富血小板血浆治疗椎间盘退变：从基础研究到临床应用

Platelet-rich-plasma for intervertebral disc degeneration: from bench to bedside

背景:椎间盘退变是下腰痛的常见原因,椎间盘内的微环境和细胞环境发生变化是诱发椎间盘退变的重要因素,但目前仍无确凿证据表明退变发生的机制。目的:针对当前富血小板血浆治疗椎间盘退变的研究概况做一综述。方法:设计综述的撰写结构,在万方数据库和Pub Med数据库中分别输入中、英文检索词,分析所得文献的摘要及内容,通过纳入和排除得到相关文献。结果与结论:尽管手术治疗中晚期椎间盘退变有显著疗效,但对于早期退变,仍没有较好的保守治疗方法。富血小板血浆可以促进组织愈合和再生,已被诸多学者用于椎间盘退变模型的治疗中。细胞学实验及动物实验证明,富血小板血浆可以有效延缓甚至逆转椎间盘早期退变;临床试验表明,下腰痛患者接受富血小板血浆治疗后疼痛有所改善,将富血小板血浆和其他生物学治疗结合,能够显著改善椎间盘退变。目前的大多数实验都局限于细胞学和动物学研究,临床治疗的报道少之又少,加之富血小板血浆的提取方法、注射剂量以及最佳注射时间都无统一标准,而对富血小板血浆治疗的不良反应也知之甚少,故富血小板血浆治疗椎间盘退变的疗效有待于进一步验证。

BACKGROUND： Intervertebral disc degeneration （IDD） is a common cause of low back pain. Microenvironmentaland cytological changes of intervertebral disc are main factors inducing disc degeneration. However, the underlying mechanism still remains unclear.OBJECTIVE： To review the application of platelet rich plasma （PRP） in the treatment of IDD.METHODS： First, the article structure was designed, and then WanFang and CNKI databases were retrieved for relatedarticles using Chinese and English keywords. After analyzing the abstract and main body, the eligible articles wereenrolled according to the inclusion and exclusion criteria.RESULTS AND CONCLUSION： Surgical treatment has achieved remarkable outcomes in the treatment of middle- andlate-stage IDD. However, there is still no good conservative therapy for early degeneration. PRP has been extensivelyapplied in the treatment of IDD due to its improvement in tissue healing and regeneration. PRP has been proved to becapable of effectively delaying and even reversing IDD through cytology tests and animal experiments. Some clinicaltrials have shown that PRP treatment can ease low back pain, while others have demonstrated that the combination ofPRP and other biological treatments can significantly improve IDD. Nowadays, most of the experiments are limited in thestudy of cytology and zoology rather than clinical trials, and there is still no unified standard for extraction method, doseand optimal injection time of PRP. Moreover, there is little reported on its side effects. Consequently, the curative effectof PRP for IDD needs to be verified further.