基质诱导自体软骨细胞移植治疗股骨滑车软骨损伤

发布时间：2018-04-30 20:14

本文选题：基质诱导自体软骨细胞移植 + 膝关节　；参考：《中国修复重建外科杂志》2017年01期

【摘要】：目的评价基质诱导自体软骨细胞移植(matrix-induced autologous chondrocyte implantation,MACI)治疗股骨滑车软骨损伤的方法及短期疗效。方法 2012年6月—2014年10月采用MACI治疗大面积股骨滑车软骨损伤10例,其中男6例,女4例;年龄15~48岁,平均33岁。左膝3例,右膝7例。9例有明确外伤史,1例为剥脱性骨软骨炎。术前合并半月板损伤1例、前交叉韧带损伤3例及内、外侧副韧带部分撕裂2例。术前病灶深度为2~7 mm、平均2.80 mm,病灶面积28.26~153.86 mm2、平均84.85 mm2。明确诊断至关节镜手术活检时间5 d~3个月,平均14 d。于关节镜下活检,采集患膝股骨滑车非负重区200~300 mg健康关节软骨作为种子细胞来源,用于分离、培养并制备MACI膜,并评价人软骨细胞在Bio-gide胶原支架上的黏附和生长状态。另外,测试支架的扯断拉长率、拉伸强度、缝合强度。2周~6个月后行MACI膜手术移植。于术前及末次随访时采用疼痛视觉模拟评分(VAS)、Lysholm评分及膝关节运动Tegner评分评价功能。结果患者MACI膜均成功制备,人软骨细胞在Bio-gide胶原支架上黏附、生长良好。力学测试示支架扯断拉长率为65.27%,拉伸强度为26.81 MPa,缝合强度为6.49 N,提示支架力学性能良好。患者MACI膜移植手术均获成功,手术时间43~99 min,平均58.5 min;住院时间6~15 d,平均7 d。术后切口均Ⅰ期愈合。10例均获随访,随访时间9~16个月,平均12个月。其中4例因受区清创后骨缺损较大予以髂骨取骨植骨术。所有移植的MACI膜与受区愈合时间为12~16周,平均14周。随访期间无软骨剥脱、膝关节疼痛、神经血管损伤、深静脉栓塞形成及膝关节粘连等并发症发生。末次随访时VAS评分、Lysholm评分及Tegner评分均较术前显著改善,比较差异均有统计学意义(t=12.060,P=0.000;t= 9.200,P=0.000;t= 14.000,P=0.000)。结论 MACI治疗股骨滑车软骨损伤近期疗效好、创伤较小、恢复较快,是一种安全可靠的治疗方法。
[Abstract]:Objective to evaluate the short-term effect of matrix-induced autologous chondrocyte implication-MACII in the treatment of femur trochlear cartilage injury by matrix induced autologous chondrocyte transplantation. Methods from June 2012 to October 2014, 10 cases of massive femoral trochlear cartilage injury were treated with MACI, including 6 males and 4 females, aged 1548 years (mean 33 years). There were 3 cases of left knee and 7 cases of right knee. There were 1 case with meniscus injury, 3 cases with anterior cruciate ligament injury and 2 cases with partial laceration of lateral collateral ligament. The preoperative depth of lesion was 2.80 mm (mean 2.80 mm), and the lesion area was 28.26 卤153.86 mm (mean 84.85 mm 2). The time from definite diagnosis to arthroscopic biopsy was 5 days to 3 months, with an average of 14 days. The healthy articular chondrocytes were collected from the non-weight-bearing region of the femoral trochlear under arthroscopy as seed cells to isolate, culture and prepare MACI membrane, and to evaluate the adhesion and growth of human chondrocytes on the Bio-gide collagen scaffold. In addition, the elongation rate, tensile strength and suture strength of the stent were measured. MACI membrane transplantation was performed after 2 weeks ~ 6 months. The pain visual analogue score (VAS) and the Tegner score of knee motion were used to evaluate the function of the patients before and after the last follow-up. Results all MACI membranes were successfully prepared and human chondrocytes adhered to Bio-gide collagen scaffold and grew well. The tensile strength, tensile strength and suture strength were 65.27, 26.81 MPA and 6.49 N respectively, which indicated that the mechanical properties of the scaffolds were good. The operation time of MACI membrane transplantation was 4399 min (mean 58.5 min) and hospital stay was 615 d (mean 7 d). All the patients were followed up for 9 ~ 16 months (mean 12 months). Among them, 4 cases were treated with iliac bone grafting because of debridement. The healing time of all transplanted MACI membrane and recipient area was 12 ~ 16 weeks (mean 14 weeks). There were no complications such as cartilage peeling, knee joint pain, nerve and vascular injury, deep vein embolization and knee joint adhesion. At the last follow-up, the VAS score, Lysholm score and Tegner score were significantly improved compared with those before operation, and the differences were statistically significant. Conclusion MACI is a safe and reliable method for the treatment of femoral trochlear cartilage injury.
【作者单位】：广西中医药大学第一附属医院骨二科;上海光华中西医结合医院创伤外科;上海中医药大学附属龙华医院骨伤科;上海中医药大学脊柱病研究所;
【基金】：上海市卫生和计划生育委员会课题资助项目(201540250)~~
【分类号】：R687.3

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