血小板浓缩物在骨关节病和运动损伤疾病中的应用

李晋; 王文波; 谢燕霞; 阎影

doi:10.3969/j.issn.2095-252X.2013.07.012

摘要： Platelet concentrate ( PC ) for surgical use is an evolution of the fibrin glue technologies used since many years. The initial concept of these preparations was to concentrate platelets and their growth factors and activate it into a fibrin gel on a surgical site, in order to improve local healing. The platelets contain alpha granules that are rich in several growth factors, such as platelet-derived growth factor, vascular endothelial growth factor, transforming growth factor-β, insulin-like growth factor, and epidermal growth factor, which play the essential roles in tissue healing and regeneration mechanisms. The relative ease of obtaining and preparation, convenience and applicability in the clinical setting, favorable safety profile and possible beneficial outcomes make PCs a new promising therapeutic approach for future regenerative therapy strategy. Numerous techniques of PC have been developed. The most common forms of autologous platelet concentrates: Platelet rich plasma ( PRP ) and platelet rich fibrin ( PRF ) have been introduced into various medical fields, including orthopedic surgery, plastic surgery, sports injury and other areas of regenerative medicine. More recently, developments in research of the regenerative effects of PC in a range of tissue types including bone, cartilage, tendon and muscle, as well as in the tissues of traumatic injury, have attracted interest in fields such as orthopedic and sport medicine. Many clinical studies suggested that the PC therapies may have benefits to osteoarthropathy such as osteoarthritis and necrosis of femoral head, and the conditions such as epicondylitis, ligament and muscle strains, and tears of rotator cuff, anterior cruciate ligament and Achilles tendon, as well as other sport related injuries. However, our understanding of the mechanisms of PCs in tissue repair and healing is still limited in basic research. There are also limited publications that provided convincing evidences of the efficacy of PCs therapy in the treatment of these injuries/disorders in a randomized controlled clinical trial based study. Therefore, in this review, we describe the various factors that proposed to contribute to the biological activity of PCs, and the published pre-clinical and clinical evidences to support the factors. We also review the current developments on the basic research and clinical application of the PC products in osteoarthropathy and sport medicine, and highlight the areas of emerging clinical applications of PCs.