• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

PURPOSE OF THE STUDY Growth factors produced by platelets enhance tissue healing. The aim of this study was to confirm or disprove the hypothesis that, in anterior cruciate ligament (ACL) reconstruction, the application of platelet-rich plasma (PRP) into the tibial and femoral tunnels and in the graft enhances graft maturation and graft-bone interface healing and thus improves knee function at 3 and 12 months post-operatively in comparison with the control group. MATERIAL AND METHODS A total of 40 patient had the surgery; 20 underwent single-bundle hamstring reconstruction with PRP application (PRP group) and 20 had the same surgery without PRP addition (control group). A 5 ml amount of PRP was obtained from the patient's peripheral blood. A graft inserted in the bone tunnels was fixed with interference screws and, after intra-articular fluid aspiration, 1 ml of PRP was injected into each tunnel and 3 ml were evenly applied to the intra-articular portion of the graft. The patients were examined by MRI at 3 and 12 months after surgery. The subsidence of swelling in the tunnelsurrounding tissues was taken as a sign of graft-bone interface healing, and increased signal intensity of the graft was considered as a result of its ligamentisation. The knee functional status was evaluated at 3 and 12 post-operative months, using the scoring systems (Cincinnati score, IKDC score). RESULTS Bone swelling was found at 3 post-operative months in 18 of 20 patients in both the PRP and the control group. Graft signal intensity was increased in most patients (19 of the PRP group; 18 control patients; p = 0.949). The Cincinnati score at 3 months had an average value of 72.7 (34-100; SO, 18.7) in the PRP group and 73.4 (42-99; SO, 16.3) in the control group (p = 0.793). The functional score after 12 months improved to 97.5 (75-100; SO, 12.8) in the PRP group and to 95.1 (66-100; SO, 13.1) in the control group; there was no significant difference between the groups (p = 0.885) at either 3 or 12 months. The IKDC score showed similar results. At 12 months bone swelling was recorded in seven out of 20 patients in the PRP group and in nine patients in the control group (p = 0.751). Graft signal intensity was increased in three and four patients of the PRP and control groups, respectively (p = 0.681). There was a statistical difference between the findings at 3 and 12 months within each group, but no difference between the groups. DISCUSSION In ACL reconstruction, the process of tendon graft-to-bone healing has several stages involving inflammation, cell proliferation and graft ligamentisation. At each stage, an important role is played by growth factors produced by thrombocytes, and therefore their potential use in the treatment of injuries to ligaments and tendons has recently come into focus. A number of experimental studies dealing with the effect of platelet-rich plasma on soft tissue healing has been published. Therefore, the method of using PRP to enhance graft healing in ACL reconstruction in humans is still being studied. CONSLUSIONS The use of PRP in ACL reconstruction does not accelerate graft remodelling and bone ingrowth into the tendon. The function scoring results showed a statistically significant improvement in knee function between 3 and 12 months of followup within each group studied but revealed no difference between the groups. The hypothesis postulated above was disproved. Key words: anterior cruciate ligament, platelet-rich plasma, anatomic single-bundle reconstruction.

• MeSH
• dospělí MeSH
• edém patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mladiství MeSH
• mladý dospělý MeSH
• plazma bohatá na destičky * MeSH
• prospektivní studie MeSH
• rekonstrukce předního zkříženého vazu metody   MeSH
• studie případů a kontrol MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

BACKGROUND CONTEXT: Spondylodesis in the operative management of lumbar spine diseases has been the subject of numerous studies over several decades. The posterolateral fusion (PLF) with pedicle screw fixation is a commonly used procedure. PURPOSE: To determine whether the addition of bone marrow concentrate (BMC) to allograft bone increases fusion rate after instrumented posterior lumbar fusion. STUDY DESIGN: The study was prospective, randomized, controlled, and blinded. METHODS: Eighty patients with degenerative disease of the lumbar spine underwent instrumented lumbar or lumbosacral PLF (22 men, 58 women; body mass index less than 35 for a good visualization of the PLF in the X-rays). In 40 cases, the PLF was done with spongious allograft chips alone (Group I, age 62.7 years in average, range 47-77 years, level of fusion 1-2). In another 40 cases, spongious allograft chips were mixed with BMC (Group II, age 58.5 years in average, range 42-80, level of fusion 1-3), including the mesenchymal stem cells (MSCs). Patients were scheduled for anteroposterior and lateral radiographs 12 and 24 months after the surgery and for computed tomography scanning 24 months after the surgery. Fusion status and the degree of mineralization of the fusion mass were evaluated separately by two radiologists blinded to patient group affiliation. The bony mass was judged as fused if there was uninterrupted bridging of well-mineralized bone between the transverse processes or sacrum, with trabeculation indicating bone maturation on least at one side of the spines. RESULTS: In Group I at 12 months, the bone graft mass was assessed in X-rays as fused in no cases (0%) and at 24 months in four cases (10%). In Group II, 6 cases (15%) achieved fusion at 12 months and 14 cases (35%) at 24 months. The statistically significant difference between both groups was proven for complete fusion at both 12 (p=.041) and 24 months (p=.011). Computed tomography scans showed that 16 cases (40%) in Group I and 32 cases (80%) in Group II had evidence of at least unilateral continuous bridging bone between neighboring vertebrae at 24 months (p<.05). CONCLUSIONS: We have confirmed the hypothesis that the autologous BMC together with the allograft is a better alternative for PLF than the allograft alone. The use of autologous MSCs in form of BMC in combination with allograft is an effective option to enhance the PLF healing.

• MeSH
• bederní obratle radiografie   chirurgie   MeSH
• dospělí MeSH
• fúze páteře metody   MeSH
• homologní transplantace MeSH
• křížová kost radiografie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci páteře radiografie   chirurgie   MeSH
• počítačová rentgenová tomografie MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• transplantace kostní dřeně metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

INTRODUCTION: Recently an articular cartilage repair has been given much attention in the orthopaedic field. Cartilage regeneration capacity is very limited. Optimal approach seems to be a delivery of natural growth factors. Autologous platelet-rich plasma (PRP) contains proliferative and chemoattractant growth factors. The objective of the present study was to determine if PRP can increase tibiofemoral cartilage regeneration and improve knee function. MATERIALS AND METHODS: Fifty consecutive and strictly selected patients, affected by Grade II or III chondromalatia, underwent 1 year treatment (9 injections) with autologous PRP in a liquid form with 2.0 to 2.5-fold platelets concentration. Outcome measures included the Lysholm, Tegner, IKDC, and Cincinnati scores. Magnetic resonance imaging was used to evaluate cartilage thickness and degree of degeneration. RESULTS: The study demonstrated significant improvement in Lysholm (p < 0.05), Tegner (p < 0.05), IKDC (p < 0.05), and Cincinnati (p < 0.05) scores. Results improved at 12-month follow-up. Cartilage assessment revealed no significant cartilage regeneration (p < 0.05). There were no adverse events reported. CONCLUSIONS: PRP significantly reduced pain and improved quality of live in patients with low degree of cartilage degeneration. Magnetic resonance imaging did not confirmed any significant cartilage condition improvement.

• MeSH
• dospělí MeSH
• femur MeSH
• kloubní chrupavka fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci chrupavky terapie   MeSH
• pilotní projekty MeSH
• plazma bohatá na destičky * MeSH
• prospektivní studie MeSH
• regenerace MeSH
• senioři MeSH
• tibie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

• Klíčová slova
• chronická lymfocytární leukemie, léčba,
• MeSH
• chlorambucil aplikace a dávkování   MeSH
• chronická lymfatická leukemie epidemiologie   farmakoterapie   MeSH
• epidemiologie MeSH
• financování organizované MeSH
• imunofenotypizace normy   MeSH
• incidence MeSH
• lidé MeSH
• monoklonální protilátky aplikace a dávkování   MeSH
• prevalence MeSH
• protokoly protinádorové kombinované chemoterapie aplikace a dávkování   MeSH
• stupeň závažnosti nemoci MeSH
• věk při počátku nemoci MeSH
• vidarabin analogy a deriváty   aplikace a dávkování   MeSH
• Check Tag
• lidé MeSH

Degenerace kloubní chrupavky a rozvoj artrózy patří k nejzávažnějším socioekonomickým problémům zdravotnictví ve všech rozvinutých zemích. Autologní plazma bohatá na trombocyty (PRP) obsahuje proliferativní a chemoatraktivní růstové faktory podporující regeneraci mezenchymální tkáně, tedy i chondrocytů. Do randomizované prospektivní zaslepené studie bude na podkladě artroskopického nálezu (první histologické vyšetření) zařazeno 80 pacientů rozdělených do 2 stejných skupin. V jedné skupině bude k podpoře regenerace chrupavky kolenního kloubu využito PRP, ve druhé preparátu s kyselinou hyaluronovou (HA). Po roce bude provedena druhá artroskopie k posouzení stavu chrupavky a odběru vzorku na druhé histologické vyšetření. Před započetím léčby a po jednom a po dvou letech bude vyhodnocen stav chrupavky na podkladě vyšetření magnetickou rezonancí. Subjektivní a objektivní stav, stejně jako funkční stav a kvalita života budou hodnoceny před léčbou a po jejím ukončení. Statististické zpracování výsledků.; The use of growth factors has been considered as a way to manipulate the host healing response to facilitate the repair and remodelling of the tissue. Platelet related growth factors treatment is based on the physiological functions of the platelets which are haemostasia and delivering proteins (growth factors) to areas where tissue is damaged. 80 patients will be included in the study. 40 patients (selected at random) will undergo the therapy with PRP application. Other 40 patients will undergo the therapy with HA. After the first arthroscopy, the MRI examinations (1 and 2 years postop.) will be undertaken and the cartilage status of the same compartment will be evaluated again. This examination will be done by the blinded radiologist (co-worker). Then, the second-look arthroscopy will be done to evaluate the macroscopic character of the cartilage in the treated part of the knee and to obtain the second specimen for the microscopic evaluation. The microscopic evaluation will do blinded histologist.

• MeSH
• artróza kolenních kloubů terapie   MeSH
• histologie MeSH
• kloubní chrupavka MeSH
• kvalita života MeSH
• kyselina hyaluronová MeSH
• magnetická rezonanční tomografie MeSH
• plazma bohatá na destičky MeSH
• řízená tkáňová regenerace MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• traumatologie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu IGA MZ ČR