OSTEOARTRİTTE PRP TEDAVİSİ. Etkilidir!

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2 OSTEOARTRİTTE PRP TEDAVİSİ Etkilidir!

3 PRP NE DEĞİLDİR!! Kök hücre! MSC! Liposit! Kemik iliği

4 ..kandaki gizemli güç

5 PRP NEDİR!

6 PLATELET POOR PLASMA (PPP) PLATELET RICH PLASMA (PRP)

7 HER PRP AYNIMIDIR?

8 ŞEMSİYE TERİM

9 Ticari bir kit ile elde edilmiş uygulamaya hazır PRP ürünü.

10 PRP Hazırlama Yöntemleri (Trombositten Zengin Plazma) Mayıs 2104, GATA

11 PATENT PENDING

12 Saf Platelet-zengin Plasma (P-PRP) Platelet-Lökosit-zengin Plazma (P-LRP) Saf Platelet-zengin Fibrin (P-PRF) Lökosit ve Platelet zengin Fibrin (L-PRF) Aulologous Condi5oned Plasma (ACP) Arhrex SmartPreP 2 Harvest Technologies Cascade Musculoskeletal Transplant Founda5on Coukroun s PRF Prepera5on Rich in Growth Factors (PRGF) Biotechnology Ins5tute GPS III Biomet Biologics PRGF Scaffold Biotechnology Ins5tute Vivostat PRF Magellan Arteriocyte Medical Systems FIBRINET PRFM Cascade Medical Enterprises Anitua s PRGF Symphony II DePuy Vivostat PRF Vivostat A/S Platelet Concentrate Collec5on System (PCCS II) Implant Innova5ons Angel Sorin Group Genesis CS EmCyte Cell Saver 5 Haemone5cs Curasan, Plateltex

13 PRP ürünlerinin özellikleri birbirinden oldukça farklıdır!

14 FARKLILIKLAR ü Büyüme faktörleri ü AkYvasyon ü Trombosit konsantrasyonu ü

15 HER PRP AYNI DEĞİLDİR!

16 PRP NASIL ETKİLER?

17 Eritrositler (Alyuvar ) Lökositler (Akyuvar) Plateletler (Trombositler) Göç Doku Tamiri HASAR GF/S

18 AkYve olmuş trombositler Büyüme Faktörleri ve Sitokinler gibi eriyebilir mediatörlere ev sahipliği yapar! Platelet-Derived Growth Factor-AB Transforming Growth Factor Beta-1 Fibroblast Growth Factor İnsulin-like Growth Factor 1 İnsulin-like Growth Factor 2 Vascular Endothelial Growth Factor Epidermal Growth Factor Interleukin 8 KeraYnocyte Growth Factor ConnecYve Tissue Growth Factor

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20 NF-κB yolunun inhibisyonu? AnYenflamatuar Etki

21 Kondrosit proliferasyonu ve differansiasyonunun symulasyonu Matriks remodelizasyonu Sinovyal hücrelerin ve anjiogenezisin modülasyonu

22 PRP YENİ BİR ÜRÜNMÜDÜR!

23 40-50 yıldır kullanılıyor. Hemorajileri önlemek / durdurmak için Yaraları kapatmak / iyileşmeyi arirmak için.. Fibrin yapışjrıcılar

24 LİTERATÜRDEKİ İLK PRP UYGULAMALARI

25 AOSSM sponsored Sports Induced Inflammation Workshop. Bethesda, Maryland. May Although the cellular events involved in the healing and repair of musculoskeletal connective tissue injuries are reasonably well described, the molecular mechanisms regulating these responses are incompletely understood. New information, particularly on the roles of various cytokines and growth factors in inflammation and wound healing, however, is continually being published. This information may ultimately have far reaching therapeutic implications.

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27 DENEYSEL SİYATİK SİNİR HASARINDA PLATELETTEN ZENGİN PLAZMA JEL VE BÜYÜME FAKTÖRLERİNİN ETKİSİ 2005-ANTALYA Dr. TANER ÖZGÜRTAŞ GATA BİYOKİMYA AD

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31 ŞEMSİYE TERİM

32 TIBBİ TEDAVİ NE YAPMALI? Semptomları azaltmalı Hastalığın seyrini yavaşlatmalı / iyileşyrmeli

33 Ağrı Deformite Fonksiyon kaybı Eklem sertliği Tutukluğu Kas Zayıflığı Lokal hassasiyet Eklem hipertrofisi Krepitasyon

34 PRP tedavisi kimlere yapılabilir? Qualification+ Candidate+ Not+a+Candidate+ Failed+previous+treatment+!! Will+not+allow+blood+removal+or+ injection+into+their+body+!! Inability+to+take+oral+anti> inflammatory+drugs+due+to+allergy+!! On+blood+thinners+!! Symptoms+persistent+enough+to+ consider+surgery+or+repeat+!! treatment+ Unable+to+be+off+of+aspirin+or+anti> inflammatory+drugs+before+or+after+!! the+procedure+ Allergic+to+lidocaine+or+numbing+ agents+!!! Diğer tedavi yöntemlerinde başarısız olunduğunda..

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36 KONTRAENDİKASYONLARI (KE) KESİN KE YOK Ø Enfeksiyon Ø Diabet hikayesi Ø Platelet anomalisi veya azlığı olanlar Ø Kan hastalıkları Ø Hb < 10 g/dl Ø Sistemik koryzon kullanımı (?) Ø Karaciğer veya böbrek yetmezliği, Diyaliz Ø Psikolojik ve emosyonel bozukluğu olanlar Ø Son üç ayda radyoterapi ve kemoterapi alanlar Ø Hamileler Ø Madde bağımlıları

37 PRP NASIL UYGULANIR? ANASTEZİ ULTROSONOGRAFİ

38 KAÇ ENJEKSİYON EN İYİ? 1 kere 2 kere 3 kere HANGİ SIKLIKLA EN İYİ? 1 hasa 2 hasa 3 hasa

39 UYGULAMA FARKLILIKLARI Uygulama yöntemi Zamanlama Miktar (hacim) Sıklık

40 PRP ETKİN MİDİR?

41 PRP ÜRÜNLERDEKİ ve TEDAVİ YÖNTEMLERİNDEKİ FARKLILIKLAR P-PRP L-PRP P-PRF L-PRF Lökosit içeriği Fibrin dansitesi Standardizasyon farklılıkları HETEROJEN HASTA POPULASYONU

42 İntraartiküler enjeksiyon OA semptomlarını azaltmaktadır!

43 þinsan çalışması olmalı þprospek5f þingilizce/tam me5n çalışmalar -Hayvan çalışmaları -Retrospek5f -Daha önce cerrahi geçirmiş -İngilizce olmayan

44 319 Makale incelenmiş; Etkili alterna5f olabilir!

45 Sonuç olarak; kısa dönemde PRP enjeksiyonları özellikle hafif ve orta derecede OA olan ve konvansiyonel tedaviden yanıt alınamıyan hastalarda placebo veya HA grubuna gore şikayetlerin azalması ve yaşam kalitesinin ve fonksiyonların artmasında daha etkili olduğu kana5ne varılmışgr.

46 A meta-analysis in a systema5c review of 6 studies, including 577 payents, compared the outcomes of pa5ents treated by platelet-rich plasma or hyaluronic acid. The study reported an overall pooled mean difference in Western Ontario and McMaster Universi5es Arthri5s Index (WOMAC) scores of 16.7 in favour of platelet-rich plasma (95% confidence interval 28.9 to 4.4, p=0.008). A mean difference value below 0 favoured platelet-rich plasma, whereas a value above 0 favoured hyaluronic acid.

47 A meta-analysis in a systema5c review of 16 studies, including 1543 payents, pooled Interna5onal Knee Documenta5on Commitee (IKDC), WOMAC and Knee Injury and Osteoarthri5s Outcome Score (KOOS) scales to compare knee func5on scores before platelet-rich plasma treatment against scores auer treatment. The study reported an overall standardised mean difference, at 12 months, of 2.9 in favour of posttreatment scores (95% confidence interval 1.0 to 4.8, p<0.001). A mean difference value above 0 favoured post- treatment, whereas a value below 0 favoured pre-treatment.

48 In a randomised controlled trial of 109 payents treated by platelet-rich plasma (n=54) or hyaluronic acid injec5ons (n=55), mean KOOS scores (ranging from 0 to 100, with higher scores indica5ng beter outcomes) for symptoms, pain, ac5vi5es of daily living, sport and qualityof-life domains improved from 64.0 to 71.3, 65.4 to 74.0, 69.9 to 77.9, 37.6 to 47.4 and 34.9 to 50.5 respec5vely in the platelet-rich plasma group at 12-month follow-up (p values <0.05). In the hyaluronic acid group, mean KOOS scores for symptoms, pain, ac5vi5es of daily living, sport and quality-of-life domains improved from 67.8 to 74.2, 63.1 to 74.0, 67.8 to 77.3, 34.2 to 46.6 and 33.6 to 49.2 respec5vely at 12-month follow-up (p values <0.05). No sta5s5cally significant differences were observed between groups at 12-month follow-up.

49 In a randomised controlled trial of 120 payents treated by platelet-rich plasma (n=60) or hyaluronic acid injec5ons (n=60), mean total WOMAC scores (ranging from 0 to 96 with lower scores indica5ng beter outcomes) improved from 79.6 to 36.5 in the plateletrich plasma group (p<0.01) and from 75.4 to 65.1 in the hyaluronic acid group (p<0.01) at 6-month follow-up. Improvements were greater in the platelet-rich plasma group (p<0.001). In pa5ents with Kellgren Lawrence grade 3 osteoarthri5s (ranging from 1 to 4 with higher grades indica5ng worse osteoarthri5s), WOMAC scores improved from 79 to 41 in the platelet-rich plasma group and from 85 to 75 in the hyaluronic acid group at 6- month follow-up. Improvements were greater in the platelet-rich plasma group (p<0.01).

50 In a non-randomised comparayve study of 150 payents treated by platelet-rich plasma (n=50), low-weight hyaluronic acid (n=50) or high-weight hyaluronic acid injec5ons (n=50), the percentages of pa5ents who were sa5sfied with theirtreatment were 82% (41/50), 64% (32/50) and 66% (33/50) respec5vely at 6-month followup (p values between groups=0.04).

51 In a prospecyve case series of 65 payents treated by platelet-rich plasma, the 5me taken for osteoarthri5c pain to reoccur in pa5ents with Kellgren Lawrence grades 1, 2 and 3 osteoarthri5s (higher grades indica5ng worse osteoarthri5s) was 9.9, 9.0 and 5.6 months respec5vely. Pain recurred more quickly in severe arthri5s (p=0.037).

52 PRP nin ETKİNMİDİR? AĞRI da AZALMA DİZ FONKSİYONEL SKORLARINDA ARTMA ARTROPLASTİ İHTİYACININ GECİKMESİ RADYOGRAFİK ve ARTROSKOPİK BULGULARDA DÜZELME

53 PRP GÜVENLİ MİDİR?

54 Adverse events including syncope, dizziness, headache, nausea, gastri5s, swea5ng and tachycardia were reported in 33% (17/51) of pa5ents at the 5me of receiving an ini5al platelet-rich plasma injec5on in a randomised controlled trial of 78 pa5ents treated by 1 platelet-rich plasma injec5on (n=26), 2 platelet- rich plasma injec5ons (n=25) or placebo (n=23) (no further details available).

55 Pain and s5ffness in the knee, which lasted for up to 2 days, were reported in 14% (7/51) of pa5ents who received a platelet-rich plasma injec5on in the randomised controlled trial of 78 pa5ents. Mild swelling or pain in the knee, which resolved within 2 weeks, was reported in 63% (41/65) of pa5ents in a prospec5ve case series of 65 pa5ents treated by platelet-rich plasma injec5ons. In the same study, 'mild local hea5ng' in the knee, which resolved within 1 week, was reported in 11% (7/65) of pa5ents.

56 PRP GÜVENLİ MİDİR? EVET

57 PRP (Trombositten Zengin Plazma)

58 Bilimsel kanıt düzeyleri TARTIŞMALIDIR! Karar vermede hasta (her hasta birbirinden farklıdır) ve hekim (her hekimin tecrübesi birbirinden farklıdır) FAYDA ve ZARARLARI düşünerek BERABER karar vermelidir! KİŞİYE ÖZEL TEDAVİ

59 HAFİF & ORTA KİLO VERME OSTEOARTRİT CİDDİ KİLO VERME (UYGUNSA) HASTA EĞİTİMİ VE AKTİVİTE MODİFİKASYONU HASTA EĞİTİMİ VE AKTİVİTE MODİFİKASYONU ZORLAYICI OLMAYAN AEROBİK EGZERSİZLER/ GÜÇLENDİRME EĞİTİMİ BREYSLEME ORTEZ ±FİZİK TEDAVİ ZORLAYICI OLMAYAN AEROBİK EGZERSİZLER/ GÜÇLENDİRME EĞİTİMİ BREYSLEME/YÜRÜME YARDIMI ORTEZ FİZİK TEDAVİ UĞRAŞI TEDAVİSİ

60 HAFİF & ORTA OSTEOARTRİT CİDDİ GLUKOZAMİN/ KONDROİTİN SÜLFAT/ ASU GLUKOZAMİN/ KONDROİTİN SÜLFAT/ASU PARASETAMOL NSAİİ (Oral ve Topikal) NSAİİ (Oral ve/veya Topikal) GÜÇLÜ ANALJEZİKLER (Kısa süreli) EKLEM İÇİ ENJEKSİYONLAR EKLEM İÇİ ENJEKSİYONLAR

61 ü NEDEN PRP? GÜVENLİ ELDE EDİLMESİ KOLAY ÜRETİMİ BASİT ve ÇABUK UCUZ

62 HASTA MEMNUNİYETİ Sağ TDP Sol diz PRP

63 biomateryaller BİOMATERYALLER BİOmateryaller

64 All new things are not necessarily be er All good things ulymately prevail. CS Ranawat

65 BIOMATERIAL & BIOLOGICAL MATERIAL

66 Sunumu tekrar görmek isterseniz!