Tissue Engineering Group, NOCERAL, Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Injury. 2011 Aug;42(8):782-9. doi: 10.1016/j.injury.2011.01.015. Epub 2011 Feb 16.
The use of bone grafts in treating non- or delayed unions as the result of large bone loss is well established. However, despite good outcomes, the time to achieve complete union is still considerably long. To overcome this problem, the use of platelet-rich plasma (PRP) has been advocated albeit with varying success. To determine the true effectiveness of PRP in treating non-/delayed unions, a study was conducted using (n=12) rabbit models.
Critical-sized defects measuring 2cm created in the midshaft of the right rabbit tibias were stabilised using 2.7-mm small fragment plates. A spacer placed in the defects to create a delay in bone union was replaced at 3 weeks with artificial bone grafts (Coragraft®), with or without PRP. The operated limbs were radiographed following the defect creation and at 3, 7 and 11 weeks (at sacrifice). Bone healing and histological changes were later assessed and scored using the appropriate grading systems. Four groups were compared for quality of healing: (group-A) control group, that is, no PRP or Coragraft; (group-B) PRP; (group-C) Coragraft; and (group-D) PRP and Coragraft.
Group-D demonstrated the best bone healing based on radiological, histological and gross findings (Kruskall-Wallis: p<0.05). Group-C had significantly higher scores than group-B, whilst group-A had significantly lower scores than all other groups (Mann-Whitney U: p<0.05).
The use of PRP with bone graft significantly improves the quality of bone healing. However, the use of PRP without bone substitute does not provide adequate repair tissue and, therefore, provides little benefit when used independently.
使用骨移植物治疗因大量骨丢失而导致的非愈合或延迟愈合已得到广泛认可。然而，尽管结果良好，但完全愈合的时间仍然相当长。为了克服这个问题，已经提倡使用富含血小板的血浆（PRP），尽管效果不一。为了确定 PRP 在治疗非/延迟愈合中的真正有效性，使用（n=12）兔模型进行了一项研究。
在右侧兔胫骨中段创建 2cm 的临界尺寸缺陷，并使用 2.7mm 小片段板稳定。在缺陷中放置一个间隔物以延迟骨愈合，该间隔物在 3 周时用人工骨移植物（Coragraft®）替换，有或没有 PRP。在缺陷形成后和第 3、7 和 11 周（在牺牲时）对手术肢体进行放射照相。随后使用适当的分级系统评估和评分骨愈合和组织学变化。为了评估愈合质量，比较了 4 组：（组-A）对照组，即无 PRP 或 Coragraft；（组-B）PRP；（组-C）Coragraft；和（组-D）PRP 和 Coragraft。
根据放射学、组织学和大体观察结果，组-D 的骨愈合效果最佳（Kruskal-Wallis：p<0.05）。与组-B 相比，组-C 的评分显著更高，而组-A 的评分显著低于所有其他组（Mann-Whitney U：p<0.05）。
使用 PRP 与骨移植物可显著改善骨愈合质量。然而，单独使用 PRP 而不使用骨替代物不能提供足够的修复组织，因此单独使用时益处不大。
