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Efficacy of Intraoperative Platelet-Rich Plasma Augmentation and Postoperative Platelet-Rich Plasma Booster Injection for Rotator Cuff Healing: A Randomized Controlled Clinical Trial
Liu B, Jeong HJ, Yeo JH, Oh JH
Orthopaedic journal of sports medicine. 2021;9(6):23259671211006100
Abstract
BACKGROUND Platelet-rich plasma (PRP) has been applied as an adjuvant treatment for arthroscopic rotator cuff repair (ARCR) to enhance rotator cuff healing. However, it remains debatable whether PRP enhances tendon-to-bone healing. PURPOSE To assess the efficacy of intraoperative augmentation and postoperative injection of PRP that was prepared using the double-spin method and calcium activation without thrombin in patients with ARCR. STUDY DESIGN Randomized controlled trial; Level of evidence, 1; and cohort study; Level of evidence, 3. METHODS A total of 58 patients underwent ARCR using intraoperative PRP augmentation. Half of the patients were randomly assigned to receive an additional ultrasound-guided PRP injection at the repair site at 2 weeks postoperatively (PRP-booster group); the other half did not receive the booster injection (PRP-only group). A control group that did not receive any PRP treatment was retrospectively matched using propensity score matching. Structural integrity was assessed using magnetic resonance imaging at 1 year postoperatively, and healing rates were compared between patients with tear sizes ≤2 cm versus >2 cm. Functional outcomes were assessed using the visual analog scale (VAS) for pain; VAS for satisfaction; shoulder range of motion; and Constant, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores at minimum 2-year follow-up. RESULTS In patients with tears >2 cm, the rate of healing failure at 1-year follow-up was significantly less in the overall PRP group than in the control group (12.9% vs 35.7%, respectively; P = .040), however, the PRP-booster group did not present a better healing rate than did the PRP-only group. The overall PRP group had lower VAS for pain scores compared with the control group (0.5 ± 1.1 vs 1.3 ± 1.8, respectively; P = .016) and higher VAS for satisfaction scores (9.2 ± 1.2 vs 8.6 ± 1.7; P = .023) at the final follow-up, whereas no statistical difference was found between the PRP-only and PRP-booster groups in functional outcomes. CONCLUSION Intraoperative PRP augmentation during ARCR demonstrated superior anatomic healing results in patients with rotator cuff tears >2 cm as well as reduced pain and increased subjective satisfaction. PRP booster injection provided no additional benefit to tendon integrity or functional recovery.
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2.
Assessment of Bone Formation After Secondary Alveolar Bone Grafting With and Without Platelet-Rich Plasma Using Computer-Aided Engineering Techniques
Chen S, Liu B, Yin N, Wang Y, Li H
The Journal of craniofacial surgery. 2020
Abstract
The aim of this study was to analyze the newly formed bone volume (FV), 6 months after secondary alveoloplasty using iliac cancellous bone graft, with and without platelet-rich plasma (PRP). Forty patients with unilateral alveolar cleft were involved in this randomized, prospective, comparative study, with 20 patients each forming the control (group A) and PRP (group B) groups, respectively. The preoperative alveolar defect volume (DV) and the postoperative FV were automatically calculated by the computer-aided engineering software using the patients' pre and postsurgical computed tomography data. The volume of the actual bone graft (AV) was identical to the DV calculated before surgery. The bone formation ratio (BF%) was calculated as follows: BF% = (FV/AV) x 100%. The mean BF% was 42.54 +/- 9.32% in group A and 46.97 +/- 18.49% in group B. There was no statistically significant difference between the 2 groups for BF% (P > 0.05). The study presents a fast and accurate method for assessing the effect of PRP in alveolar grafting. However, the study found no conclusive evidence on the effect of PRP on bone growth.
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3.
Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion
Yang Y, Zhang L, Liu B, Pang M, Xie P, Chen Z, Wu W, Feng F, Rong L
Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology. 2017;18((4):):395-400
Abstract
BACKGROUND Hidden haemorrhage has been proved to be significant in joint surgery. However, when referring to lumbar interbody fusion, it is often ignored because of its invisibility. This randomized controlled study aimed to calculate and compare hidden haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion (MIS-TLIF and open TLIF). Meanwhile, its clinical significance was also analyzed. MATERIALS AND METHODS A total of 41 patients were included in this study, then they were randomized to receive MIS-TLIF or open TLIF, 21 and 20, respectively. For each case, total volume loss of red blood cell (RBC) was calculated by Gross' formula based on perioperative haematocrit change, then perioperative visible volume loss of RBC was calculated through haemorrhage volume and weight. After deducting it from total volume loss of RBC, hidden volume loss of RBC was obtained. Absolute amount of hidden haemorrhage and its ratio upon total haemorrhage, as well as indicators assessing clinical outcomes, including visual analogue scale (VAS) for back and leg, Oswestry disability index (ODI), interbody fusion rate and complication incidence were compared and analyzed. RESULTS Mean hidden volume loss of RBC in MIS-TLIF was significantly reduced compared with open TLIF (166.7 versus 245.6 ml). Besides, both mean total and visible volume loss of RBC in MIS-TLIF were also statistically less than those in open TLIF (355.3 versus 538.6 ml; 188.6 versus 293.0 ml). While mean ratio of hidden haemorrhage upon total haemorrhage was 46.7% for MIS-TLIF and 44.5% for open TLIF, respectively, showing no statistical significance. At one week postoperatively, more significant improvements of VAS for back and leg, as well as ODI were seen in MIS-TLIF compared with open TLIF. While at final follow-up of at least 2 years, all parameters continued to improve and revealed no statistical difference between both surgeries. Similar interbody fusion rate and complication incidence were observed in both series. CONCLUSIONS Besides reduced visible haemorrhage and improved clinical outcomes, MIS-TLIF also owns the superiority of less hidden haemorrhage, offering another advantage over open TLIF. LEVEL OF EVIDENCE Level II.
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4.
Systematic review of transfusion strategies for cardiac surgery . Chinese
Wu Q, Zhou R, Liu B
Shengwu Yixue Gongchengxue Zazhi/Journal of Biomedical Engineering. 2014;31((2):):319-26.
Abstract
This paper is aimed to assess the effects of red blood cell (RBC) transfusion on clinical outcomes in cardiac surgery. Trials were identified by computer searches of the Pubmed, MEDLINE, Cochrane Library (Issue 10, 2012), from January 1980 to October 2012. References in identified trials and review articles were checked and experts contacted to identify any additional trials. The homogeneous randomized controlled trials (RCTs) were analyzed with RevMan 5.1 software. Five trials involving a total of 1,203 patients were identified. The results of meta-analyses showed that restrictive transfusion strategies reduced the risk of receiving a RBC transfusion (MD = - 1.46, 95% CI -1.18(-) -1.1) and the volume of RBCs transfusion (RR = 0.69, 95% CI 0.53-0.89). No significant difference was noted between the two strategies in terms of mortality, adverse events and hospital or intensive care length of stay. Based on the results mentioned above, one can draw a conclusion that restrictive transfusion strategies reduced the risk of receiving RBC transfusion and the volume of RBCs transfused. Restrictive transfusion strategies did not appear to impact on the rate of adverse events and hospital or intensive care length of stay, compared to liberal transfusion strategies.
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5.
Half-dose aprotinin does not affect haemorheological properties in patients undergoing bypass surgery
Liu B, Belboul A, Radberg G, Dernevik L, Liang Z, Berglin E, Roberts D
Coronary Artery Disease. 1996;7((8):):609-13.
Abstract
OBJECTIVE To investigate haemorheological changes in patients undergoing coronary artery bypass grafting and to determine whether the protective effect on haemorheology of high-dose aprotinin also exists under a half-dose regimen. METHODS Forty patients were studied in a double-blind, placebo-controlled study design. Patients in the aprotinin group received half of the standard high dose of aprotinin during surgery. Erythrocyte and white-cell clogging rates as well as whole blood and plasma viscosity were measured. Viscosity results were expressed as a ratio to the viscosity of saline. RESULTS Erythrocyte and white-cell clogging rates were increased significantly, whereas whole blood and plasma viscosity were decreased significantly during cardiopulmonary bypass. The reduction in viscosity had a strong correlation to haemodilution. There was no significant difference in any of the measured variables between the aprotinin and the placebo groups. CONCLUSION This study showed that blood cell damage occurred during cardiopulmonary bypass surgery, as measured by a raised clogging rate. This tendency was the same in both groups and therefore no increased potential for microthrombi could be attributed to aprotinin haemorheologically. However, half-dose aprotinin did not show any preserving effect in haemorheology when the blood-cell clogging rate and blood viscosity were studied.
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6.
Half-dose aprotinin preserves hemostatic function in patients undergoing bypass operations
Liu B, Tengborn L, Larson G, Radberg LO, Belboul A, Dernevik L, Roberts D
Annals of Thoracic Surgery. 1995;59((6):):1534-40.
Abstract
High-dose aprotinin reduces bleeding in cardiac operations but with potential side-effects and increased cost. It is therefore mandatory that the effectiveness of a low dose be investigated. Half of the Hammersmith regimen was studied in cardiac surgical patients to find out how it could reduce bleeding. Blood fibrinolysis parameters were studied in 40 elective patients undergoing coronary artery bypass grafting in a double-blind, placebo-controlled study design. The plasma activities of tissue plasminogen activator, plasminogen activator inhibitor, alpha 2-antiplasmin, plasminogen, fibrinogen, and D-dimer as well as platelet number, bleeding times, activated clotting time, and aprotinin plasma concentrations were assessed before, during, and after the operation. Fibrinolysis was inhibited by aprotinin as evidenced by decreased D-dimer (p = 0.0001) and tissue plasminogen activator (p = 0.0432) levels and increased plasminogen activator inhibitor (p = 0.0105) and alpha 2-antiplasmin (p = 0.0002) levels during the operation. A postoperative abnormal bleeding time occurred 38% more frequently in the placebo group (p < 0.05). Aprotinin plasma concentrations reached adequate levels to inhibit plasmin and plasma kallikrein. This study showed that half-dose aprotinin significantly inhibits fibrinolysis and prevents postoperative abnormal bleeding time in cardiac surgical patients.
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7.
Effect of reduced aprotinin dosage on blood loss and use of blood products in patients undergoing cardiopulmonary bypass
Liu B, Belboul A, Radberg G, Tengborn L, Dernevik L, Roberts D, William-Olsson G
Scandinavian Journal of Thoracic & Cardiovascular Surgery. 1993;27((3-4):):149-55.
Abstract
High-dose aprotinin reduces bleeding after cardiac surgery, but has also evoked concern with regard to potential side effects and hospital costs. To evaluate the effects of reduced-dose aprotinin on blood loss and need for blood transfusion, 40 patients undergoing myocardial revascularization were studied (double-blind, placebo-controlled). Postoperative bleeding was reduced by 40% and erythrocyte infusion by 85% in the group given 3 x 10(6) KIU aprotinin (1 x 10(6) as a loading dose before cardiopulmonary bypass, 1 x 10(6) in the priming volume and 2.5 x 10(5)/hour intraoperatively) Aprotinin concentrations during the operation were monitored and maintained above the required level. There were no adverse effects of the drug. Hospital expenditure on blood products was reduced by 51% when aprotinin was used. Our study suggests that aprotinin in reduced dosage diminishes bleeding and requirements for blood products, and that it should be given before, during and after cardiopulmonary bypass.