Hemiplejik omuz ağrısında trombositten zengin plazmanın etkinliği
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Dosyalar
Tarih
2016
Yazarlar
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Hemiplejik omuz ağrılı hastalarda trombositten zengin plazmanın ağrı ve fonksiyon üzerine etkisini araştırmaktır. Bu amaçla çift kör randomize, prospektif planlanan çalışmamızda hemiplejik omuz ağrılı hastalarda trombositten zengin plazmanın etkisi serum fizyolojik ile karşılaştırıldı. Gereç ve yöntem: Kliniğimiz polikliniklerine başvuran ilk inmeye bağlı hemipleji gelişmiş, 2 haftadan fazla plejik taraftaki omuzda ağrısı olan, 18-80 yaş aralığında, inmenin üstünden en az 3 ay geçmiş 55 hasta tarandı. Bu hastalardan 6' sı çalışmanın dâhil edilme kriterlerini karşılamadığı, 6 hasta da çalışmaya katılmayı reddettiği için çalışma dışı bırakıldı, toplam 43 hasta çalışma için randomize edildi. Tedavi grubuna TZP, 2. gruba plasebo olmak üzere tüm hastalara 1' er hafta arayla 3 kez enjeksiyon uygulandı. Tedavi grubundaki hastalara etkilenmiş omuz intraartiküler alanına; kendi venöz kanlarının santrifüji ile elde edilen trombosit zengin plazma, 2. gruptaki hastalara ise aynı miktar serum fizyolojik enjekte edildi. Tüm tedavi grupları yapılan enjeksiyona ek olarak nörolojik rehabilitasyon programlarına devam etti. Çalışma, hem hastaların hem de enjeksiyonu ve değerlendirmeyi yapan araştırmacıların hastaların hangi gruba dahil olduğunu bilmeksizin, kör olarak gerçekleştirildi. Üç aylık takip sonunda 40 hasta çalışmayı tamamladı. Primer ölçüm parametresi olarak hareketle olan VAS-ağrı skoru, sekonder ölçüm parametreleri olarak spontan VAS ağrı skoru, omuz pasif EHA(eklem hareket açıklıkları), FBÖ(fonksiyonel bağımsızlık ölçeği) ve kullanılan parasetamol miktarı kullanıldı. Tüm hastalar tedavi öncesi, son enjeksiyondan 1 hafta sonra, 1. ayda ve 3. ayda değerlendirildi. Bulgular: Çalışmamızda spontan ve hareketle olan VAS değerlerinde, omuz pasif EHA'da 1. ay ve 3.ay vizitlerinde her iki grupta da anlamlı iyileşme gözlendi (p<0.05). Ancak gruplar arası istatistiksel olarak anlamlı fark saptanmadı. Benzer şekilde FBÖ değerlerinde de tüm hastalarda iyileşme gözlenirken(p<0.05), gruplar arası fark yoktu. Kullanılan parasetamol miktarı arasında iki grup arası fark bulunmadı. iii Tartışma: Trombositten zengin plazma; tam kanın santrifüjü ile elde edilen ve tam kandan daha yüksek trombosit konsantrasyonu içeren hücresel plazma komponentidir. Biyoaktif protein ve büyüme faktöründen zengin trombositler dokuya bırakılıraak yaşlı ve rejenerasyonu iyi olmayan dokularda anjiyonegenezin, epitelizasyonun, hücre farklılaşmasının ve ekstraselüler matriks formasyonunun stimulasyonuyla doku iyileşmesine yardımcı olunması amaçlanır. Tüm bu yararlı etkilerinden dolayı HOA tedavisinde etkili olacağı hipotezine dayanarak yapılan bu çalışmada her iki grubun da zaman içinde iyileşme gösterdiği, ancak gruplar arası fark olmadığı görülmüştür. TZP enjeksiyonlarının plaseboya göre üstünlük göstermemesi iğnenin uyarıcı etkisi, TZP' nin hazırlanma biçimi, hazırlık aşamasında özellikle aktivatör kullanılmamış olması, hastaların aspirin alıyor olmaları ve HOA' nın heterojen yapısı ve olguların kronik olmaları ile açıklanabilir. Ayrıca tüm hastalara iyi bir eğitim sağlanması ile düzenli egzersiz programının başlanması bütün hastaların iyileşmesi üzerine etkili faktörler arasında sayılabilir. Bununla birlikte kesin bir yargıya varmak için HOA' nın akut-kronik, subluksasyonun eşlik edip etmediği alt gruplara ayrılabildiği daha çok hasta üzerinde yapılan, aktivatör kullanılarak hazırlanan TZP grubunun da yer aldığı çalışmalara ihtiyaç vardır.
Objective: In this study, our aim was to examine the effects of platelet rich plasma (PRP) on pain and functional outcomes in patients with hemiplegic shoulder pain. We compared the effects of PRP against saline solution by designing a double blind, randomized, prospective study. Materials and Methods: 55 patients with hempilegia of more than 3 months duration, who complained of shoulder pain for more than 2 weeks, and who were between 18-80 years of age were evaluated for inclusion. 6 of these patients did not meet the inclusion criteria and 6 more patients rejected enrollment. A total of 43 patients were included and randomized. All patients received a total of 3 injections, one week apart. First group received PRP injections while the second group received placebo injections. Patients in the treatment group received intraarticular injections to their affected shoulders consisting of PRP that was obtained from the centrifugation of the subjects’ venous blood, while the patients in the control group received intraarticular saline injections of the same volume. All patients continued receiving neurologic rehabilitation in addition to the injections. Subjects and researchers were blind to treatment allocations. After 3 months of follow up, 40 patients completed the trial. Primary outocome measure was movement-induced pain score (VAS) and secondary outcome measures were spotaneous pain score, shoulder passive range of motion (ROM), functional independence measure score and the amount of paracetamol used. All subjects were evaluated at baseline, 1 week, 1 month and 3months after the completion of the last injection. Results: Both groups showed an improvement in spontaneous and movement-related pain scores and shoulder passive ROM values on 1st and 3rd month visits (p<0,05). No significance difference was detected between groups. Similarly, FIM scores improved significantly in both groups (p<0,05) but no difference was found between groups. Paracetamol use did not differ significantly between groups. Discussion: Platelet rich plasma is the cellular plasma component of blood that is obtained by centifugation of whole blood and that contains higher platelet concentrations. Introduction into the tissues of this platelet suspension that is rich in proteins and growth factors aims to facilitate healing by increasing angiogenesis, epithelisation, cell differentiation and stimulation of extracellular matrix formation in tissues that are old and with poor regeneration capabilities. Based on these beneficial effects, we hypothesized that PRP may alleviate hemiplegic shoulder pain, however no difference was detected between groups. The non-superiority of PRP over placebo may be due to the needle stimulus effect in placebo group, preparation of PRP suspension, lack of activator use in PRP preparation, aspirin use, the etiologic heterogenicity of hemiplegic shoulder pain and chronicity of pain in our patient population. Concurrent patient education and a formal rehabilitation and exercise program may also have contributed to the positive outcomes. There is still need for further research that incorporates subgroup analyses of subjects with acute and chronic stroke, presence or absence of subluxation that includes larger numbers of patients and also examines the effects of activator use during PRP preparation.
Objective: In this study, our aim was to examine the effects of platelet rich plasma (PRP) on pain and functional outcomes in patients with hemiplegic shoulder pain. We compared the effects of PRP against saline solution by designing a double blind, randomized, prospective study. Materials and Methods: 55 patients with hempilegia of more than 3 months duration, who complained of shoulder pain for more than 2 weeks, and who were between 18-80 years of age were evaluated for inclusion. 6 of these patients did not meet the inclusion criteria and 6 more patients rejected enrollment. A total of 43 patients were included and randomized. All patients received a total of 3 injections, one week apart. First group received PRP injections while the second group received placebo injections. Patients in the treatment group received intraarticular injections to their affected shoulders consisting of PRP that was obtained from the centrifugation of the subjects’ venous blood, while the patients in the control group received intraarticular saline injections of the same volume. All patients continued receiving neurologic rehabilitation in addition to the injections. Subjects and researchers were blind to treatment allocations. After 3 months of follow up, 40 patients completed the trial. Primary outocome measure was movement-induced pain score (VAS) and secondary outcome measures were spotaneous pain score, shoulder passive range of motion (ROM), functional independence measure score and the amount of paracetamol used. All subjects were evaluated at baseline, 1 week, 1 month and 3months after the completion of the last injection. Results: Both groups showed an improvement in spontaneous and movement-related pain scores and shoulder passive ROM values on 1st and 3rd month visits (p<0,05). No significance difference was detected between groups. Similarly, FIM scores improved significantly in both groups (p<0,05) but no difference was found between groups. Paracetamol use did not differ significantly between groups. Discussion: Platelet rich plasma is the cellular plasma component of blood that is obtained by centifugation of whole blood and that contains higher platelet concentrations. Introduction into the tissues of this platelet suspension that is rich in proteins and growth factors aims to facilitate healing by increasing angiogenesis, epithelisation, cell differentiation and stimulation of extracellular matrix formation in tissues that are old and with poor regeneration capabilities. Based on these beneficial effects, we hypothesized that PRP may alleviate hemiplegic shoulder pain, however no difference was detected between groups. The non-superiority of PRP over placebo may be due to the needle stimulus effect in placebo group, preparation of PRP suspension, lack of activator use in PRP preparation, aspirin use, the etiologic heterogenicity of hemiplegic shoulder pain and chronicity of pain in our patient population. Concurrent patient education and a formal rehabilitation and exercise program may also have contributed to the positive outcomes. There is still need for further research that incorporates subgroup analyses of subjects with acute and chronic stroke, presence or absence of subluxation that includes larger numbers of patients and also examines the effects of activator use during PRP preparation.
Açıklama
Anahtar Kelimeler
Ağrı, Hemipleji, İnme, Omuz, Trombositten Zengin Plazma, Hemiplegia, Pain, Platelet-Rich Plasma, Shoulder, Stroke
