Objective To systematically evaluate the clinical effectiveness of platelet-rich plasma (PRP) combined with grafting material for the treatment of periodontal intrabony defects. Methods The following databases such as PubMed, The Cochrane Library, EMbase, CNKI, CBM and WanFang Data were searched on computer from inception to August, 2012 to collect the relevant randomized controlled trials (RCTs) on PRP combined with grafting material versus grafting material alone for periodontal intrabony defects. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of the included studies. RevMan 5.2 software was applied for meta-analysis. Results A total of 11 RCTs involving 342 patients were included. The pooled analysis on 7 RCTs showed that there was a significant difference in lower increase of clinical attachment loss (WMD=0.70, 95%CI 0.51 to 0.90, Plt;0.000 01) between the PRP combined with grafting material group and the grafting material alone group. But there was no significant difference in the gingival recession (WMD= −0.01, 95%CI −0.15 to 0.13, P=0.86). The pooled analysis on 9 RCTs showed that there was no significant difference in the reduction of plaque index (WMD= −0.04, 95%CI −0.09 to 0.02, P=0.20) between the two groups. Conclusion PRP combined with grafting material is superior to grafting material alone in the clinical attachment loss. But, there are no significant differences in gingival recession and plaque index. However, given the limited sample size and incomplete measure indexes of included studies, this conclusion still needs to be further proved by conducting more high-quality and large-scale RCTs.
Cardiopulmonary bypass(CPB) is associated with thrombocytopenia and platelet dysfunction. The primary cause of acquired platelet defect is thought to be activation and release of alpha granules during CPB. Before CPB, platelet-rich plasma (PRP) was prepared by obtaining the required amount of patient’s whole blood by autologous plateletpheresis. PRP could be reinfused after operation in order to protect the function and quantities of the platelets. On the other hand, PRP could be made into autologous platelet gel (APG). APG contains supraphysiologic amounts of growth factors, and has adequate tensile strength and adhesive ability. Therefore, it can be used for hemostasis in operation, sealing wound and enhancing incision or dehiscent sternal wounds healing.
Objective To study the effect of platelet-rich plasma (PRP) on the survival and quality of fat grafts in the nude mice so as to provide a method and the experimental basis for clinical practice. Methods Fat tissue was harvested from the lateral thigh of a 25-year-old healthy woman and the fat was purified by using saline. The venous blood was taken from the same donor. PRP was prepared by centrifugation (200 × g for 10 minutes twice) and activated by 10% calcium chloride (10 : 1). Then 24 female nude mice [weighing (20 ± 3) g, 5-week-old] were allocated randomly to the experimental group and the control group (12 mice per group). Each subcutaneous layer of two sides of the back (experimental group) was infiltrated with 0.8 mL fat tissue-activated PRP mixtures (10 : 2); the control group was infiltrated with 0.8 mL fat tissue-saline mixtures (10 : 2); 0.14 mL activated PRP and 0.14 mL saline were injected into the experimental group and the control group respectively at 5 and 10 days after the first operation. At 15, 30, 90, and 180 days after the first operation, the samples were harvested for gross and histological observations. Results All nude mice survived to the end of the experiment. No inflammation and abscess formation of the graft were observed. Experimental group was better than control group in angiogenesis, liquefaction, and necrosis. The grafted fat weight and volume in the experimental group were significantly larger than those in the control group at 15, 30, and 90 days (P lt; 0.05); but there was no significant difference between the 2 groups at 180 days (P gt; 0.05). Histological observation showed good morphological and well-distributed adipocytes, increasing vacuoles, few necrosis and calcification in the experimental group; but disordered distribution, obvious necrosis, and calcification in the control group. The necrosis area ratio of the experimental group was significantly lower than that of the control group (P lt; 0.05), and the number of micro-vessels was significantly higher in the experimental group than in the control group at 15 and 180 days (P lt; 0.05). Conclusion The method of repeatedly using the PRP within 180 days in assisting fat grafts can obviously improve the survival and quality.
【Abstract】 Objective To find out the best method to prepare platelet-rich plasma (PRP) and to evaluate the effect of PRP gel on skin flap survival and its mechanism. Methods Totally, 72 Wistar rats (aged 12 weeks, weighing 250-300 g) were used for the experiment. The arterial blood (8-10 mL) were collected from the hearts of 24 rats to prepare PRP with three kinds of centrifuge methods: in group A, 200 × g centrifuge for 15 minutes, and 500 × g centrifuge for 10 minutes；in group B, 312 × g centrifuge for 10 minutes, and 1 248 × g centrifuge for 10 minutes；and in group C, 200 × g centrifuge for 15 minutes, and 200 × g centrifuge for 10 minutes. The platelet was counted in the whole blood, PRP, and platelet-poor plasma (PPP) to determine an ideal centrifuge. PRP, PPP, and the serum after first centrifuge were collected. The concentrations of platelet-derived growth factor BB (PDGF-BB) and transforming growth factor β1 (TGF-β1) were measured in the PRP, PPP, and serum using the enzyme-linked immunosorbent assay method, and PRP and PPP gels were prepared. The flaps of 11 cm × 3 cm in size were elevated on the back of 48 rats, which were divided into 3 groups: PRP gel (PRP group, n=16) and PPP gel (PPP group, n=16) were injected, no treatment was given in the control group (n=16). The flap survival rate was measured at 7 days. Histological and real-time PCR were used to count the inflammatory cells and blood vessel density, and to detect the expressions of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), PDGF-AA, and PDGF-BB mRNA at 8 hours, 24 hours, 3 days, and 7 days. Results Platelet counting showed platelet in group A was the highest. ELISA evaluation showed that the concentrations of TGF-β1 and PDGF-BB were significantly higher in PRP than in PPP and serum (P lt; 0.05). The flap survival rate was 61.2% ± 9.1% in PRP group, showing significant differences (P lt; 0.05) when compared with that in PPP group (35.8% ± 11.3%) and control group (28.0% ± 5.4%). The inflammatory cells were significantly lower and the blood vessel density was significantly higher in PRP group than in PPP group and control group (P lt; 0.05). When compared with PPP group and control group, the expressions of VEGF and PDGF-BB increased at all time after operation in PRP group; the expression of EGF increased within 24 hours; and the expression of PDGF-AA increased after 3 days. There were significant differences in PDGF-AA mRNA at 3 days and 7 days, PDGF-BB mRNA at 8 hours, VEGF mRNA at 24 hours and 3 days, and EGF mRNA at 24 hours between PRP group and PPP and control groups (P lt; 0.05). Conclusion 200 × g centrifuge for 15 minutes and 500 × g centrifuge for 10 minutes is the best PRP preparation method. PRP can improve the skin flap survival by regulating the genes involved in angiogenesis.
Objective Platelet-rich plasma (PRP) can promote wound heal ing. To observe the effect of PRP injection on the early heal ing of rat’s Achilles tendon rupture so as to provide the experimental basis for cl inical practice. Methods Forty-six Sprague Dawley rats were included in this experiment, female or male and weighing 190-240 g. PRP and platelet-poor plasma (PPP) were prepared from the heart arterial blood of 10 rats; other 36 rats were made the models of Achilles tendon rupture, and were randomly divided into 3 groups (control group, PPP group, and PRP group), 12 rats for each group. In PPP and PRP groups, PPP and PRP of 100 μL were injected around the tendons once a week, respectively; in the control group, nothing was injected. The tendon tissue sample was harvested at 1, 2, 3, and 4 weeks after operation for morphology, histology, and immunohistochemistry observations. The content of collagen type I fibers also was measured. Specimens of each group were obtained for biomechanical test at 4 weeks. Results All the animals survived till the end of the experiment. Tendon edema gradually decreased and sliding improved with time. The tendon adhesion increased steadily from 1 week to 3 weeks postoperatively, and it was relieved at 4 weeks in 3 groups. There was no significant ifference in the grading of tendon adhesion among 3 groups at 1 week and at 4 weeks (P gt; 0.05), respectively. The inflammatory cell infiltration, angiogenesis, and collagen fibers were more in PRP group than in PPP group and control group at 1 week; with time, inflammatory cell infiltration and angiogenesis gradually decreased. Positive staining of collagen type I fibers was observed at 1-4 weeks postoperatively in 3 groups. The positive density of collagen type I fibers in group PRP was significantly higher than that in control group and PPP group at 1, 2, and 3 weeks (P lt; 0.05), but no significant difference was found among 3 groups at 4 weeks (P gt; 0.05). The biomechanical tests showed that there was no significant difference in the maximal gl iding excursion among 3 groups at 4 weeks postoperatively (P gt; 0.05); the elasticity modulus and the ultimate tensile strength of PRP group were significantly higher than those of control group and PPP group at 4 weeks (P lt; 0.05). Conclusion PRP injection can improve the healing of Achilles tendon in early repair of rat’s Achilles tendon rupture.
Objective Platelet-rich plasma (PRP) can enhance the chondrocyte prol iferation and repair of cartilage defects. To explore the safety and efficacy of intra-knee-articular injection of PRP to treat knee articular cartilage degeneration by comparing with injecting sodium hyaluronate (SH). Methods Thirty consecutive patients (30 knees) with knee articular cartilage degeneration were selected between January 2010 and June 2010. According to different injections, 30 patients wererandomly divided into PRP group (test group, n=15) and SH group (control group, n=15). There was no significant difference in gender, age, body mass index, and Kellgren-Lawrence grade between 2 groups (P gt; 0.05). Test group received 3.5 mL of PRP intra-knee-articular injections while control group received 2 mL of SH during the same time period. Both treatments were administered in series of 3 intra-knee-articular injections at 3-week intervals. Then, adverse reactions were recorded. International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Lequesne index were used for evaluation of treatment results. Results The patients of 2 groups were followed up 6 months. There were significant differences in IKDC score, WOMAC score, and Lequesne index between pre- and post-injection in 2 groups (P lt; 0.05); no significant difference was found between different time points (3, 4, and 6 months) in test group (P gt; 0.05), while significant differences were found between the postoperative 6th month and the postoperative 3rd and 4th months in control group (P lt; 0.05). There was no significant difference in IKDC score, WOMAC score, and Lequesne index between 2 groups within 4 months (P gt; 0.05), but the effectiveness of test group was significantly better than that of control group at 6 months after injection (P lt; 0.05). Adverse reactions occurred in 12 patients (31 injections) of test group and in 12 patients (30 injections) of control group. No significant difference in onset time, termination time, and duration of adverse reactions were found between 2 groups (P gt; 0.05). Conclusion Intra-knee-articular injection of PRP to treat knee articular cartilage degeneration is safe, which can alleviate symptoms of pain and swell ing and improve the qual ity of l ife of patients; however, further data of large samples and long-term follow-up are needed to confirm the safety and effectiveness.
Objective To calculate the recovery rate and enrichment factor and to analyse the correlation by measuring the concentrations of platelets, leukocyte, and growth factors in platelet-rich plasma (PRP) so as to evaluate the feasibil ity and stabil ity of a set of PRP preparation. Methods The peripheral blood (40 mL) was collected from 30 volunteers accorded with the inclusion criteria, and then 4 mL PRP was prepared using the package produced by Shandong Weigao Group Medical Polymer Company Limited. Automatic hematology analyzer was used to count the concentrations of platelets and leukocyte in whole blood and PRP. The enrichment factor and recovery rate of platelets or leukocyte were calculated; the platelet and leukocyte concentrations of male and female volunteers were measured, respectively. The concentrations of platelet-derived growth factor (PDGF), transforming growth factor β (TGF-β), and vascular endothel ial growth factor (VEGF) were assayed by ELISA. Results The platelet concentrations of whole blood and PRP were (131.40 ± 29.44) × 109/L and (819.47 ± 136.32) × 109/L, respectively, showing significant difference (t=—27.020, P=0.000). The recovery rate of platelets was 60.85% ± 8.97%, and the enrichment factor was 6.40 ± 1.06. The leukocyte concentrations of whole blood and PRP were (5.57 ± 1.91) × 1012/L and (32.20 ± 10.42) × 1012/L, respectively, showing significant difference (t=—13.780, P=0.000). The recovery rate of leukocyte was 58.30% ± 19.24%, and the enrichment factor was 6.10 ± 1.93. The concentrations of platelets and leukocyte in PRP were positively correlated with the platelet concentration (r=0.652, P=0.000) and leukocyte concentration (r=0.460, P=0.011) in whole blood. The concentrations of platelet and leukocyte in PRP between male and female were not significantly different (P gt; 0.05). The concentrations of PDGF, TGF-β, and VEGF in PRP were (698.15 ± 64.48), (681.36 ± 65.90), and (1 071.55 ± 106.04) ng/ mL,which were (5.67 ± 1.18), (6.99 ± 0.61), and (5.74 ± 0.83) times higher than those in the whole blood, respectively. PDGF concentration (r=0.832, P=0.020), TGF-β concentration (r=0.835, P=0.019), and VEGF concentration (r=0.824, P=0.023) in PRP were positively correlated with platelet concentration of PRP. Conclusion PRP with high concentrations of platelets, white blood cells and growth factors can be prepared stably by this package.
Objective Platelet-rich plasma (PRP) secretes many growth factors, including transforming growth factor β1 (TGF-β1), platelet derived growth factor, vascular endothl ial growth factor, insul in-l ike growth factor 1, and so on, which can promote cell prol iferation, chemotaxis, and collagen synthesis in wound heal ing. To investigate the effects of PRPon the tendon heal ing, and to explore the mechanism of action so as to provide the experimental basis for the tissue engineered tendons. Methods Forty healthy New Zealand white rabbits, weighing 2.5-3.0 kg and male or female, were randomly divided into the experimental group (n=20) and the control group (n=20). PRP was prepared from arterial blood of rabbit’s ears through twice centrifugation method of Landesberg. The platelet concentrations of whole blood and PRP were determined. The right achilles tendons of the rabbits were transected to make rupture models. In experimental group, the tendon was sutured after PRP (0.5 mL) was immediately appl ied at repair site. In control group, the tendon was sutured directly after transection. At 1, 2, 4, and 6 weeks after operation, the tendons of 5 rabbits in each group were harvested for morphological, histological, and immunohistochemical observations; the fibroblast counting, the content of collagen fibers, and the expression of TGF-β1 were detected. Results The concentration of platelet of PRP was 4.03 times of whole blood. All the animals survived till the end of the experiment, and the incision healed well. No death, infection, and other compl ications occurred. With time, the tendons almost healed in 2 groups, and the fibrous tissue at anastomosis site was more remarkable in control group than in experimental group. The histological observation showed significant differences in fibroblast counting at 1, 2, and 4 weeks after operation between 2 groups (P lt; 0.05), while no significant difference at 6 weeks (P gt; 0.05). The contents of collagen fibers in the parenchyma at repair site in experimental group were significantly higher than those in control group at each time point (P lt; 0.05). Immunohistochemistry staining showed the expression of TGF-β1 in experimental group was upregulated at 1 week and 2 weeks and reached the peak at the 2nd week, and subsequently downregulated at 4 and 6 weeks in comparison with the control group, showing signficant differences between 2 groups at each time point (P lt; 0.05). Conclusion PRP can facil itate rabbit’ s tendons heal ing and significantly improve the heal ing qual ity, which may be associated with its advancing the peak time of the TGF-β1 expression in tendon.
Objective Platelet-rich plasma (PRP) can promote the repair of soft tissue, wound, and bone defect. To investigate the effect of PRP on synovitis by establ ishing papain-induced osteoarthritis model of rabbit knee and interfering withPRP. Methods Twenty healthy 6-month-old rabbits (male or female, weighing 2.5-3.5 kg) were randomly divided into theexperimental group (n=10) and the control group (n=10). The whole blood (10 mL) was extracted from the central aural artery and PRP was prepared with the Landesberg’s method. Meanwhile, the platelet derived growth factor (PDGF), transforming growth factor (TGF), and vascular endothel ial growth factor (VEGF) concentrations in the circulating blood and PRP were measured. The 4% papain solution (0.3 mL) was injected into the knee joint cavity to establ ish the osteoarthritis model. After that, PRP (0.3 mL) was injected into the knee joints every week for 10 weeks in the experimental group, while normal sal ine of the same volume in the control group. At 2nd, 4th, 6th, 8th, and 10th weeks after the first injection, the erythrocyte sedimentation rate (ESR) and interleukin 1β (IL-1β) concentrations in the whole blood were tested, and the histological changes of the synovium were observed by HE staining and the Mankin scores were made. Results The blood cell counting showed that the platelet concentration of PRP was 6.8 times as that of the circulating blood. PDGF, TGF-β, and VEGF were 5, 8, and 7 times as those of the circulating blood, showing significant differences (P lt; 0.05). All animals survived to the end of experiment. There were significant differences in the ESR at 2nd, 6th, 8th, and 10th weeks and in the IL-1β at 4th, 6th, 8th, and 10th weeks between 2 groups (P lt; 0.05). In the control group, the synovium was edematous and thickened with fibrous effusion and pannus on surface; in the experimental group, the effusion of the synovium was decreased and less congestion and edema were observed at the 2nd week; the synovium was observed to be a bit thickened without obvious edema, with sl ight amount of yellowish joint fluid on surface and no conglutination at the 10th weeks. There were significant differences in the Mankin score at 4th, 6th, 8th,and 10th weeks (P lt; 0.05) between 2 groups. Conclusion PRP is beneficial to the alleviation of synovitis induced by papain according to restoring the damaged tissue and depressing the inflammatory factors.
Objective To investigate whether combining use of platelet-rich plasma (PRP) and decalcified bone matrix (DBM) has synergistic action on promoting bone consol idation and heal ing. Methods Forty male New Zealand rabbits (weighing 2.2-2.8 kg) were randomly divided into 4 groups (n=10). The whole blood was extracted from the central aural artery and PRP was prepared with the Landesberg’s method. An 1 cm-defect was made below the tibiofibular joint of the lefttibia through osteotomy. In group A, defect was repaired by distraction osteogenesis (1 cm); in group B, defect was repaired with 0.5 cm DBM and then by distraction osteogenesis (0.5 cm); in group C, defect was repaired by distraction osteogenesis (1 cm) and local injection of 1 mL PRP; in group D, defect was repaired by 0.5 cm DBM combined with 1 mL PRP and then by distraction osteogenesis (0.5 cm). Then lengthening started at 7 days after operation, at a rate of 1 mm/day and 0.5 mm every time for 10 days (groups A and C) or for 5 days (groups B and D). After the lengthening, the consolidation was performed. The X-ray films were taken at 0, 12, 17, 27, and 37 days after operation. At 37 days after operation, the tibial specimens were harvested for Micro-CT scanning, three-dimensional reconstruction and biomechanical test. Results The X-ray films showed that new bone formation in groups B and C was obviously better than that in groups A and D at 37 days. The bone mineral density (BMD), bone mineral content (BMC), and bone volume fraction (BVF) of groups B and C were significantly higher than those of groups A and D (P lt; 0.05); the BMD and BMC of group C were significantly higher than those of group B (P lt; 0.05); the BVF had no significant difference between groups B and C (P gt; 0.05). There was no significant difference in BMD, BMC, and BVF between groups A and D (P gt; 0.05). The trabecula number (Tb.N) of group C was significantly more than that of other groups (P lt; 0.05), and the trabecula spacing (Tb.Sp) of group C was significantly smaller than that of other groups (P lt; 0.05), but no significant differencewas found among other groups (P gt; 0.05). There was no significant difference in the trabecula thickness among 4 groups (P gt; 0.05). The ultimate angular displacement had no significant difference among 4 groups (P gt; 0.05). The maximum torque of groups B and C was significantly higher than that of groups A and D (P lt; 0.05); the maximum torque of group C was significantly higher than that of group B (P lt; 0.05); no significant difference was found between groups A and D (P gt; 0.05). Conclusion In the rabbit bone defect/lengthening model, local injection of PRP can enhance bone consol idation effectively during consol idation phase. In normal distraction rate, DBM can promote bone consol idation during distraction osteogenesis. In the early stage of distraction osteogenesis, combining use of DBM and PRP can not further promote bone consolidation and healing.