Siyatik sinir kesi modelinde Eritropoetin ile TZP (Trombositten zengin plazma)'nın rejenerasyon üzerine etkisinin karşılaştırılması
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Tarih
2011
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Kaza, kitle basısı, ameliyat vb nedenlerle hasarlanan periferik sinirlerde meydana gelen fonksiyon kaybının geriye dönmesi oldukça uzun zaman almakta bazen de hiç dönmemektedir. Yaralanma sonrası hastaların bırakın eski yaşam konforuna dönmesini, çoğu zaman hastanın hayat kalitesi oldukça azalmaktadır. Çeşitli çalışmalarda Eritropoetin (EPO) ve Trombositten Zengin Plazma (TZP)'nın sinir iyileşmesi üzerinde olumlu etkileri bildirilmiştir. Bu çalışmada EPO ve TZP'nın, sinir iyileşmesi üzerindeki etkilerini, gerçeğe daha yakın değerlendirme testlerinden olan izole sinir üzerinde çalışılarak karşılaştırılması amaçlandı.Gereç ve yöntem: İkinci ve dördüncü ayda elektrofizyolojik ve histopatolojik değerlendirmeler yapılmak üzere 60 adet dişi Wistar albino sıçan 4 gruba ayrıldı. İlk grup kontrol grubuydu ve hiçbir işlem yapılmayan siyatik sinirlerinden oluşturuldu. İkinci grupta (Kesi grubu) kontrol grubu sıçanlarının sol siyatik siniri kesildikten sonra sadece dikildi. Üçüncü grupta (EPO grubu), siyatik sinir kesilerek dikildikten sonra intraperitoneal EPO uygulandı. Dördüncü grupta (TZP grubu), sinir kesildikten sonra dikildi ve üzerine Anitua'nın tariflediği yöntemle TZP uygulandı. Sıçanlar derin anestezi altındayken elektrofizyolojik değerlendirme amacıyla lomber pleksusla tibia distali arasında diseke edilip izole edilen sinir üzerinde elektriksel aktivite ölçümü yapıldı. Sonrasında %10'luk formole konan sinirler enine kesitlerde Hematoksilen-Eozinle boyanarak, birim kesit alandan miyelinli-miyelinsiz sinir lifleri sayımı yapıldı. Ayrıca Toluidine Blue boyası ile demonstre edildi.Bulgular: Histopatolojik olarak 2 ve 4. ayda EPO grubu Kesi grubuna göre anlamlı olarak daha iyi bulundu. Kesi ile TZP grubu arasında fark anlamlı bulunmazken, kontrol grubu ile tüm deney grupları arasındaki fark anlamlı bulundu. Elektrofizyolojik ölçümlerde EPO grubunda tüm sıçanlarda (%100) kesi bölgesinden distale iletim alınabildi. TZP grubunda % 85.7-%75 sıçanda distale iletim tespit edilebilirken, Kesi grubunda % 71.4-% 80 oranında sıçanda iletim elde edildi. Fakat iletim kalitesini gösteren verilerde kontrol grubu ile tüm deney grupları arasında fark anlamlı iken deney gruplarının kendi arasında anlamlı fark tespit edilemedi.Tartışma-sonuç: Sinir fonksiyonları hakkında gerçeğe daha yakın bilgiler veren izole sinir tekniği ile yapılan çalışmamızda, EPO ve TZP'nın Kesi grubuna göre iyileşme üzerinde belirgin üstünlüğünün olmadığı bulundu. Özellikle TZP uygulamasının primer onarımla kıyaslanınca herhangi bir fayda sağlamadığı kanısındayız. Ayrıca histopatolojik olarak EPO gurubunun sonuçlarının daha iyi olması, tüm deneklerde distalden iletim alınabilmesi ama iletim kalitesinin iyi olmaması nedeniyle EPO üzerinde daha detaylı araştırmalar yapmak gerektiğini düşünmekteyiz. Sonuç olarak sinir yaralanması sonrasında en önemli ve en iyi tedavi yönteminin deneyimli bir cerrah tarafından yapılacak itinalı ve özenli bir cerrahi olduğu kanısındayız.Anahtar kelimeler: Eritropoetin, trombositten zengin plazma, sinir yaralanması, izole sinirde elektrofizyolojik çalışma, iletim hızı dağılımı
Peripheral nevre injury that occur due to accident, mass compression, surgery etc., loss of nerve function after injury, it takes quite time to heal or sometimes never return. Let us return to the comfort of the old life of patients after injury, quite often decreases the patient's quality of life. Several studies, erythropoietin (EPO) and Platelet Rich Plasma (PRP) of the reported positive effects on nerve healing. In this study, compare the effect of the PRP and EPO on nerve healing closer to the truth by working on isolated nerve to use evaluation testing.Material and methods: Electrophysiological and histopathological assessments to be made at the second and fourth month of 60 female Wistar albino rats were divided into 4 groups. The first group was the control group and the sciatic nerves was created without any action. In the second group (Cut group), left sciatic nerve of control group rats was only repaired after cut off. The third group (EPO group), the sciatic nerve were cut and intraperitoneal injection of EPO performed after the repair. The fourth group (PRP group), the nerve is cut off and repaired and PRP was performed with the method of described by Anitua. The rats under deep anesthesia electrical activity was measured for electrophysiological evaluation of the sciatic nerve was disected and isolated between lumbar plexus and distal tibia. Then put in 10% formalin nerves cross sections stained with Hematoxylin - Eosin and unit cross-sectional area were counted in myelinated-unmyelinated nerve fibers. Toluidine Blue staining was also demonstrated.Findings: At 2 and 4 months EPO group was significantly better than in the incision group histopathologically. There was no significant difference between the cut with the PRP group, and found no significant difference between the control group and all experimental groups. Electrophysiological measurements in all rats into the EPO group (100%) the transmission are taken to distal from incision site. PRP-group, identified distal transmission in 85.7%- 75% of the rats, 71.4%- 80% transmission was obtained in rats of cut group. But showing the data transmission quality was significant between all experimental groups and the control group but in the experimental groups, no significant difference could not be determined between them.Discussion-conclusion: In the study found that the providing information closer to reality about the functions of the nerve with the technique of isolated nerve, the EPO and PRP was not significant improvement on healing according to the cut group. Particularly we believe that the application of PRP does not provide any benefit compared to primary repair. In addition, the EPO group was histopathologically to have better outcomes, and taken distal conduction of all subjects but not good quality transmission more detailed research on the need to consider. Our opinion after the nerve injury as a result of the most important and best method of treatment by an experienced surgeon, a surgical that careful and attentive.Key Words: erythropoietin, Platelet Rich Plasma, nerve injury, electrophysiological working on isolated nevre, Conduction velocity distribution
Peripheral nevre injury that occur due to accident, mass compression, surgery etc., loss of nerve function after injury, it takes quite time to heal or sometimes never return. Let us return to the comfort of the old life of patients after injury, quite often decreases the patient's quality of life. Several studies, erythropoietin (EPO) and Platelet Rich Plasma (PRP) of the reported positive effects on nerve healing. In this study, compare the effect of the PRP and EPO on nerve healing closer to the truth by working on isolated nerve to use evaluation testing.Material and methods: Electrophysiological and histopathological assessments to be made at the second and fourth month of 60 female Wistar albino rats were divided into 4 groups. The first group was the control group and the sciatic nerves was created without any action. In the second group (Cut group), left sciatic nerve of control group rats was only repaired after cut off. The third group (EPO group), the sciatic nerve were cut and intraperitoneal injection of EPO performed after the repair. The fourth group (PRP group), the nerve is cut off and repaired and PRP was performed with the method of described by Anitua. The rats under deep anesthesia electrical activity was measured for electrophysiological evaluation of the sciatic nerve was disected and isolated between lumbar plexus and distal tibia. Then put in 10% formalin nerves cross sections stained with Hematoxylin - Eosin and unit cross-sectional area were counted in myelinated-unmyelinated nerve fibers. Toluidine Blue staining was also demonstrated.Findings: At 2 and 4 months EPO group was significantly better than in the incision group histopathologically. There was no significant difference between the cut with the PRP group, and found no significant difference between the control group and all experimental groups. Electrophysiological measurements in all rats into the EPO group (100%) the transmission are taken to distal from incision site. PRP-group, identified distal transmission in 85.7%- 75% of the rats, 71.4%- 80% transmission was obtained in rats of cut group. But showing the data transmission quality was significant between all experimental groups and the control group but in the experimental groups, no significant difference could not be determined between them.Discussion-conclusion: In the study found that the providing information closer to reality about the functions of the nerve with the technique of isolated nerve, the EPO and PRP was not significant improvement on healing according to the cut group. Particularly we believe that the application of PRP does not provide any benefit compared to primary repair. In addition, the EPO group was histopathologically to have better outcomes, and taken distal conduction of all subjects but not good quality transmission more detailed research on the need to consider. Our opinion after the nerve injury as a result of the most important and best method of treatment by an experienced surgeon, a surgical that careful and attentive.Key Words: erythropoietin, Platelet Rich Plasma, nerve injury, electrophysiological working on isolated nevre, Conduction velocity distribution
Açıklama
Anahtar Kelimeler
Elektrofizyoloji, Electrophysiology, Eritropoietin, Erythropoietin, Kan trombositleri, Blood platelets
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Göncü, R. G. (2011). Siyatik sinir kesi modelinde Eritropoetin ile TZP (Trombositten zengin plazma)'nın rejenerasyon üzerine etkisinin karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Ortopedi ve Travmatoloji Anabilim Dalı, Konya.
