Evaluasi Radiologis - PENGARUH PEMBERIAN PLATELET RICH FIBRIN

Evaluasi radiologis untuk penilaian bone healing pada kasus fraktur femur yang ditatalaksana dengan ORIF, menggunakan skoring Goldberg et al.: 1. no fracture healing; 2. Moderate healing; and 3. Complete healing.

28 E. Evaluasi Histopatologis

Evaluasi histologis menggunakan skoring oleh Huo et al.:

Tabel 3. Skoring untuk evaluasi histopatologis pada proses fracture healing.

Skor Gambaran histopatologis 1 Jaringan fibrous

2 Dominan jaringan fibrous dengan sedikit jaringan kartilago 3 Jumlah jaringan fibrous sama dengan jaringan kartilago

4 Dominan jaringan kartilago dengan sedikit gambaran jaringan fibrous 5 Kartilago

6 Dominan jaringan kartilago dengan sedikit gambaran tulang immature 7 Jumlah jaringan kartilago sama dengan jaringan tulang immature 8 Dominan gambaran tulang immature daripada kartilago

9 Union fraktur dengan gambaran tulang immature 10 Union fraktur dengan gambaran tulang matur

29 F. Kerangka Konsep

Gambar 12. Kerangka Konsep stem cells and connective tissue cells (fibroblast

 Formasi jaringan konektif dan kalus

Keterangan:

: Variabel yang diteliti : Hasil yang diharapkan

30 G. Hipotesis

H1: Pemberian platelet rich fibrin dapat meningkatkan sekresi growth factor dan mempengaruhi proses terjadinya bone healing pada fraktur diafisis femur tikus (Rattus norvegicus) yang difiksasi dengan intramedullary nail.

H0: Pemberian platelet rich fibrin tidak dapat meningkatkan sekresi growth factor dan mempengaruhi proses terjadinya bone healing pada fraktur diafisis femur tikus (Rattus norvegicus) yang difiksasi dengan intramedullary nail.

31 BAB III

METODOLOGI PENELITIAN

A. Jenis Penelitian

Penelitian ini menggunakan desain penelitian eksperimental post-test only control group design dengan tikus Wistar rats (Rattus norvegicus) sebagai hewan percobaan karena pengukuran pada hewan uji dilakukan pada waktu tertentu setelah pemberian perlakuan. Dalam penelitian ini sampel dibagi dua kelompok, dimana terdapat kelompok yang diberikan platelet rich fibrin dan kelompok satunya yaitu kelompok kontrol yang tidak diberikan apa-apa.

B. Lokasi Penelitian

Perlakuan pada tikus Wistar rats dan pemeriksaan sampel dilakukan di Laboratorium Hewan Coba Pusat Antar Universitas Universitas Gajah Mada Yogyakarta, sedangkan pemeriksaan radiologi dilakukan di Laboratorium Radiologi Universitas Gajah Mada.

C. Waktu Penelitian

Waktu penelitian ini dilakukan pada bulan November 2021 - Desember 2021.

Tahap pengolahan, analisis, dan pelaporan data dilakukan pada bulan Januari - Februari 2022.

D. Populasi dan Sampling 3.3.1 Populasi Penelitian

Subjek penelitian adalah tikus Wistar rats model bone graft umur 12 - 14 minggu, jenis kelamin jantan, dengan rentang berat badan 450 – 600 gram,

32 diperoleh dari Laboratorium Hewan Coba Pusat Antar Universitas Universitas Gajah Mada Yogyakarta.

1. Kriteria inklusi:

a. Jenis Tikus: Wistar rats b. Umur 12 - 14 minggu.

c. Berat badan 450 - 600 gram.

d. Jenis Kelamin: Jantan 2. Kriteria eksklusi:

a. Tikus Wistar rats yang mati saat penelitian.

b. Tikus dengan kondisi sakit.

3.3.2 Jumlah Sampel

Jumlah replikasi ditentukan berdasarkan rumus Resource Equation :

E adalah Degree of freedom (derajat kebebasan). Angka “E” dianggap optimal jika dalam rentang 10 hingga 20 (Charan dan Biswas, 2013).

E = 4n – 4 (optimal bila E 10-20) (E : Degree of freedom)

Jika E = 10 10 = 4.n – 4 4n = 14 E = 3,5

Jika E = 20 20 = 4.n – 4

33 4n = 24

E = 6

E dalam rentang 10 dan 20, maka hewan coba tiap kelompok berkisar antara 4 hingga 6 ekor. Dipilih 4 ekor hewan coba tiap kelompok.

E. Variabel dan Definisi Operasional Penelitian 3.E.1 Variable penelitian

a. Variabel Bebas: pemberian PRF pada fraktur tulang panjang tikus Wistar rats

b. Variabel terikat: Variabel yang akan diteliti, yaitu Callus formation pada area fraktur

3.E.2 Definisi operasional variabel a. Pemberian PRF

Platelet rich fibrin (PRF) merupakan konsentrat platelet yang di peroleh dari proses sentrifugasi sampel pungsi darah vena tanpa penambahan antikoagulan. Darah diambil dari 2 sampel tikus sebanyak 10 mm kemudian disentrifugasi dengan kecepatan 3000 rpm selama 10 menit.

Ketika proses sentrifugasi, femomena hemostasis membagi sampel darah menjadi bagian-bagian, yang salah satu bagian tersebut merupakan PRF, sebuah lapisan fibrin yang terdiri dari trombosit dan plasma (Kim et al., 2014). Pembuatan PRF dilakukan Laboratorium Hewan Coba Pusat Antar Universitas Universitas Gajah Mada Yogyakarta.

b. Pemeriksaan Radiologis

34 Pemeriksaan radiographic AP dilakukan setelah 4 minggu setelah perlakuan tindakan. Kemudian dinilai berupa bridging callus formation dan fracture line. Skoring berdasarkan Goldberg et al.

c. Pemeriksaaan histopatologis

Pemeriksaan dilakukan dengan menilai gambaran histopatologis pada area fraktur melalui pengecatan hematoxylin eosin. Skoring berdasarkan Huo et al.

F. Cara Kerja dan Teknik Pengambilan Data 1.1 Tahap Persiapan

a. Persiapan Alat dan Bahan 1) Membuat ethical clearance 2) Persiapan hewan percobaan

b. Pembuatan PRF

1) Penggunaan anestesi umum sebelum pengambilan darah dari jantung sebanyak 10 ml dari 2 ekor hewan (Bölükbaşi et al., 2013)

2) Darah dikumpulkan di sterile glass test tubes 10 ml tanpa penambahan antikoagulan (menyebabkan aktivasi platelet di sample darah setelah kontak dengan dinding tube dalam beberapa menit dan pelepasan kaskade koagulasi) 3) Langsung disentrifugasi 3000 rpm selama 10 menit

4) Hasil berupa pemisahan tiga fraksi akibat perbedaan fraksi: RBCs dilapisan bawah, PRF di lapisan tengah, dan PPP (platelet-poor plasma) dilapisan atas.

PPP diaspirasi dan dibuang

35 5) Gel PRF dipisahkan dari lapisan RBCs dibawahnya menggunakan sterile

stainlesssteel scissors

6) Bekuan PRF dipotong kecil-kecil dan dicampur dengan material graft atau dengan membrane PRF yang dipersiapkan dengan menekan PRF clot diantara dua potong kain kasa bedah untuk membuang serum.

(Rosamma Joseph et al., 2014) 1.2 Tahap Penelitian

Tikus dibagi scara random menjadi 2 kelompok yaitu kelompok perlakuan dan kelompok kontrol. Tikus dipersiapkan pada ruang operasi, kemudian sterilisasi medan operasi. Insisi dilakukan pada regio paha kiri tikus sebesar 2 cm pada sisi lateral. Fraktur femur dibuat dengan menggunakan oscillator saw. Kemudian difiksasi dengan menggunakan k wire 0,8. pada kelompok perlakuan diberikan PRF. Kemudian luka insisi ditutup dengan menggunakan 4.0 non absorbable suture.

1.3 Tahap Pengambilan Sampel

Kelompok hewan coba, dibagi menjadi 4. Dua kelompok diterminasi pada hari ke 14 dan dua kelompok lain diterminasi pada hari ke 28. Tulang femur diambil, kemudian dilakukan pemeriksaan roentgen femur AP dan lateral dan pemeriksaan histopatologi.

G. Analisis Data

Pada penelitian ini, data yang diperoleh dianalisis secara statistik menggunakan program Statistical Product and Service Solutions (SPSS) for Microsoft Windows release 25.0. Jumlah sampel penelitian kurang dari 50

36 sampel maka digunakan uji distribusi Shapiro-Wilk untuk menentukan distribusi data. Uji statistik yang digunakan uji independent T-Test untuk membandingkan atau komparasi 2 kelompok sampel tidak berpasangan berdistribusi normal. (Dahlan, 2011).

37 H. Alur Penelitian

Bagan 2. Alur Penelitian

Kelompok P1 dan P3 diterminasi dan dilakukan pengambilan roentgen femur AP pada hari ke 14, pada area fraktur dilakukan pengambilan sampel untuk penilaian gambaran histopatologis.

Kelompok P2 dan P4 diterminasi dan dilakukan pengambilan roentgen femur AP pada hari ke 28, pada area fraktur dilakukan pengambilan sampel untuk penilaian gambaran histopatologis

Hasil penilaian radiologis dan histopatologis dianalisis dengan uji statistik Populasi Tikus Wistar Rats

Sampel 16 tikus, umur 12-14 minggu, BB 450 - 600 gram Adaptasi 1 minggu

Dibagi secara acak menjadi 4 kelompok

P3 4 tikus P2 4 tikus

Pembuatan Fraktur Femur

Fraktur kemudian difiksasi dengan menggunakan k-wire 0,8

Kelompok P1dan P2 tidak diberikan

apa-apa

Kelompok P3 dan P4 diberikan platelet rich

fibrin

P1 4 tikus P4 4 tikus

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Dalam dokumen PENGARUH PEMBERIAN PLATELET RICH FIBRIN (Halaman 33-0)