Platelet Rich Plasma Injection PRP 富血小板血漿注射

Dr. Adrian Leung > Platelet Rich Plasma Injection PRP 富血小板血漿注射

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Platelet Rich Plasma Injection PRP 富血小板血漿注射

Background 背景

Growth factors are signaling proteins that trigger and boost the body self repair mechanism.

Growth factors help wounds and injury heal. It also helps the body to reverse some degenerative process, which is an imbalance of breaking down and repair of the body.

Scientists know platelets for long time. Platelets not only help the blood clot when there is a cut wound, but they also aid in repairing and regenerating tissue because platelets are a rich source of growth factors. The idea behind platelet rich plasma is to provide a much higher concentration of platelets to an injured or degenerative area to ease pain, repair tissue and even regenerate.

Platelet rich plasma is made by taking a sample of a person’s own blood and then concentrating the platelets by centrifuge. The enriched platelets are then injected back into the same person, into the injured or degenerative tissue.

There have been a number of studies looking at whether platelet rich plasma is effective. When these studies are taken as a whole, there is no overwhelming evidence to support using platelet rich plasma. However, in selected cases, significant clinical improvement is observed.

生長因子是觸發和增強人體自我修復機制的信號蛋白。

生長因子有助於傷口癒合。退化關乎於新陳代謝速度下降，修復身體組織效能不足。結果是身體組織損耗和修復量變得不平衡。生長因子有助增加人體自我修復機能，所以理論上有利於逆轉某些退化病情。

科學家其實很早就知道血小板這血液成份。我們清楚明白血小板在傷口割傷時能幫助血凝結，隨著更多研究，我們得知血小板含豐富生長因子，因此還有助於修復和再生組織。注射含大量血小板的血漿到組織的背後想法就是為受傷或退化的區域提供更高濃度的生長因子，以減輕疼痛，修復受損組織甚至催化組織再生。

富含血小板的血漿是通過採集30到60毫升該患者自身血液，然後通過離心機分離及濃縮血小板而製成的。然後把血小板注射回到同一個人受傷或退化的組織中。

到目前為止，醫學界已經進行了許多研究，以研究富血小板血漿是否有效。如果總體上考慮這些研究，暫時未有壓倒性證據支持使用富血小板血漿。但是，在某些情況下，我們經常會觀察到明顯的臨床改善。

Middle layer contains Platelet concentrate 中間位置為濃縮血小板

Indication 適應症

Promote healing on 強化修復對以下問題有正面效果

Preparation 預備

  • Avoid anti-inflammatory drug for 2 weeks 注射前2星期避免服用消炎藥
  • Keep moving the limb to avoid stiffness 堅持多活動，避免僵化
  • Continue usual medication on injection day 注射當天照常食藥
  • No need for fasting 注射前無需禁食
  • If injection is over the lower limb, bring a hiking stick 如果注射位置是下肢，帶備行山手仗

Risk 風險

While all medical and nursing professionals endeavor to provide best and safest practice, complications still would occur.
General operative risks including infection, bruises, persistent swelling, pain, stiffness and redness related to reflex sympathetic dystrophy, etc, is possibly encountered but extremely rare.
Blood vessel and nerve injury might cause loss of sensation or movement over the limb, but is extremely rare. Anatomical variants also carry more risk.
Recurrence or persistent of symptom is around 20%, but this might be the natural course of the disease rather than complication.

儘管醫生和護士都會盡最大努力提供最佳和最安全的治療，但併發症仍會發生。
一般手術可能會遇到的風險，包括感染，瘀血，關於區域性神經紊亂相關的患肢持續性紅腫僵硬疼痛等，這手術也不例外。
血管及神經線損傷是很罕見的風險。可能會引致肢體觸感受損以及乏力。先天結構異常會有更高的風險。
持續病癥不改善或復發機率大概為20%，但這屬疾病的自然進程，不屬併發症。

Budget Estimation 預算費用

CPT code and RVU is as follows

  • 232T Platelet Rich Plasma injection, RVU not given

CPT碼和RVU如下

  • 232T 富含血小板血漿注射，RVU 不計算

Estimation based in Aug-2020,

  • Surgeon fee $10,000 (Clinic); $18,000 (Hospital)
  • Consultation fee $1,200; Ward round $1,200
  • Facility charge $3,000 (Clinic); Hospital charge $13,000

Total $14,200  (Clinic); $32,200 (Hospital) around

根據於2020年8月進行的估算，

  • 外科醫生費$10,000 (診所); $18,000 (手術室)
  • 診金$1,200; 巡房費$1,200
  • 物料費 $3,000 (診所); 醫院費$13,000 (手術室)

總計$ $14,200  (診所); $32,200 (手術室)　約數

Post-injection care 注射後料理

  • Control inflammation with rest (might need splint) regular usage of ice and compression.
  • Avoid using anti-inflammatory drug for 6 weeks
  • The wound is covered by a waterproof dressing. You can shower with it. Keep the dressing intact for 1 day then remove it by yourself.
  • Gently move the injected body part few times a day through the full motion range, to avoid stiffness.
  • No exercise for the injected body part for 6 weeks. Avoid  lift heavy things (for upper limb) or walking too much (for lower limb).
Preparation of Platelet Rich Plasma 製作富血小板血漿
Middle layer contains Platelet concentrate 中間位置為濃縮血小板
  • 患肢必須盡量休息（可能需要夾板），經常使用冰塊和穿戴壓力套可控制炎症。
  • 避免使用抗炎藥6週
  • 傷口已用防水敷料覆蓋。 你可以照常淋浴。保持敷料1天，然後自己將其移除。
  • 每天把患肢全幅位運動幾次，以避免僵硬。
  • 注射的身體部位在6週內不要運動。 避免舉重（對於上肢）或走太多路或樓梯（對於下肢）。

Early Post-op Complication　手術後早期併發症

Notify surgeon in case you have

  • Persistent fever of more than 37.5 Celcius
  • Chills and rigor
  • Wound pain despite rest
  • Wound redness and swelling
  • Purulent discharge from wound

如發現以下情況，要立即通知醫生

  • 持續高燒（口探高於攝氏37.5度）
  • 發冷打顫
  • 無論運動或休息時，傷口痛楚都持續增加
  • 傷口持續發紅腫脹
  • 傷口有膿液

Rehabilitation after 6 weeks 手術後6週復健

Range of Motion Exercise:

  • Continue full range of motion exercise, gradual stretching to gain additional range. 

Strengthening:

  • Gradual increase in weight and number of repetition.

活動範圍運動:

  • 全幅度活動，並逐漸拉伸，增加活動範圍。

肌力訓練：

  • 逐漸增加重量及重複次數

Reference 參考文獻

    1. Adrian DKL, Lawrence Enweze, Malcolm R. DeBaun, et al. Current Clinical Recommendations for Use of Platelet-Rich Plasma Curr Rev Musculoskelet Med. 2018 Dec; 11(4): 624–634. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220007/
    2. Di Matteo B, Filardo G, Kon E, Marcacci M. Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy–a systematic review. Musculoskelet Surg. 2015 Apr;99(1):1-9. https://pubmed.ncbi.nlm.nih.gov/25323041/