背景：富血小板血浆是一种含有高浓度血小板的血浆，含有多种生长因子和细胞因子，有助于促使韧带和肌腱再生，促进多发性肌肉骨骼疾病的恢复。

目的：探讨富血小板血浆用于肌腱和韧带损伤修复的最新文献分析。

方法：以“platelet-rich plasma，ligament injury，repair of ligament，tendon injury，repair of tendon，growth factors”为检索词，应用计算机检索PubMed数据库1990至2018年发表的相关文献共64篇；以“富血小板血浆”在中国知网检索相关文献1篇，对富血小板血浆的制备、分类、血小板源生长因子的释放及其促进韧带、肌腱修复的相关文献进行综述。

结果与结论：虽然富血小板血浆对肩袖和髌骨肌腱病变及尺侧支、前交叉韧带等韧带损伤的治疗效果有限且无定论，但是多项基础科学和活体动物实验支持富血小板血浆在肌腱和韧带疾病中的应用。目前富血小板血浆是一种可行的保守治疗措施，其并发症或不良反应风险较低。在选择富血小板血浆注射方式时，病因可能会有一定的影响，例如富白细胞富血小板血浆与贫白细胞富血小板血浆，贫白细胞富血小板血浆对于肱骨外上髁炎等疾病的治疗可能更有益处，因为其可能有助于诱导炎症反应以达到促进恢复的目的。目前富血小板血浆尚未成为治疗的标准方法之一，然而随着对最佳候选方案的进一步研究，在未来其可能发展为较为普遍的疗法。

BACKGROUND:Platelet-rich plasma contains high levels of platelets and a variety of growth factors and cytokines, which help promote ligament and tendon regeneration and the recovery of multiple musculoskeletal disorders.

OBJECTIVE:To analyze the latest publications regarding application of platelet-rich plasma in the repair of tendon and ligament injuries.

METHODS:A computer-based online search of PubMed database was performed for related literatures published during 1990-2018 with the search terms “platelet-rich plasma, ligament injury, repair of ligament, tendon injury, repair of tendon, growth factors”. A total of 64 literatures were retrieved. CNKI was searched with “platelet-rich plasma” as the search term. One related literature was retrieved. These retrieved literatures were summarized from the perspectives of preparation and classification of platelet-rich plasma, release of platelet-derived growth factor, and promotion of ligament and tendon repair by platelet-rich plasma.

RESULTS AND CONCLUSION:Although platelet-rich plasma has limited and inconclusive therapeutic effects on rotator cuff and iliac tendon lesions, ulnar collaterals and anterior cruciate ligament injury, many basic science and live animal experiments support the application of platelet-rich plasma in tendon and ligament diseases. At present, platelet-rich plasma is a feasible conservative treatment with a lower risk of complications or adverse reactions. The cause of disease may have certain effects on the injection methods of platelet-rich plasma. For example, leukocyte-poor platelet-rich plasma exhibits better therapeutic effects on the external humeral epicondylitis than leukocyte-rich platelet-rich plasma because it likely helps induce an inflammatory response to promote recovery. Platelet-rich plasma has not become one of the standard treatment methods of tendon and ligament injuries. With in-depth research on the optimal candidate, platelet-rich plasma may develop into a more common therapy in the future.

0 引言 Introduction

近10年来，生物疗法在治疗各种肌肉骨骼疾病方面的应用显著增加，特别是富血小板血浆注射治疗已成为临床医生越来越普遍的治疗方法，尤其是在治疗肌腱病和退行性纤维病方面。临床上富血小板血浆的发展史始于20世纪80年代，DelRossi等[1-2]发现富血小板血浆在心脏手术中能有效减少出血；石晟等[3]在体外循环前利用自体血小板分离技术从患者全血中分离出富血小板血浆，在体外循环结束后用鱼精蛋白中和再回输入患者体内，以减少围术期的出血量和血液制品输注量，证明富血小板血浆是一种可行的血液保护方法。由于富血小板血浆再生特性对骨成熟和形成的影响，近年来在牙科领域得到了广泛研究[4]。随着时间的推移，富血小板血浆在肌肉骨骼医学中的应用越来越广泛，在肌腱和组织愈合中的作用也获得了大量研 究[5]。

富血小板血浆是指血小板浓度高于正常基线水平的自体血液样本[6-7]。尽管与更常见的治疗方法如类固醇或麻醉剂相比，使用患者自身血液进行治疗是成功的，但血小板的制备和浓度却存在内在差异[6]。一般来说，富血小板血浆的制备包括从患者体内获得自体全血，然后通过一二步离心分离红细胞和白细胞[8]，分离过程中收集管的类型和离心速度对富血小板血浆制备过程中血小板和白细胞的最终浓度有影响[6，9](表1，图1)。在白细胞浓度方面存在2种类型：贫白细胞富血小板血浆和富白细胞富血小板血浆[6]。虽然白细胞在伤口愈合和促进组织修复中起重要作用，但其也有可能引起注射部位的不良炎症反应。遗憾的是，目前还没有足够的体内证据表明哪种制备方法是最理想的，但是了解获得和制备富血小板血浆的多种方法是必不可少的。