富血小板血漿的治療法 - 概論


損傷後的骨骼與軟組織要經過數階段的修復過程。其中最能令連動和創傷醫生感興趣的是最初階段:炎症及細胞增生。近日使用富有血小板成份血漿 (PRP) 以促進復元的療法很受媒體的重視:一些較著名的專業人仕和特級運動員都曾接受這療法。


PRP 是甚麽東西?

PRP是從病人自體的血液提取,它濃縮了血漿中的一種成份:血小板。血小板随血液循環體內,是血液能凝固的重要成份。它及血漿都蘊藏著很多對細胞的集結、復製及轉變的因子;這是各細胞組織的修復的必經過程。

把從病人抽取的血液標本放進一部離心機、分開血液各種成份後,抽取集中血小板的部份血漿,經過一定處理程序後,注射到受損傷的組織,它可以是骨骼、軟組織和肌腱韌帶。

PRP是透過注射到要接受治療的組織,它可能是直接注射到病灶中,例如受傷的肌肉或肌腱韌帶;也可以注射到關節中,例如幫助重建膝內的前十字靱帶或半月板等;也可以在受患組織周遭,例如在修補撕裂的亞基理氐跟腱後,注射到腱鞘內。病人在注射後要在一段短時間內避免運動,然後跟進一個復康療程。


PRP療法有效嗎?

有數個在動物身上做的基礎研究顯示 PRP療法能促進軟組織和骨骼損傷的癒合。例如在阿基里斯跟腱損傷後,能使組織細胞增加,跟腱加强;在腓腸肌損傷後,能促使肌肉細胞復元。

這些在動物試驗中有正面效果的研究,促使廣泛使用PRP療法於多種病況,包括各急性或慢性的肌腱炎症、肌肉和韌帶損傷等。一些臨床的研究的早期的效果也是令人滿意的。其中在使用PRP治療慢性筋腱的疾病,如手肘外髁炎 (綱球手肘) 、阿基里斯跟腱炎等,早期效果是不錯的。

另一方面根據美國醫學雜誌的最新報告,以PRP注射阿基里斯筋腱炎的效果和注射生理鹽水(安慰劑) 是沒有分別的。

一個關於膝關節炎的研究顯示,注射PRP的效用較注射透明質酸(hyaluronic acid ) 好。而以PRP 來治理肩袖撕裂和膝內側副韌帶拉傷也有相若的功效。

總的來說,在已發表的臨床研究中,能証實PRP 的療效的報告還是很有限。基於 PRP是從患者自身的血液中提取,是一個較低風險、旨在改善和加速組織的痊癒機制的療法。但它仍需要經過進一步的研究以審定它的療效和訂定使用準則。


結論

富血小板血漿 (PRP) 是由病人本身的血液提取。

PRP 包含豐富的生長因子及細胞的訊息,促進組織的癒合。

一些基礎研究顯示 PRP療法能促進組織復元。

一些人類的臨床研究顯示 PRP對軟組織的復元有效。

使用 PRP治療時需要停用消炎藥物。


黃仕雄醫生


Platelet Rich plasma(PRP) Treatment - Overview

Bone and soft tissue injuries heal in many stages. One of the most exciting areas of research in orthopedic surgery and sports medicine involves making use the most of the initial healing stages: inflammation and an increase in cells, or cell proliferation.

Platelet rich plasma (PRP) treatment is becoming a popular option for giving a biological boost to the healing process.It received significant attention from the media as it has been used by some popular professional and elite athletes overseas.


What is PRP?

PRP is produced from a person's own blood. It is a concentration of one of its constituents, the platelets. Platelets circulate in the blood and are critical for blood clotting. Platelets and the plasma portion of the blood contain many factors that are essential for cell recruitment, multiplication and specialization. These processes are required for tissue healing.

A blood sample is obtained from the patient, and is then put into a centrifuge, a tool that separates the blood into its many components. Platelet rich plasma can then be obtained and treated before it is delivered to an injured tissues, bone or soft tissue, tendon or ligament.

PRP is given to patients through an injection into the region where it is required. This may be intralesional (as in the muscle or aponeurosis), intra-articular (as in ACL reconstruction), or surrounding the involved tissue bed (e.g. within the sheath of Achilles tendon after rupture repair). After the injection, a patient must avoid exercise for a short period of time and then follow a rehabilitation exercise program.


Is PRP Treatment Effective?

Several basic science studies in animal models suggest that PRP treatment can improve healing in soft tissue and bone. For example, increased numbers of cells and improved tendon strength have been noted in Achilles tendon injuries, and improved muscle regeneration has been shown in gastrocnemius (calf) muscle injuries.

These favorable findings in animal models have led to the widespread use of PRP treatment for a variety of conditions, including acute and chronic tendon problems, as well as injuries to ligaments and muscles. Some clinical studies in humans gave some promising early results. ,

The most promising early results have been seen in PRP treatment for chronic tendon conditions, such as lateral epicondylitis (tennis elbow) and Achilles tendinosis. Nonetheless, a recent study in the Journal of the American Medical Association reported no advantage with PRP injection compared to saline (placebo) injection for the treatment of Achilles tendinosis.

In a small study involving knee osteoarthritis, PRP treatment was shown to be more effective than hyaluronic acid treatment. PRP has also resulted in positive or comparable results when used in the treatment of rotator cuff tears in the shoulder and medial collateral ligament (MCL) injuries in the knee.

Overall, there is limited support of PRP treatment in published clinical studies. However, because PRP is created from a patient's own blood, it is considered a relatively low-risk treatment with a potential in improving or speeding up tissue  healing.

More research are however needed to show the effectiveness of treatment with PRP as well as its stanadardisation in preparation.


In summary

•Platelet Rich Plasma (PRP) comes from a patient's own blood.

•PRP is a rich source of growth factors and cellular signaling factors that play a significant role in the biology of healing.

•There are some basic science studies that show PRP treatment may improve healing in many tissues.

•A few clinical studies in humans show the effectiveness of PRP treatment on soft tissue healing. 

Anti-inflammatory medicines should be stopped before and after PRP treatment is given.



Dr. Wong Sze-hung

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