Platelet rich plasma combined with core decompression and allogeneic fibula rod support for the treatment of osteonecrosis of the femoral head (ficat stage ii); a short-term follow-up
1) The study investigated the effectiveness of platelet-rich plasma (PRP) combined with core decompression and allogeneic fibula rod support for treating osteonecrosis of the femoral head (ONFH).
2) Patients treated with PRP in addition to core decompression and rod support showed significantly improved Harris hip scores after surgery, with no differences compared to the control group that did not receive PRP.
3) Imaging at 3 months post-surgery found no deformities or collapses in either group, with the fibula rods properly positioned and beginning to integrate with surrounding bone.
Dr. Xavier Casanova Canals. Upper Extremity Orthopaedic and Trauma surgeon in...MuscleTech Network
PRP (platelet rich plasma) injections can prevent surgical treatment of lateral epicondylitis: Prospective analysis of 48 patients in work compensation environment
Clinical and epidemiological profile of patients undergoing total hip arthro...David Sadigursky
Clinical and epidemiological profile of patients undergoing total hip arthroplasty.
Rheumatology and Orthopedic Medicine
Rheumatol Orthop Med, 2017 doi: 10.15761/ROM.1000120
Dr. Xavier Casanova Canals. Upper Extremity Orthopaedic and Trauma surgeon in...MuscleTech Network
PRP (platelet rich plasma) injections can prevent surgical treatment of lateral epicondylitis: Prospective analysis of 48 patients in work compensation environment
Clinical and epidemiological profile of patients undergoing total hip arthro...David Sadigursky
Clinical and epidemiological profile of patients undergoing total hip arthroplasty.
Rheumatology and Orthopedic Medicine
Rheumatol Orthop Med, 2017 doi: 10.15761/ROM.1000120
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
Reperfusion strategy in patients with ST-Segment Elevation Myocardial Infarct...Premier Publishers
Reperfusion therapy is the cornerstone in management of STEMI. This study was designed to evaluate both In-hospital and 30 days outcome in patients with STEMI treated with primary percutaneous coronary intervention (PPCI) versus fibrinolysis. This prospective, controlled, study included 140 patients with STEMI who were eligible for reperfusion therapy. In hospital and 30 days major adverse cardiovascular events (MACE) were reported and head to head comparison was done between PPCI versus fibrinolysis. All-cause mortality was reported in 5% of patients (10% versus 0% in fibrinolysis and PPCI respectively, p=0.07), recurrence of ischemic symptoms was reported in 18% of patients (30% versus 7% in fibrinolysis and PPCI respectively, P =0.02), heart failure was evident in 22% of patients (33% versus 10% in fibrinolysis and PPCI respectively, P =0.02). PPCI is safe and effective treatment option for patients with STEMI
A primary Percutaneous Coronary Intervention (PCI) Primary PCI continues to be the optimal reperfusion therapy in
patients with ST elevation myocardial infarction however, in areas where PCI centers are not readily available, a pharmaco-invasive strategy has been proposed. This study investigated the safety, efficacy and cost effective analysis of a pharmaco-invasive strategy compared with primary (PCI) strategy for ST-Segment Elevation Myocardial Infarction (STEMI) in Gaza.
Methods: We ran domized 145 patients presenting within 2 hours of symptom onset of acute ST elevation myocardial infarction to primary PCI or for pharmaco-invasive PCI 2-24 hours after streptokinase, except in the event of failed reperfusion, in which case, emergency angiography was recommended. The primary endpoint a composite of death, shock and congestive heart failure at 30 days. Secondary end points: total bleeding and failed streptokinase required emergent PCI. Tertiary end points: cost effective analysis.
Intranasal adhesions formation was a troub-lesome complication following endoscopic sinus surgery. It can be advocated that silastic splints should be routinely used in endoscopic sinus surgery to reduce the occurrence of post-opera-tive adhesions with their associated morbidity regardless of patient’s age, gender and duration of symptoms.
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
Reperfusion strategy in patients with ST-Segment Elevation Myocardial Infarct...Premier Publishers
Reperfusion therapy is the cornerstone in management of STEMI. This study was designed to evaluate both In-hospital and 30 days outcome in patients with STEMI treated with primary percutaneous coronary intervention (PPCI) versus fibrinolysis. This prospective, controlled, study included 140 patients with STEMI who were eligible for reperfusion therapy. In hospital and 30 days major adverse cardiovascular events (MACE) were reported and head to head comparison was done between PPCI versus fibrinolysis. All-cause mortality was reported in 5% of patients (10% versus 0% in fibrinolysis and PPCI respectively, p=0.07), recurrence of ischemic symptoms was reported in 18% of patients (30% versus 7% in fibrinolysis and PPCI respectively, P =0.02), heart failure was evident in 22% of patients (33% versus 10% in fibrinolysis and PPCI respectively, P =0.02). PPCI is safe and effective treatment option for patients with STEMI
A primary Percutaneous Coronary Intervention (PCI) Primary PCI continues to be the optimal reperfusion therapy in
patients with ST elevation myocardial infarction however, in areas where PCI centers are not readily available, a pharmaco-invasive strategy has been proposed. This study investigated the safety, efficacy and cost effective analysis of a pharmaco-invasive strategy compared with primary (PCI) strategy for ST-Segment Elevation Myocardial Infarction (STEMI) in Gaza.
Methods: We ran domized 145 patients presenting within 2 hours of symptom onset of acute ST elevation myocardial infarction to primary PCI or for pharmaco-invasive PCI 2-24 hours after streptokinase, except in the event of failed reperfusion, in which case, emergency angiography was recommended. The primary endpoint a composite of death, shock and congestive heart failure at 30 days. Secondary end points: total bleeding and failed streptokinase required emergent PCI. Tertiary end points: cost effective analysis.
Intranasal adhesions formation was a troub-lesome complication following endoscopic sinus surgery. It can be advocated that silastic splints should be routinely used in endoscopic sinus surgery to reduce the occurrence of post-opera-tive adhesions with their associated morbidity regardless of patient’s age, gender and duration of symptoms.
Similar to Platelet rich plasma combined with core decompression and allogeneic fibula rod support for the treatment of osteonecrosis of the femoral head (ficat stage ii); a short-term follow-up
Conservative Management of Knee osteoarthritisEsserHealth
Osteoarthritis is a major burden on personal health and international health care expenditures. Learn the basics of osteoarthritis and conservative management options for the physician.
Ppi for bleeding ulcers intermittent vs continuousHassan Al tomy
in last few years there is emergent data on use of intermittent PPI in bleeding ulcers compared to continous infusion
in this meta-analysis the invistigator select 13 randomized controlled trial
Intermittent PPI regimens are comparable to continuous PPIinfusion regimens in patients with bleeding ulcers and high risk endoscopic findings
Because of ease of use and lower cost and resource utilization, intermittent PPI therapy may be the regimen of choice after endoscopic therapy in such patients
Similar to Platelet rich plasma combined with core decompression and allogeneic fibula rod support for the treatment of osteonecrosis of the femoral head (ficat stage ii); a short-term follow-up (20)
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Platelet rich plasma combined with core decompression and allogeneic fibula rod support for the treatment of osteonecrosis of the femoral head (ficat stage ii); a short-term follow-up
1. Platelet-rich plasma combined with core decompression and al-
logeneic fibula rod support for the treatment of osteonecrosis of
the femoral head (Ficat stage II): a short-term follow-up
35
Biao-fang Wei et al
Clin Surg Res Commun 2017; 1: 35-40
Abstract
Background: The objective of this study was to investigate the potency of platelet-rich plasma (PRP) combined
with core decompression and allogeneic fibula rod support for the treatment of osteonecrosis of the femoral
head (ONFH, Ficat stage II).
Methods: This was a retrospective study of clinical data of patients who were admitted to our hospital for
treatment of ONFH from July 2014 to June 2015. In PRP group, patients (9 cases) were treated with platelet-
rich plasma combined with core decompression and allogeneic fibula rod support. In control group, patients
(7 cases) were treated with core decompression and allogeneic fibula rod support only. The time from onset
of symptoms to surgery was 3–6 months (mean: 4.5 months). Harris hip scores before and after surgery were
recorded (> 90, excellent; 75–90, good; 60–74, poor; and < 60, bad). An imaging study was performed 1 and 3
months after surgery.
Results: In the PRP group, the Harris scores increased from 67.82 ± 9.61 to 88.45 ± 6.02. In the control group,
the Harris scores increased from 69.74 ± 8.26 to 87.36 ± 6.17. There were statistically significant differences
in pretherapy and post-treatment scores (P < 0.05). Three months postsurgery, the shapes of the femoral
heads in both groups were good, with no deformation or collapse. The location of the top of the allograft fibula
was perfect (no fibula out). Additionally, the fibula rods began to combine with the surrounding bone after 3
months postsurgery, without infection.
Conclusion: PRP can ease hip pain and improve joint function
Keywords: PRP, ONFH, core decompression, allogeneic fibula rod
*Corresponding author: Biao-fang Wei
Address: Department of Orthopaedic Surgery, Lin Yi People's
Hospital, No.27 East Jiefang Road, Linyi, 276000
E-mail: 317516288@qq.com
Received: 20 October 2017 Accepted: 25 December 2017
a
Guang zhou University of Chinese Medicine ; b
Department of Orthopaedic Surgery, Lin Yi People's Hospital
Liang-bin Jianga,b
, Song Liua,b
, Biao-fang Weib
Creative Commons 4.0
INTRODUCTION
Osteonecrosis of the femoral head (ONFH) is a painful
disorder of the hip that affects patients with various
risk factors, such as glucocorticoid use, alcohol abuse,
trauma, and autoimmune diseases (1-3)
. The progress
of joint destruction in ONFH can lead to hip arthritis,
which seriously affects the patient’s health. In the
absence of appropriate surgical treatment, the femoral
head will collapse within 2–3 years in the vast majority
of patients (4)
. Steinberg(5)
reported that collapse of the
femoral head occurred in 92% of nonsurgical cases (48
hips) within 3 years after a definite diagnosis of ONFH.
As ONFH occurs mostly in young and middle-aged
patients, Garrigues et al. (6)
believe that all possible
treatment measures should be taken to protect the
femoral head. At present, the main methods to protect
the femoral head in ONFH are core decompression,
with or without a bone graft, in addition to bone flap
transplantation with blood vessels and blood vessel
bundle transplantation. However, these treatments
have not achieved satisfactory clinical results.
Platelet-rich plasma (PRP), an autologous enriched
source of various growth factors, is widely used during
trauma and orthopedic surgery. PRP contains a variety
of cytokines, such as platelet-derived growth factor
(PDGF), vascular endothelial growth factor, platelet-
derived angiogenesis factor, transforming growth
factor (TGF), insulin-like growth factor, and platelet-
derived epidermal growth factor. PRP can accelerate
the healing of hard and soft tissues after maxillofacial,
plastic, dermatologic, dental, and orthopedic surgery
Research article
DOI: 10.31491/CSRC.2017.12.006
2. Published online: 25 December 2017
CLINICAL SURGERY RESEARCH COMMUNICATIONS
36 Biao-fang Wei et al
(7-9)
. However, evidence from preclinical and clinical
research suggests that PRP has no significant
therapeutic effects on ONFH. The aim of the present
study was to investigate whether PRP promoted
healing of ONFH in a clinical setting.
MATERIAL AND METHODS
Patients
Thiswasaretrospectivestudyofclinicaldataofpatients
who were admitted to our hospital for treatment of
ONFH from July 2014 to June 2015. The patients were
assigned to a PRP group or a control group. In the PRP
group, there were seven males and two females aged
28–45 years (mean: 36.5 years). The group included
six cases of alcoholic avascular necrosis and three
cases of glucocorticoid-induced avascular necrosis.
The Harris score was 60–86 points (mean: 73 points)
prior to surgery. Patients were treated with platelet-
rich plasma combined with core decompression and
allogeneic fibula rod support. In the control group,
there were five males and two females aged 26–44
years (mean: 35 years). The group contained four
cases of alcoholic avascular necrosis, two cases of
glucocorticoid-induced avascular necrosis, and one
case of traumatic ONFH. The Harris score was 62–86
points(mean:74points)priortosurgery.Patients were
treated with core decompression and allogeneic fibula
rod support only. In all patients, ONFH was confirmed
by symptoms, a physical examination, patient history,
and results of imaging studies, including X-ray and
magnetic resonance (MR) examinations. The time from
onset of symptoms to surgery was 3–6 months (mean:
4.5 months). There were no statistically significant
differencesinthecommondatabetweenthetwogroups
(P > 0.05). The clinical experiments were approved by
the ethics committee of Linyi People’s Hospital. All the
patients volunteered to take part in the study, and all
signed informed consent forms.
Preparation of PRP
After successful induction of general anesthesia, whole
blood(30mL)wascollectedfromthemarginalauricular
vein using an 18-gauge catheter. The blood was then
injected into a sterile centrifuge tube containing 1.5
mL of sodium citrate. The mixture was centrifuged at
1500×g for 20 min to separate the plasma from red
blood cells. A straw was then used to suck out the
supernatant. The plasma was centrifuged again at
1500×g for 10 min (4 °C), and the precipitated platelets
(i.e., PRP) were collected (10).
Surgical procedure
A longitudinal incision (4–6 cm) was made in the big
tuberosity distal along the lateral femoral hip to expose
the far side of the greater trochanter of the femur,
which was used as the entry point. Using C-arm X-ray
machine monitoring, a bone tunnel (diameter of 12
mm) was drilled in the central necrosis area (5–7 mm
under the articular cartilage). All dead bone tissue was
then removed along the bone tunnel, and autologous
PRP was implanted. Selecting suitable length allogeneic
fibula rod support and fixed. After confirming the depth
and location of allogeneic fibula rod, the incision was
sutured. The surgical protocol is shown in Figure 1.
Postoperative management
All the patients were treated with anti-inflammatory
agents after the surgery. After awakening from
anesthesia, active flex and outreach of joint function
rehabilitation exercise was carried out. Postsurgery,
the patients were supported by crutches for 3 months
to avoid femur neck fracture caused by falling. Each
Figure 1. Surgical procedure. (A) Step 1: Identifying the location of ONFH. (B) Step 2: Construction of a bone tunnel and removal
of dead bone tissue. (C) Step 3: Implantation of autologous PRP. (D) Step 4: Selection of an allogeneic fibula rod support of a suitable
length and fixation. The anesthesia method, incision approach, and operative procedure in the control group were the same as those
in the PRP group, except PRP was not implanted in the control group.
3. 37
Biao-fang Wei et al
Clin Surg Res Commun 2017; 1: 35-40
patient was advised to avoid excessive body weight and
intense activity for 1 year.
Postoperative follow-up and evaluation of the curative
effect
Asanindicatorofthecurativeeffect,theHarrishipscore
was used (> 90, excellent; 75–90, good; 60–74, poor;
and < 60, bad) (11)
. Imaging studies were performed 1
and 3 months after the surgery to evaluate changes in
bone morphology.
Statistical analysis
All data are expressed as means ± standard deviation
(SD). The statistical analysis was performed using SPSS
16.0 software (SPSS Inc., Chicago, IL, USA). Differences
betweengroupsweredetectedusingaone-wayanalysis
of variance, followed by Scheffe’s multiple comparison
test. P < 0.05 was considered statistically significant.
RESULTS
Comparison of Harris hip scores in the two groups
In the PRP group, the Harris scores increased from
67.82 ± 9.61 to 88.45 ± 6.02 (P < 0.05, Table 1). Seven
(77.8%)hipswereclassedasexcellent,andone(22.2%)
hip was classed as good. No hips were classed as poor
or bad. In the control group, the Harris scores increased
from 69.74 ± 8.26 to 87.36 ± 6.17 (P < 0.05, Table 1). Six
(85.7%) hips were classed as excellent, and 1 (14.2%)
hip was classed as good. No hips were classed as poor
or bad. There were statistically significant differences
in pretreatment and post-treatment scores (P <
0.05, Table 1). There were no statistically significant
differences in the postoperative scores of the two
groups (P > 0.05, Table 1).
Imaging findings
Three months after the operation, the shapes of the
femoral heads in the two groups were good, with no
deformation and collapse. The location of the top of
the allograft fibula was perfect (no fibula out), and it
was located in the weight-bearing area and 5–7 mm
(mean 6 mm) under the articular cartilage. The fibula
rods began to combine with the surrounding bone after
3 months postsurgery, without infection. There were
no statistically significant differences in the imaging
findings of the two groups (Fig. 2).
DISCUSSION
The purpose of this study was to evaluate the
therapeutic effect of PRP in ONFH (Ficat stage II). In
the initial stage of ONFH, core decompression, together
with allogeneic fibula rod support, is considered an
effective surgical intervention. However, However, this
treatment retains the femoral head in only 60–80% of
cases in the short and medium term (12)
. Femoral head
core decompression involves drilling a tunnel to reduce
the pressure on the femoral head, thereby alleviating
pain. A combination of core decompression with other
treatments, such as a bone graft and implants, with
growth factors, can promote local osteogenesis and
avoid channel collapse. The ultimate aim is to reduce
pressure in the necrotic area, remove necrotic tissue,
and provide effective mechanical support. The clinical
application of PRP in the treatment of early-stage ONFH
offers a new strategy to combat disease progression.
The platelet (PLT) concentration in PRP is several
times higher than that in whole blood, although
findings differ on this issue. Marx et al. (13)
reported
that the concentration of PLT in PRP was four times
higher than that in whole blood. In contrast, Okuda et
al. (14)
concluded that the concentration of PLT in PRP
was 2.83 times higher than that in whole blood. Others
reported that the concentration of PLT in PRP was 2.05
(15)
, 5.05 (artificial count) (15)
, 5.29 (automated account)
(16)
, and even 9–11 times higher as compared with that
in whole blood (17)
.
PRP-inducedboneregenerationismainlyduetogrowth
factors, which are released in response to activation of
PRP (18-20)
. Growth factors, especially PDGF and TGF-β
play a vital role in the process of bone regeneration
and repair (21)
. In addition to growth factors in PLTs,
macrophages and endothelial cells, which synthesize
and secrete PDGF, promote wound healing (22)
. PDGF
promotes mitosis and related angiogenesis (23)
and
Table 1 Comparison of Harris hip scores in the two groups before and after treatment
Group n Before treatment Final follow-up P
PRP group 9 67.82±9.61 88.45±6.02 <0.05
Control group 7 69.74±8.26 87.36±6.17 <0.05
P >0.05 >0.05
4. Published online: 25 December 2017
CLINICAL SURGERY RESEARCH COMMUNICATIONS
38 Biao-fang Wei et al
improves the activity of macrophages and other
growth factors. TGF-β induce mitosis, osteoblast
differentiation, osteoid formation, and bone
regeneration (24)
. nsulin-like growth factor (IGF)
accelerates bone formation by increasing the number
of osteoblasts (25)
. To shed light on the therapeutic
effect of growth factors, Lynch et al. (26)
used different
concentrations of PDGF, IGF, epidermal growth factor
(EGF), and Fibroblast growth factor (FGF) mixtures
to repair wounds and found that a 2:1 ratio of PDGF
and IGF was the best combination. They suggested
that a variety of growth factors constitute a growth
factor net and have a synergistic effect. For example,
combined PDGF and TGF-β had a strong biological
chemotactic effect on human osteoblasts (27)
. TGF-β not
only regulated growth and differentiation of bone cells
and cartilage cells but also regulated the expression of
other growth factors in bone and cartilage tissue (28)
.
PDGF and TGF-β promoted the expression of vascular
endothelial growth factor (29)
. In combination with
other growth factors, IGF promoted differentiation
and maturation of a variety of cells (30)
. Okuda et al. (14)
reported that PRP stimulated osteoblast DNA synthesis
and cell division. We contend that the combined effect
of a variety of the high concentration of growth factors
in PRP can stimulate osteogenesis and accelerate bone
repair.
In the current study, we analyzed retrospectively
the clinical efficacy of 16 recent cases (16 hips) of
ONFH. According to the postoperative 3-month
follow-up, none of the cases in either group showed
disease progression, such as femoral head collapse,
osteoarthritis requiring a total hip replacement,
infections, or femoral neck fracture. In all patients, hip
pain was significantly reduced or had disappeared.
There is no consensus in the literature on the potential
role of PRP in promoting bone regeneration and repair.
Whitman et al. (31)
were the first to successfully use
used PRP and bone transplantation to treat a bone
defect in the field of maxillofacial surgery. Marx et al. (13)
used PRP and a bone graft to treat a bone defect. They
reported that the callus growth rate in the combined
transplantation group was 1.62–2.16 times higher than
that in a pure bone transplantation group. However,
in a rabbit skull defect model Ahgaloo et al. (32)
found
that PRP did not promote bone regeneration after an
autologous bone graft. Choi et al. (33)
reported that PRP
did not promote healing of bone defects 6 weeks later.
Furthermore, in a study of PRP with an autologous
bone composite, biological materials, and organic bone
matrix, Kim et al. (34)
used and reported that PRP did not
promote bone regeneration effectively.
The present study has several limitations. First, the
follow-up time was relatively short. The study was
performed only in the first 3 months after the surgery
during the initial stage of rehabilitation. Second, the
number of cases in the study was relatively small.
Finally, the study was a retrospective case series.
CONCLUSIONS
In this comparison of a PRP group and controls in
a clinical setting, the use of PRP was not associated
with any obvious advantages. PRP eased hip pain and
improved joint function. Long-term follow-up studies
Figure 2. Imaging findings. (A1 and B1) AP X-ray films before surgery. (B1 and B2) Coronal T1 magnetic resonance (MR) images
before surgery. (A3&B3) AP X-ray films after surgery. (A4 and B4) AP X-ray films 3 months after surgery.
5. 39
Biao-fang Wei et al
Clin Surg Res Commun 2017; 1: 35-40
are needed to clarify the potential role of PRP in
promoting repairing of ONFH.
ACKNOWLEDGEMENT
This work was supported by the Science and
Technology Development Planning of Shan Dong
Province(2014GSF119022)
CONFLICT OF INTEREST
The authors declare no conflict of interests.
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