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Platelet-Rich Plasma (PRP) at mga Therapiya ng Ineksyon

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What the evidence shows for platelet-rich plasma and related injection therapies in tendinopathy, osteoarthritis and rotator cuff disease — where they help and where the data is weak.

Isang sentripugo na tubo ng hiwalay na plasma ng dugo.
Ang PRP ay nagpo-pupulong ng mga platelet mula sa iyong sariling dugo at ginagamit para sa ilang kondisyon ng tendon at kasukasuan, na may halong ebidensya. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ito

Ang platelet-rich plasma, o PRP, ay isang gamutan na gumagamit ng iyong sariling dugo upang tulungan ang paggaling ng mga sugat na kasu-kasuan at tendon. Kukunin ng iyong doktor ang isang maliit na sample ng iyong dugo at iikot ito sa isang makina. Ang prosesong ito ay naghihiwalay ng mga platelet mula sa natitirang dugo. Ang mga platelet ay ang mga selula na tumutulong sa iyong katawan na ayusin ang tissue. Ang resulta ay isang nakonsentrasyong likido na mayaman sa mga selulang nagpapagaling.

Madalas itong itinuturing para sa wear-and-tear arthritis sa tuhod. Para sa kondisyong ito, inirerekomenda ang hindi bababa sa dalawang PRP injection. Ang ginhawang nararamdaman mo ay maaaring tumagal ng hindi bababa sa 24 linggo. Ginagamit din ito para sa tennis elbow, na kilala bilang lateral epicondylitis, at pamamaga ng mga tendon sheath, na tinatawag na chronic tenosynovitis. Maaaring makatulong ang PRP sa mga atleta na may malaking joint arthritis upang suportahan ang kanilang mga kasu-kasuan habang kumakatawan. Minsan itong ginagamit para sa mga acute muscle injuries sa sports, bagaman selektibo lamang ito.

Gumagana ang PRP sa pamamagitan ng pagdadala ng mataas na dose ng mga signal na nagpapagaling direkta sa lugar ng problema. Ang dami ng ginhawa na makukuha mo ay madalas na nakadepende sa konsentrasyon ng mga platelet na ginamit. Ang mas mataas na dose ay maaaring magbigay ng mas malaking ginhawa sa mga sintomas para sa mga kondisyon tulad ng tennis elbow. Maaaring pumili ang iyong doktor ng iba't ibang uri ng PRP batay sa iyong partikular na isyu. Halimbawa, ang ilang uri ay nagbabawas ng pamamaga sa maagang yugto ng arthritis, habang ang iba ay nagpapalakas ng pag-aayos ng tissue sa mga advanced na kaso. Ang ganitong targeted na pamamaraan ay tumutulong na bawasan ang sakit at mapabuti ang iyong kakayahang gumalaw at kumilos.

Gumagana ba ito?

Ang sagot ay nakadepende sa kondisyon na mayroon ka. Para sa arthritis na dulot ng pagkasira ng tuhod, inirerekomenda ang hindi bababa sa dalawang suntok. Ang mga benepisyo ay tumatagal ng hindi bababa sa 24 linggo. Pinapabuti ng paggamot na ito ang kabuuang pagganap, lalo na sa mga mas batang pasyente. Ang pagpagsama ng PRP sa hyaluronic acid (isang lubricating gel) ay ligtas at maaaring magbigay ng mas mahusay na pagpapagaan ng sakit kaysa sa PRP mag-isa. Parehong uri ng PRP—ang may mga puting selula ng dugo at ang walang mga puting selula ng dugo—ay gumagana nang pareho para sa mga tuhod.

Para sa tennis elbow (lateral epicondylitis), magkakaiba-iba ang mga resulta. Mas tumutulong ang corticosteroids sa maikling panahon. Gayunpaman, ipinapakita ng PRP ang mas magagandang resulta sa pangmatagalang panahon sa 6 at 12 buwan. Nagbibigay ang high-dose PRP ng makabuluhang pagpapagaan ng mga sintomas. Gayunpaman, ang ilang mga de-kalidad na pag-aaral ay nagpapakita ng walang benepisyo kumpara sa placebo. Dapat mong bigyang-pansin ang mga magkakaibang natuklasan na ito nang may pag-iingat dahil sa mga limitasyon ng pag-aaral.

Para sa sakit ng Achilles tendon, hindi sinusuportahan ng kasalukuyang ebidensya ang paggamit ng PRP. Hindi ito mas epektibo kaysa sa placebo. Dapat mong iwasan ang paggamot na ito para sa mga isyu sa Achilles hanggang sa magkaroon ng mas magagandang mga pagsubok. Para sa ibang mga kronikong pamamaga ng tendon, maaaring epektibong mapabuti ng PRP ang sakit at pagganap. Ang mga mid-term na resulta nito ay mas mahusay kaysa sa corticosteroids.

Sa sports medicine, maaaring tumulong ang PRP sa mga akutong sugat sa kalamnan. Maaaring irekomenda ito ng iyong doktor para sa mga atleta. Para sa maagang pagkamatay ng buto sa balikat (osteonecrosis), ang pagdaragdag ng PRP sa core decompression surgery ay nagpapabuti ng sakit at kalidad ng buhay. Gayunpaman, para sa rekonstruksyon ng ligamento sa tuhod (ACLR), masyadong mahina ang ebidensya upang sabihin kung tumutulong ang PRP. Hindi ito karaniwang tumutulong sa sakit sa gilid ng hita (greater trochanteric pain syndrome). Laging talakayin ang mga partikular na resulta na ito sa iyong doktor upang makita kung ang PRP ay angkop para sa iyo.

Tama ba ito para sa iyo?

Magandang kandidato ka kung mayroon kang wear-and-tear arthritis sa iyong tuhod o tennis elbow. Para sa knee arthritis, inaasahan mong tatanggapin mo ang hindi bababa sa dalawang injeksyon. Ang pagpapagaan ng sintomas ay tumatagal ng hindi bababa sa 24 linggo. Maaari kang pumili sa pagitan ng dalawang uri ng plasma. Parehong magkakatumbas ang epekto nito para sa iyong tuhod. Kung mayroon kang tennis elbow, ang mas mataas na dose ay nagbibigay ng mas maraming pagpapagaan ng sintomas. Mas epektibo rin ang terapiyang ito kumpara sa placebo para sa chronic wrist tendon inflammation.

Maaaring i-customize ng iyong doktor ang paggamot base sa yugto ng iyong arthritis. Ang early arthritis ay maganda ang tugon sa isang uri na may mababang platelets at mataas na white blood cells. Tumutulong ito upang bawasan ang pamamaga. Ang advanced arthritis ay mas nakikinabang sa isang uri na may mataas na platelets at mababang white blood cells. Pinapaganda nito ang pagkakaayos ng tissue. Kung ikaw ay isang competitive athlete na may malaking joint arthritis, inirerekomenda ang terapiyang ito para sa iyo. Maaari rin nitong tulungan ang mga acute muscle injuries, bagaman magkakaiba ang mga protocol.

Hindi malamang na makakakita ka ng malalaking benepisyo kung ikaw ay nagsasagawa ng anterior cruciate ligament reconstruction. Ang kasalukuyang ebidensya ay hindi nagpapakita ng malinaw na pagpapabuti kumpara sa karaniwang operasyon. Dapat mo ring tandaan na magkakaiba ang kalidad ng mga pag-aaral. May ilang pag-aaral na kulang sa detalyadong impormasyon tungkol sa ginamit na plasma. Nagpapatigil ito sa paghula ng mga resulta para sa lahat.

Ang gastos at availability ay nakadepende sa iyong revision risk at preparation fees. Hindi pare-pareho ang halaga para sa bawat pasyente. Walang malalaking surgical risks, ngunit kailangan mong talakayin ang mga detalyeng ito sa iyong doktor. Ito ay isang shared decision na batay sa iyong partikular na kondisyon at mga layunin.

Ang pangwakas na konklusyon

Maaaring tumulong ang mga PRP injection para sa sakit sa tuhod at pagkadikit ng siko, ngunit magkakaiba ang resulta depende sa kondisyon. Para sa arthritis sa tuhod, kailangan ng hindi bababa sa dalawang injection upang magtagal ang pagpapagaan ng hindi bababa sa 24 linggo. Mas epektibo ito kumpara sa steroids sa pangmatagalang epekto para sa mga isyu sa siko, ngunit hindi para sa Achilles tendons. Maaaring i-customize ng iyong doktor ang halo ayon sa yugto ng iyong sakit. Mag-ingat dahil madalas na mababa ang kalidad ng mga pag-aaral, kaya't tamang-handaan ang iyong mga inaasahan.


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