Intradiscal Injection of Autologous Platelet-Rich Plasma Releasate to Treat Discogenic Low Back Pain: A Preliminary Clinical Trial.
Intradiscal Injection of Autologous Platelet-Rich Plasma Releasate to Treat Discogenic Low Back Pain: A Preliminary Clinical Trial.
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DOI：
10.4184/asj.2017.11.3.380
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发表时间：
2017-06
影响因子：
2.3
通讯作者：
Sudo A
中科院分区：
文献类型：
--
作者：
Akeda K;Ohishi K;Masuda K;Bae WC;Takegami N;Yamada J;Nakamura T;Sakakibara T;Kasai Y;Sudo A
初步临床试验。确定椎间盘内注射自体富血小板血浆（PRP）释放物治疗椎间盘源性腰痛患者的安全性和初步疗效。PRP由自体生长因子和细胞因子组成，已广泛用于组织再生和修复的临床环境。PRP已在体外和体内显示出潜在地刺激椎间盘基质代谢。本研究的入选标准包括慢性腰痛，不伴有超过3个月的腿部疼痛;一个或多个腰椎间盘（L3/L4至L5/S1）有退行性变的证据，如通过磁共振成像（MRI）所示;以及至少一个有症状的椎间盘，使用标准化的激发性椎间盘造影术证实。将从凝结的PRP中分离的PRP释放物注射到髓核的中心。结果测量包括使用视觉模拟量表（VAS）和Roland-Morris残疾问卷（RDQ），以及X线和MRI（T2量化）。分析了14例患者（8例男性和6例女性;平均年龄33.8岁）的数据。平均随访10个月。治疗后，没有患者发生不良事件或椎间盘高度显著变窄。治疗前平均疼痛评分（VAS，7.5±1.3; RDQ，12.6±4.1）在1个月时显著降低，并且通常在整个观察期内持续降低（治疗后6个月：VAS，3.2±2.4; RDQ; 3.6±4.5; 12个月：VAS，2.9±2.8; RDQ，2.8±3.9; p<0.01）。治疗后平均T2值无显著变化。我们证明，椎间盘内注射自体PRP释放物治疗腰痛患者是安全的，随访期间未观察到不良事件。今后应开展随机对照临床研究，系统评价该疗法的疗效。
Preliminary clinical trial. To determine the safety and initial efficacy of intradiscal injection of autologous platelet-rich plasma (PRP) releasate in patients with discogenic low back pain. PRP, which is comprised of autologous growth factors and cytokines, has been widely used in the clinical setting for tissue regeneration and repair. PRP has been shown in vitro and in vivo to potentially stimulate intervertebral disc matrix metabolism. Inclusion criteria for this study included chronic low back pain without leg pain for more than 3 months; one or more lumbar discs (L3/L4 to L5/S1) with evidence of degeneration, as indicated via magnetic resonance imaging (MRI); and at least one symptomatic disc, confirmed using standardized provocative discography. PRP releasate, isolated from clotted PRP, was injected into the center of the nucleus pulposus. Outcome measures included the use of a visual analog scale (VAS) and the Roland-Morris Disability Questionnaire (RDQ), as well as X-ray and MRI (T2-quantification). Data were analyzed from 14 patients (8 men and 6 women; mean age, 33.8 years). The average follow-up period was 10 months. Following treatment, no patient experienced adverse events or significant narrowing of disc height. The mean pain scores before treatment (VAS, 7.5±1.3; RDQ, 12.6±4.1) were significantly decreased at one month, and this was generally sustained throughout the observation period (6 months after treatment: VAS, 3.2±2.4, RDQ; 3.6±4.5 and 12 months: VAS, 2.9±2.8; RDQ, 2.8±3.9; p<0.01, respectively). The mean T2 values did not significantly change after treatment. We demonstrated that intradiscal injection of autologous PRP releasate in patients with low back pain was safe, with no adverse events observed during follow-up. Future randomized controlled clinical studies should be performed to systematically evaluate the effects of this therapy.