Özgürsoy Selmin Karataylı, Tunçkaşık Fatma, Tunçkaşık M Emin, Akıncıoğlu Egemen, Doğan Handan, Beriat Güçlü Kaan
Department of Otolaryngology, Ufuk University Faculty of Medicine, Ankara, Turkey.
Department of Otolaryngology, Halil Şıvgın Çubuk State Hospital, Ankara, Turkey.
Turk Arch Otorhinolaryngol. 2018 Mar;56(1):30-35. doi: 10.5152/tao.2018.2942. Epub 2018 Mar 1.
Various materials are used by otolaryngologists for vocal cord injections in the management of vocal cord paralysis. An ideal injection material should be long-term effective, readily available, cheap, easy to prepare, have no donor morbidity, easy to use, biocompatible, resistant to resorption or migration, and easy to extract during revision. In this study, we aimed to see the histopathological effects of hyaluronic acid (HYA) and platelet-rich plasma (PRP) injections into the vocal cords of New Zealand rabbits.
PRP was injected into the right vocal cords of twelve rabbits, which was prepared from their serum (PRP group). HYA was injected into the left vocal cords of first six rabbits (numbered 1-6) (HYA group), and the left vocal cords of the other six rabbits (numbered 7-12) were followed with no intervention (control group). Two months later, histomorphological findings in the vocal cords were assessed by two experienced pathologists in seven parameters: chronic inflammation, mucosal atrophy, necrosis, neovascularization, fibrosis, foreign body reaction, and muscular atrophy. They were scored double-blinded as negative (0), mild (+1), moderate (+2), and severe (+3). Fisher's chi-square test was used to evaluate any statistical significance among the three groups.
Chronic inflammation, mucosal atrophy, necrosis, foreign body reaction, and muscular atrophy parameters were scored as "0" for each preparate by both pathologists. For neovascularization and fibrosis, a stasistically significant difference was seen among the three groups (p<0.05). Neovascularization was increased in the PRP and HYA groups compared with the control group. No significant difference was observed in fibrosis when the groups were compared separately. After two months, two of the six vocal cords injected with HYA revealed HYA; however, none of the PRP-injected vocal cords showed PRP.
HYA and PRP can be safely injected into vocal cords. Our findings show that HYA is a biocompatible and safe injection material for clinical use. Only two of the six vocal cords showed HYA at the end of two months, suggesting that HYA is a short-term effective material. Similarly, PRP was also shown to be a short-term effective material and can be used in patients for testing purpose before using a long-term effective material. The advantages of PRP are that it is inexpensive, readily available, and completely inert as it is prepared from the subject itself.
耳鼻喉科医生在声带麻痹的治疗中使用多种材料进行声带注射。理想的注射材料应具有长期有效性、易于获取、价格低廉、易于制备、无供体并发症、易于使用、生物相容性好、抗吸收或迁移，并且在翻修时易于取出。在本研究中，我们旨在观察透明质酸（HYA）和富血小板血浆（PRP）注射到新西兰兔声带后的组织病理学效应。
将PRP注射到12只兔子的右侧声带，PRP由其血清制备（PRP组）。将HYA注射到前6只兔子（编号1 - 6）的左侧声带（HYA组），另外6只兔子（编号7 - 12）的左侧声带不进行干预作为对照（对照组）。两个月后，由两名经验丰富的病理学家对声带的组织形态学结果在七个参数方面进行评估：慢性炎症、黏膜萎缩、坏死、新生血管形成、纤维化、异物反应和肌肉萎缩。他们进行双盲评分，分为阴性（0）、轻度（+1）、中度（+2）和重度（+3）。采用Fisher卡方检验评估三组之间的任何统计学意义。
两位病理学家对每种制剂的慢性炎症、黏膜萎缩、坏死、异物反应和肌肉萎缩参数均评分为“0”。对于新生血管形成和纤维化，三组之间存在统计学显著差异（p<0.05）。与对照组相比，PRP组和HYA组的新生血管形成增加。单独比较各组时，纤维化方面未观察到显著差异。两个月后，注射HYA的6条声带中有2条显示有HYA；然而，注射PRP的声带中没有一条显示有PRP。
HYA和PRP可以安全地注射到声带。我们的研究结果表明，HYA是一种生物相容性好且安全的临床注射材料。两个月结束时，6条声带中只有2条显示有HYA，这表明HYA是一种短期有效的材料。同样，PRP也被证明是一种短期有效的材料，可在患者使用长期有效材料之前用于测试目的。PRP的优点是价格低廉、易于获取，并且由于它是由受试者自身制备的，所以完全无活性。
