的组织工程材料;PRP/MSCs组:植入复合PRP、MSCs的组织工程材料.于术后第4、8周取出骨缺损区标本进行大体观察和组织学切片观察,图像分析骨缺损区域骨小梁的生成数量.结果 术后8周,大体观察显示PRP/MSC组骨缺损区域表面新生骨连续,外观类似正常骨.术后4、8周,组织学显示PRP/MSCs组骨缺损边缘区域类骨质数量明显增多,骨缺损部多为点片状新生骨组织,其中大的片状新生骨组织明显增多.术后4周空白组、单纯材料组、PRP组、MSCs组、PRP/MSCs组的成骨面积百分比分别为8.79±3.63、14.49±3.72、24.18±5.38、24.42±5.10、31.10±3.49:8周时分别为15.41±4.21、25.36±5.37、30.71±4.39、33.97±4.45、48.60±5.97,4周、8周PRP/MSCs组骨修复效果均优于其他各组(P<0.05).结论 负载PRP和MSCs的新型可注射组织工程骨具有良好的骨修复作用.     

Can platelet-rich plasma (PRP) improve bone healing? A comparison between the theory and experimental outcomes

The increased concentration of platelets within platelet-rich plasma (PRP) provides a vehicle to deliver supra-physiologic concentrations of growth factors to an injury site, possibly accelerating or otherwise improving connective tissue regeneration. This potential benefit has led to the application of PRP in several applications; however, inconsistent results have limited widespread adoption in bone healing. This review provides a core understanding of the bone healing mechanisms, and corresponds this to the factors present in PRP. In addition, the current state of the art of PRP preparation, the key aspects that may influence its effectiveness, and treatment outcomes as they relate specifically to bone defect healing are presented. Although PRP does have a sound scientific basis, its use for bone healing appears only beneficial when used in combination with osteoconductive scaffolds; however, neither allograft nor autograft appear to be appropriate carriers. Aggressive processing techniques and very high concentrations of PRP may not improve healing outcomes. Moreover, many other variables exist in PRP preparation and use that influence its efficacy; the effect of these variables should be understood when considering PRP use. This review includes the essentials of what has been established, what is currently missing in the literature, and recommendations for future directions.     

PRP modulates expression of bone matrix proteins in vivo without long-term effects on bone formation

This experimental study (domestic pig) examined the bone formation after filling defined defects of the frontal skull with autogenous bone or a deproteinized bovine bone matrix (DBBM) in combination with platelet-rich plasma (PRP). Six groups, both materials with and without PRP in two different concentrations (4.1x and 6.5x referring to untreated whole blood) were evaluated at 2, 4, 12, and 26 weeks by means of immunohistochemical staining for different bone matrix proteins, microradiography, light microscopy and polychromatic fluorescence labeling. The sequential expression of bone matrix proteins reflected the specific roles these proteins fulfil in the mineralization of hard tissue. Collagen I expression at 2 weeks was enhanced in all autogenous bone groups. No specific modification of the collagen I expression was found after use of DBBM with or without PRP. Osteopontin and especially osteonectin showed a remarkable enhancement at 4 weeks in nearly all autogenous bone and DBBM groups. These increased levels closely resembled the mineralization content evaluated by microradiography at that time. For the three autogenous bone groups, an expression peak for osteocalcin was demonstrated at 12 weeks, further reflecting the way of de novo bone formation. The microradiographic evaluation demonstrated a statistically significant enhancement in bone regeneration by PRP only after use of autogenous bone plus PRP at 2 weeks (P = 0.002). After 4 weeks, mineralization values after use of autogenous bone were significantly lower if PRP was added to the autogenous bone (P = 0.002). No long-term effects of the PRP administration were found in the mineralization process. In all DBBM groups, bone formation remained unchanged, confirming the lack of any osteoinductive capacity of PRP. PRP modulated the expression of bone matrix proteins in this experimental setting. However, an enhancement of bone formation was demonstrated only at 2 weeks after application of the higher PRP concentration in combination with autogenous bone. In conjunction with an anorganic bovine bone no effects of PRP on defect mineralization were discovered, demonstrating the lack of osteoinductive capacity in PRP as well as in DBBM.     

Controlled release of platelet growth factors enhances bone regeneration at rabbit calvaria.

OBJECTIVE: Platelet-rich plasma (PRP) has been clinically employed to promote bone regeneration. However, few studies have investigated the enhancement of biological function of platelet growth factors after integration of PRP into biomaterials. In this study, the feasibility of gelatin hydrogels for controlled release of platelet growth factors and the consequent enhancement of PRP-induced bone regeneration were evaluated in rabbit calvarial defect. STUDY DESIGN: Gelatin hydrogels incorporating PRP, PRP-activated thrombin, or an empty gelatin hydrogel were applied to the defect, or the defect was left untreated. Bone regeneration was evaluated by microfocus computed tomography, peripheral quantitative computed tomography, and histological examinations. RESULTS: Successful bone regeneration was observed at the bone defect applied with the gelatin hydrogel incorporating PRP, which is in marked contrast to other groups. CONCLUSION: The gelatin hydrogel is a promising material capable of controlled release of platelet growth factors to enhance bone regeneration.