Name: preparation, procedures and evaluation of platelet-rich plasma injection in the treatment of knee osteoarthritis
Uploaded: 2019-01-04T13:00:00
Description: Watch this Scientific Journal Video about Preparation, Procedures and Evaluation of Platelet-Rich Plasma Injection in the Treatment of Knee Osteoarthritis at JoVE.com

本研究得到了国家自然科学基金 (81371991) 和广东省科技重点项目 (2015 b020225007) 的支持。

上述方法得到了广东总医院伦理委员会的批准。
1. 通过手动离心获得 prp
<ol><li>在室温和湿度舒适的无菌层流手术室中, 让患者处于仰面位置, 室温为 22°c, 室温为60%。</li>
	<li>使用1毫升注射器绘制 0.2 ml 的肝素钠 (2 毫升 = 12, 500 u), 然后弄湿一个50毫升的注射器。 注: 3 毫升柠檬酸钠也是典型的, 在这一步, 以取代肝素钠。</li>
	<li>组织止血带, 对肘部进行2-3 次消毒, 然后使用?...

<ol>
	<li>Loeser, R. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Age-related+changes+in+the+musculoskeletal+system+and+the+development+of+osteoarthritis.">Age-related changes in the musculoskeletal system and the development of osteoarthritis.</a> Clinics in Geriatric Medicine. 26 (3), 371-386 (2010).</li><li>Bhatia, A., Peng, P., Cohen, S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiofrequency+procedures+to+relieve+chronic+knee+pain:+an+evidence-based+narrative+review.">Radiofrequency procedures to relieve chronic knee pain: an evidence-based narrative review.</a> Reg Anesth Pain Med. 43 (1), 72 (2018).</li><li>S&#225;nchez, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+randomized+clinical+trial+evaluating+plasma+rich+in+growth+factors+(PRGF-endoret)+versus+hyaluronic+acid+in+the+short-term+treatment+of+symptomatic+knee+osteoarthritis.">A randomized clinical trial evaluating plasma rich in growth factors (PRGF-endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis.</a> Arthroscopy the Journal of Arthroscopic &amp; Related Surgery. 28 (8), 1070-1078 (2012).</li><li>LaPrade, R. 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D., Fuller, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Platelet-rich+plasma+for+osteoarthritis+treatment.">Platelet-rich plasma for osteoarthritis treatment.</a> Revista Brasileira de Reumatologia (English Edition). 56 (2), 152-164 (2016).</li><li>Weibrich, G., Kleis, W. K., Hafner, G., Hitzler, W. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Growth+factor+levels+in+platelet-rich+plasma+and+correlations+with+donor+age,+sex,+and+platelet+count.">Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count.</a> J Craniomaxillofac Surg. 30 (2), 97-102 (2002).</li><li>Landesberg, R., Roy, M., Glickman, R. 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正常血液中的血小板浓度在 150, 000μμl 和 350000/ll 之间, 人们普遍认为 prp 的血小板浓度应达到 1000000/μl, 是正常浓度9的3至5倍。根据 paw 层次体系, 认为当血小板浓度低于正常浓度的三倍时, prp 没有明显的效果, 而当血小板浓度大于6时, prp 有抑制作用乘以正常浓度的 12。因此, 该方案的最低要求是, prp 的血小板浓度介于这些水平之间。
手动 pr...

膝关节骨关节炎 (koa) 是骨科最常见的疾病之一;30%-50% 的65岁以上的人经历过这种疾病1。目前, koa 的保守治疗主要包括口服非甾体抗炎药和软骨营养药物、关节内注射透明质酸钠和物理治疗。然而, 这些方法不能阻止膝关节退化2的过程。关节软骨缺损可导致关节表面磨损、关节不稳定和代谢变化, 这些都是 koa 3 发病机制的一部分.然而, 由于关节软骨中缺乏血管、神经和淋巴组织, 损伤后恢复困难。一种有效的软骨修复方法对 koa 的治疗尤为重要。破骨细胞的治疗也是 koa 治疗的重点。
富含血小板的血浆 (prp) 是一种自体生物活性物质, prp 在骨和关节中的应用问题也越来越多。prp 临床应用的生物学原理包括其对生长因子局部传递和炎症反应改变的影响及其对细胞增殖和分化的积极影响4。关节内注射后激活后, prp 通过去颗粒释放α颗粒, 并分泌各种生长因子, 包括血小板衍生生长因子、转化生长因子β、胰岛素样生长因子、表皮生长因子、血管内皮生长因子和成纤维细胞生长因子。这些促进成骨细胞和软骨细胞增殖, 抑制软骨变性, 增强软骨和软骨下骨的稳定性, 调节金属蛋白酶的基因表达组织抑制剂, 并保持合成的平衡和蛋白多糖降解5,6。因此, prp 可以修复软骨损伤, 促进骨再生。
prp 注射的结果受各种因素的影响, 包括取样点7、离心机制备方法8、抗凝剂9和激活剂10的使用.制备 prp 的离心方法大约有3种。虽然是最常用的人工离心、设备离心或等离子过滤技术, 但也有手工和设备过滤技术。手动方法要求最少的设备, 方便, 成本低, 操作简单 (图 1)。prp 是通过人工离心两次制备的。将混合外周血和抗凝剂离心, 将血细胞从血浆和血小板中分离出来。丢弃底层红血球后, 将上清液离心再分离, 分为上清液血小板差血浆、中 prp 和亚钠残留红细胞。中间层用于膝关节腔注射 (如果数量不足, 可以提取部分上清液)。该方法的评价包括对血小板浓度和临床结果的评估。
临床研究中对 prp 制备方案的报告非常不一致, 大多数研究没有提供足够的信息, 使协议无法复制 11.在这里, 我们描述了一种可重复的方法, 准备 prp 和治疗 koa 与 prp 关节内注射, 并对结果进行评价。纳入标准是膝关节骨关节炎患者谁有不良的疼痛缓解简单的镇痛药物 (如对乙酰氨基酚) 和保守治疗。排除标准包括静脉回流或淋巴引流障碍患者;膝关节感染患者;注射区发生皮肤病或感染的病人;发热患者;凝血功能异常患者;严重心血管疾病的患者。整个治疗过程不到 30分钟, prp 的血小板浓度被证明达到了标准化的测量。它的有效性通过在密切随访期间评估结果来证明。

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			<td>Shanghai Likang Disinfectant HiTech Co., LTD</td>
			<td>310173</td>
			<td>Disinfect the skin</td>
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			<td>KDL&#160; Medical Equipment Co., LTD</td>
			<td>0.4*13 RWLB</td>
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			<td>KDL&#160; Medical Equipment Co., LTD</td>
			<td>1.2*38 TWSB</td>
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			<td>KDL&#160; Medical Equipment Co., LTD</td>
			<td>0.7*32 TWLB</td>
			<td></td>
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			<td height="20" style="height:20px;">Medical Tourniquet</td>
			<td>Changzhou Jinli Latex Products Co., LTD</td>
			<td>0087-2011</td>
			<td></td>
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			<td height="20" style="height:20px;">Single-use sterile rubber surgical gloves</td>
			<td>Shanghai jinxiang Latex Products Co., LTD</td>
			<td>17060</td>
			<td></td>
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			<td height="20" style="height:20px;">Disposable Draw Blood Needle</td>
			<td>KDL&#160; Medical Equipment Co., LTD</td>
			<td>0.55*20 L(II) RWLB</td>
			<td></td>
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			<td height="20" style="height:20px;">Heparin Sodium Injection</td>
			<td>SPH No.1 Biochemical &#38; Pharmaceutical Co., LTD</td>
			<td>1706101</td>
			<td>2ml:12500U</td>
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			<td height="20" style="height:20px;">Jifro Hand Antiseptic Rinse Free Gel</td>
			<td>Shanghai Likang Disinfectant HiTech Co., LTD</td>
			<td>311793</td>
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			<td>Foshan Kangzheng Medical Supplies Co., LTD</td>
			<td>KZ3-12</td>
			<td>Disinfect the skin</td>
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			<td height="20" style="height:20px;">10ml Normal Saline&#160;</td>
			<td>Jiangxi Shuangshi Pharmecutical Co., LTD</td>
			<td>140211458</td>
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			<td>Beckman Coulter</td>
			<td>LH-750</td>
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			<td>Becton, Dickinson and Company</td>
			<td>CNL17-COO56</td>
			<td>Store in a cool dry place within 4 to 25 degrees Celcius</td>
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			<td>RWD LIFE SCIENCE</td>
			<td>F12006-10</td>
			<td></td>
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			<td height="20" style="height:20px;">Sterile Gauze</td>
			<td>Guangdong Ze Chang Trade Co., LTD</td>
			<td>170915</td>
			<td></td>
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			<td height="20" style="height:20px;">Adhesive Plaster</td>
			<td>3M Transpore</td>
			<td>1527C-0</td>
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			<td height="20" style="height:20px;">Skin Marker Pen</td>
			<td>Guangzhou Mingjia Medical Device Manufacturing Co., LTD</td>
			<td>10110</td>
			<td></td>
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preparation, procedures and evaluation of platelet-rich plasma injection in the treatment of knee osteoarthritis

膝关节骨关节炎 (koa) 是骨科最常见的疾病之一。现有的非手术治疗对软骨的修复和骨再生的影响有限。富含血小板的血浆 (prp) 是一种自体生物活性物质, 能有效修复软骨损伤, 促进骨再生。然而, 临床研究中对 prp 制备方案的报告非常不一致, 大多数研究提供的信息不足, 无法复制该方案。我们描述了一种可重复的方法, 准备 prp 视觉, 使用 prp 关节内注射治疗 koa, 以及评估结果的方法。采用人工双离心法制备了 prp。从外周血中提取 prp 层, 用于膝关节腔注射。评估包括对血小板浓度和临床结果的评估。人工离心制备 prp 所需的设备较少, 而且比使用设备的等离子过滤或离心成本更低。我们的双离心方法的离心时间分别为6分钟和 5分钟, 分别为800和 1400 x g 的离心, 以便一致地制备标准化的 prp。但是, 手动方法容易受到操作人员错误的影响, 并且不提供 prp 批处理准备。关节内注射 prp 是治疗膝关节骨关节炎的有效方法。整个治疗过程不到 30分钟, 可规范 prp 的血小板浓度, 经随访评估证明治疗有效。

因此, prp 的血小板计数达到了 1121 x 103 l 的标准浓度水平。我们对一名55岁的男性患者进行了协议中描述的15项随访调查。可见, 早期临床结果是满意的关节内给药后的 prp (图 2)。然而, 中期疗效略差。观察到明显的镇痛效果 (图 2a)。kss 膝关节得分高于 kss 功能评分 (图 2c,图 2d)...

Watch this Scientific Journal Video about Preparation, Procedures and Evaluation of Platelet-Rich Plasma Injection in the Treatment of Knee Osteoarthritis at JoVE.com

Preparation, Procedures and Evaluation of Platelet-Rich Plasma Injection in the Treatment of Knee Osteoarthritis

膝关节骨关节炎在骨科经常出现。我们详细介绍了全膝关节骨关节炎治疗过程中富含血小板的血浆注射, 包括制备, 程序, 和评价。

富血小板血浆注射液治疗膝关节骨关节炎的制备、程序及评价

Knee osteoarthritis (KOA) is one of the most frequently encountered diseases in the orthopedic department. Existing non-surgical treatments have a limited ...

膝盖骨关节炎经常出现在骨科。我们详细介绍了整个膝关节骨关节炎的治疗过程与血小板丰富的血浆注射。包括准备、程序和评估。膝盖骨关节炎，KOA，是骨科最常见的疾病之一。30 至 50% 的 65 岁患者患有此病，但现有的非手术治疗对软骨修复和骨骼再生的影响有限。血小板丰富的血浆PRP是一种自体生物活性物质，可以有效修复软骨损伤，加速骨骼再生。PRP在骨骼和关节问题中的应用也越来越受到研究。PRP临床应用的生物学合理性包括其对生长因子局部传递的影响和炎症反应的修饰及其对细胞增殖和分化的积极影响。然而，在临床研究中，PRP制备方案的报告是非常不一致的。而且大多数研究没有提供足够的信息，使协议能够被复制。手动方法要求设备最少，方便，成本低，操作简单。首先，我们通过手动双离心性能来准备PRP。从外周血中提取PRP层。接下来使用此层执行膝关节腔注射。最后对该方法的评价包括血小板浓度评估和临床结果。在这里，我们描述了一种可重复的方法，用PRP关节注射制备PRP和治疗KOA。通过评估结果，整个治疗过程需要不到30分钟，PRP的血小板浓度被证明达到标准化测量。其有效性通过在密切后续行动中评估成果来证明其有效性。在无菌的层流手术室中，让患者处于一个超前位置，具有舒适的室温和湿度。绘制点两毫升肝素钠。润湿 50 密耳注射器。钻一个旅游。对肘部进行消毒。从肘静脉中抽出3000万密远血。执行第一个离心。将外周血平均分为两个50密耳无菌离心管。将两个管子放入水平转子中，然后在无菌条件下放入离心机。使用 800 G 离心力进行 6 分钟的离心机。将水平转子拿出来。戴上无菌手套。然后拿出离心管。观察分层，确保外周血分层为两层。从一个离心管中收集超净液体，放入干净的离心管中。对另一个离心管重复此步骤。将超坦层液体添加到同一离心管中。执行第二次离心。将等量的无菌水或普通盐水加入另一根干净的离心管。将管子放入水平转子中。用粘合石膏标记超薄层液体。在1400 G离心力下离心5分钟。将水平转子拿出来。选择标记的管。通过观察分层，检查标记管的液体是否分为三层。使用 10 密耳注射器从中间颗粒细胞层（即 PRP 层和超密度底层的一部分）中抽出 4 密耳液体。如果中间层数量足够，只需从中抽出四密耳。将四密耳液体放入无菌抗凝管中进行评估，将3.6密耳液体留在注射器中。让患者躺在手术台上，将膝盖弯曲到90度。找到刺穿点在内缘的帕泰拉和一厘米从侧侧韧带。戴上无菌手套，在穿刺现场进行皮肤灭菌三次。用无菌孔巾盖住。将注射器与气天高原平行放置，然后以 45 度的角度执行穿刺。针头应完全插入皮肤。将 3.6 mil PRP 从注射器注射到膝关节腔中。用无菌纱布盖住穿刺位置，用粘合石膏固定。向伤口施加压力 10 分钟。观察任何严重不良反应30分钟。整个治疗包括每月注射三次。评估PRP中血小板的浓度。我们使用来自抗凝管的四密耳 PRP 点。使用自动血细胞分析仪分析PRP的血小板浓度。评估 PRP 注射的术后结果。三次治疗前一天进行会诊，每次治疗后一天、每次治疗后三天、每次治疗后一周、第三次治疗后一个月、第三次治疗后三个月、第三次治疗后六个月后，再进行患者随后随从。使用视觉模拟比例，西安大略和麦克马斯特大学骨关节炎指数，膝盖社会分数，和莱肖姆膝盖功能量表评估术后效果。Jove 视频中准备的 PRP 的血小板计数达到标准浓度水平 1121 倍 10 到 3 微升。我们进行了15次后续调查，在协议中描述的一个55岁的男性患者与早期KAO，很明显，早期的结果是令人满意的后，在关节内管理PRP。然而，中期疗效略低。观察到明显的明显镇痛效果。KSS膝盖得分高于KSS功能得分，这意味着PRP对主观症状的影响优于客观症状。lysholm膝关节功能量表得分表明，该方法对改善软骨损伤和软组织损伤症状有证据作用。总体而言，我们的PRP协议的治疗效果显著。人们普遍认为，PRP的血小板浓度应达到每微升约100万，是正常浓度的三到五倍。因此，此协议的最低要求是PRP的血小板浓度在这些水平之间。为了获得高浓度的血小板，我们使用双离心。血小板的收集率与离心力和时间有关。通过团队的探索，我们为第一台和第二台离心机建立了最佳离心时间，用于双离心六分钟和五分钟。和力是800和1400G分别准备PRP。最后，为了评估患者的结果，我们使用了一些量表。总之，PRP的关节内注射是治疗膝盖骨关节炎的有效方法。本研究报告详细介绍了整个治疗程序，包括编制可靠质量的PRP、引入标准注射程序以及科学实用的评价方案。

Research

JoVE Journal

Medicine

Effects of Allogeneic Platelet-Rich Plasma (PRP) on the Healing Process of Sectioned Achilles Tendons of Rats: A Methodological Description

Effects of Allogeneic Platelet-Rich Plasma PRP on the Healing Process of Sectioned Achilles Tendons of Rats: A Methodological Description

同种异体富血小板血浆 (PRP) 对大鼠分段腱愈合过程的影响: 方法学描述

This article describes the experimental procedures used to observe if PRP can positively affect tendon healing. There are 4 main steps to follow: induce a ...

科研

医学

The Lower Body Positive Pressure Treadmill for Knee Osteoarthritis Rehabilitation

下体正压跑步机用于膝关节骨关节炎康复

Here, based on a clinician&rsquo;s point-of-view, we propose a two-model lower body positive pressure (LBPP) protocol (walking and squatting models) in ...

Osteoarthritis Pain Model Induced by Intra-Articular Injection of Mono-Iodoacetate in Rats

大鼠关节内注射单碘乙酸酯诱导的骨关节炎疼痛模型

The current animal models of osteoarthritis (OA) can be divided into spontaneous models and induced models, both of which aim to simulate the ...

Standardized Histomorphometric Evaluation of Osteoarthritis in a Surgical Mouse Model

手术小鼠模型中骨关节炎的标准化形态学评价

One of the most prevalent joint disorders in the United States, osteoarthritis (OA) is characterized by progressive degeneration of articular cartilage, ...

Platelet-Rich Plasma Lysate for Treatment of Eye Surface Diseases

富血小板血浆裂解物用于治疗眼表疾病

Various ocular surface diseases are treated with blood-derived eye drops. Their use has been introduced in clinical practice because of their metabolite ...

FSN Therapy for Knee Osteoarthritis Pain Management

Fu's Subcutaneous Needling for Knee Osteoarthritis Pain

Fu's Subcutaneous Needling for Knee Osteoarthritis Pain (Video) | JoVE 

傅氏皮下针刺治疗膝关节骨关节炎疼痛

Fu's subcutaneous needling (FSN) is a new acupuncture and dry needling technique based on traditional Chinese medicine. It rapidly produces long-lasting ...

Treating Knee Osteoarthritis with Tuina in a Rabbit Model

Tuina Intervention in Rabbit Model of Knee Osteoarthritis

Using a Rabbit Model to Explore the Efficacy of Tuina in Treating Knee Osteoarthritis (Video) | JoVE

推拿干预膝骨关节炎兔模型

Knee osteoarthritis (KOA) is mainly characterized by degenerative changes in the knee joint's cartilage and surrounding soft tissues. The efficacy of ...

Experimental Modeling of Knee Osteoarthritis in Rats

Experimental Modeling of Knee Osteoarthritis in Rats (Video) | JoVE 

大鼠膝关节骨关节炎的实验建模

Establishment of the KOA Model in Rabbits Using the Modified Videman Method

Application of Acupotomy in a Knee Osteoarthritis Model in Rabbit

Author Spotlight: Investigating the Mechanism of Action of Acupotomy in Treating Knee Osteoarthritis

Knee osteoarthritis (KOA) is one of the most frequently encountered diseases in the orthopedic department, which seriously reduces the quality of life of ...

Therapeutic Potential of Tuina Massage for Knee Osteoarthritis

Tuina Intervention in Sodium Monoiodoacetate Injection-Induced Rat Model of Knee Osteoarthritis

Treating Knee Osteoarthritis with Tuina - A New Perspective (Video) | JoVE

单碘乙酸钠注射液诱导膝骨关节炎大鼠模型的推拿干预

Knee osteoarthritis (KOA), a common degenerative joint disorder, is characterized by chronic pain and disability, which can progress to irreparable ...