Ferhat Say, Deniz Gurler, Erkan Inkaya, Murat Bulbul

Plantar fasiit tedavisinde trombositten zengin plazma ve steroid enjeksiyonunun karşılaştırması

Amaç: Bu çalışmada plantar fasiit tanısı konulan hastalarda trombositten zengin plazma (TZP) ve steroid enjeksiyonunun etkilerinin karşılaştırılması amaçlanmaktadır.Çalışma planı: Kronik plantar fasiit tanısı konan 50 hasta 2 gruba ayrıldı. TZP grubundaki hastaların (n=25) kanlarından hazırlanan TZP kalsiyum klorür ile aktive edilerek, tek doz enjeksiyon uygulandı. Steroid grubundaki hastalara (n=25), tek doz metilprednizolon lokal anestezik ile beraber uygulandı. Klinik değerlendirmede Amerikan Ayak ve Ayak Bileği Skoru (AAAS) ve görsel ağrı skalası (GAS) kullanıldı.Bulgular: Hastaların hiçbirinde komplikasyon görülmedi. TZP grubunda 6. hafta ortalama AAAS skoru 85.5±4.2 ve 6. ay skoru 90.6±2.6; steroid grubunda ise, sırasıyla, 75.3±4.8 ve 80.3±4.7 bulundu (p<0.001). Altıncı hafta ve 6. ay sonunda TZP grubunun ortalama GAS skoru (2.4±0.8 ve 1±0.8) steroid grubundan (4±1.1 ve 2.6±0.9) istatistiksel olarak anlamlı derecede farklı idi (p<0.001). TZP grubunun AAAS ve GAS skorlarındaki değişimin steroid grubuna kıyasla anlamlı şekilde yüksek olduğu kaydedildi (p<0.001).Çıkarımlar: Kronik plantar fasiit tedavisinde TZP uygulaması steroid enjeksiyonuna göre ağrı ve fonksiyonel sonuçlar üzerinde daha etkili bir yöntemdir.

Anahtar Kelimeler:

Büyüme faktörü; plantar fasiit; steroid; trombositten zengin plazma.

Comparison of platelet-rich plasma and steroid injection in the treatment of plantar fasciitis

Objective: The aim of this study was to compare the effects of platelet-rich plasma (PRP) and steroid injections in patients diagnosed with plantar fasciitis.Methods: A total of 50 patients with chronic plantar fasciitis were included in the study and divided into 2 groups. In the PRP group (n=25), PRP taken from the patients’ blood was activated using calcium chloride and injected in a single dose. In the steroid group (n=25), a single dose methylprednisolone with local anesthetic injection was given. Clinical evaluation was made using the American Foot and Ankle Score (AFAS) and the visual analog scale (VAS).Results: No complications were seen in any patients. Mean AFAS was 85.5±4.2 at 6 weeks and 90.6±2.6 at 6 months in the PRP group and 75.3±4.8 and 80.3±4.7, respectively, in the steroid group (p<0.001). The difference in the mean VAS between the PRP group (2.4±0.8 and 1±0.8) and the steroid group (4±1.1 and 2.6±0.9) at the 6th week and 6th month was statistically significant (p<0.001). Changes in AFAS and VAS scores were significantly higher in the PRP group (p<0.001).Conclusion: The application of PRP appears to be more effective than steroid injection in terms of pain and functional results in the treatment of chronic plantar fasciitis.

Keywords:

Growth factor, plantar fasciitis, platelet-rich plasma steroid,

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League AC. Current concepts review: plantar fasciitis. Foot Ankle Int 2008;29:358-66. CrossRef
Crawford F, Thomson C. Interventions for treat- ing plantar heel pain. Cochrane Database Syst Rev 2010;1:CD000416.
Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am 2003;85-A:872-7.
Scher DL, Belmont PJ Jr, Bear R, Mountcastle SB, Orr JD, Owens BD. The incidence of plantar fasciitis in the United States military. J Bone Joint Surg Am 2009;91:2867-72.
Jarde O, Diebold P, Havet E, Boulu G, Vernois J. Degen- erative lesions of the plantar fascia: surgical treatment by fasciectomy and excision of the heel spur. A report on 38 cases. Acta Orthop Belg 2003;69:267-74.
Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a de- generative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003;93:234-7. CrossRef
Healey K, Chen K. Plantar fasciitis: current diagnos- tic modalities and treatments. Clin Podiatr Med Surg 2010;27:369-80. CrossRef
Davis PF, Severud E, Baxter DE. Painful heel syn- drome: results of nonoperative treatment. Foot Ankle Int 1994;15:531-5. CrossRef
Gill LH, Kiebzak GM. Outcome of nonsurgical treatment for plantar fasciitis. Foot Ankle Int 1996;17:527-32. CrossRef
Sánchez M, Anitua E, Orive G, Mujika I, Andia I. Plate- let-rich therapies in the treatment of orthopaedic sport injuries. Sports Med 2009;39:345-54. CrossRef
Barrett SL, Erredge SE. Growth factors for chronic plan- tar fasciitis? Podiatry Today 2004;17:36-42.
Akşahin E, Doğruyol D, Yüksel HY, Hapa O, Doğan O, Celebi L, et al. The comparison of the effect of cortico- steroids and platelet-rich plasma (PRP) for the treat- ment of plantar fasciitis. Arch Orthop Trauma Surg 2012;132:781-5. CrossRef
Ragab EM, Othman AM. Platelets rich plasma for treat- ment of chronic plantar fasciitis. Arch Orthop Trauma Surg 2012;132:1065-70. CrossRef
Martinelli N, Marinozzi A, Carnì S, Trovato U, Bianchi A, Denaro V. Platelet-rich plasma injections for chronic plantar fasciitis. Int Orthop 2013;37:839-42. CrossRef
de Vos RJ, van Veldhoven PL, Moen MH, Weir A, Tol JL, Maffulli N. Autologous growth factor injections in chronic tendinopathy: a systematic review. Br Med Bull 2010;95:63-77. CrossRef
Castillo TN, Pouliot MA, Kim HJ, Dragoo JL. Com- parison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems. Am J Sports Med 2011;39:266-71. CrossRef
Anitua E. Plasma rich in growth factors: preliminary re- sults of use in the preparation of future sites for implants. Int J Oral Maxillofac Implants 1999;14:529-35.
Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Au- tologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 2004;91:4-15.
Maffulli N, Del Buono A. Platelet plasma rich products in musculoskeletal medicine: any evidence? Surgeon 2012;10:148-50. CrossRef
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myer- son MS, Sanders M. Clinical rating systems for the ankle- hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349-53. CrossRef
Crawford F, Atkins D, Young P, Edwards J. Steroid injec- tion for heel pain: evidence of short-term effectiveness. A randomized controlled trial. Rheumatology (Oxford) 1999;38:974-7. CrossRef
Acevedo JI, Beskin JL. Complications of plantar fascia rupture associated with corticosteroid injection. Foot An- kle Int 1998;19:91-7. CrossRef
Buccilli TA Jr, Hall HR, Solmen JD. Sterile abscess forma- tion following a corticosteroid injection for the treatment of plantar fasciitis. J Foot Ankle Surg 2005;44:466-8. CrossRef
Gidumal R, Evanski P. Calcaneal osteomyelitis following steroid injection: a case report. Foot Ankle 1985;6:44-6.
Lucarelli E, Beccheroni A, Donati D, Sangiorgi L, Cenac- chi A, Del Vento AM, et al. Platelet-derived growth fac- tors enhance proliferation of human stromal stem cells. Biomaterials 2003;24:3095-100. CrossRef
Kajikawa Y, Morihara T, Sakamoto H, Matsuda K, Os- hima Y, Yoshida A, et al. Platelet-rich plasma enhances the initial mobilization of circulation-derived cells for tendon healing. J Cell Physiol 2008;215:837-45. CrossRef
Alsousou J, Thompson M, Hulley P, Noble A, Willett K. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. J Bone Joint Surg Br 2009;91:987-96. CrossRef
Mishra A, Woodall J Jr, Vieira A. Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med 2009;28:113-25. CrossRef
Baksh N, Hannon CP, Murawski CD, Smyth NA, Ken- nedy JG. Platelet-rich plasma in tendon models: a sys- tematic review of basic science literature. Arthroscopy 2013;29:596-607. CrossRef
Andia I, Sánchez M, Maffulli N. Joint pathology and platelet-rich plasma therapies. Expert Opin Biol Ther 2012;12:7-22. CrossRef
Graziani F, Ivanovski S, Cei S, Ducci F, Tonetti M, Gabri- ele M. The in vitro effect of different PRP concentrations on osteoblasts and fibroblasts. Clin Oral Implants Res 2006;17:212-9. CrossRef
Pietrzak WS, Eppley BL. Platelet rich plasma: biology and new technology. J Craniofac Surg 2005;16:1043-54.
Ferrari M, Zia S, Valbonesi M, Henriquet F, Venere G, Spagnolo S, et al. A new technique for hemodilution, preparation of autologous platelet-rich plasma and intra- operative blood salvage in cardiac surgery. Int J Artif Or- gans 1987;10:47-50.
Mei-Dan O, Mann G, Maffulli N. Platelet-rich plasma: any substance into it? Br J Sports Med 2010;44:618-9.