自体软骨细胞联合Ⅰ型胶原治疗剥脱性膝骨软骨炎

目的探讨自体软骨细胞联合Ⅰ型胶原蛋白三维支架治疗膝关节剥脱性骨软骨炎的疗效。 方法选取近5年来在青岛市黄岛区中心医院采用自体软骨细胞联合Ⅰ型胶原蛋白三维支架治疗膝关节剥脱性骨软骨炎的患者12例,用单因素方差分析评估术前与术后6个月、12个月国际膝关节文献委员会(IKDC)膝关节评估表、Lysholm膝关节功能评分。术后12个月磁共振成像(MRI)评估软骨修复情况。 结果12例患者术后6个月、12个月的IKDC评分分别为(83.7±5.6)、(91.7±3.7),Lysholm评分分别为(87.5±5.2)、(93.6±2.1),均较术前IKDC评分(53.9±6.7)(F＝158.877)、Lysholm评分(59.1±7.2)(F＝104.258)明显改善(均为P<0.05);每2个时间点之间的IKDC评分、Lysholm评分,差异均具有统计学意义(P<0.05)。术后12个月MRI检查显示,所有患者的移植软骨恢复良好,均未出现移植物脱落或局部水肿。术后随访期内,所有患者均未出现膝关节感染。 结论自体软骨细胞联合Ⅰ型胶原蛋白三维支架能有效治疗膝关节剥脱性骨软骨炎。     

骨-骨膜原位翻转修复髌软骨软化症的中长期疗效

 目的 探讨骨-骨膜原位翻转修复治疗髌骨软化症的软骨缺损方法, 观察其中长期疗效。 方法 1996年 4月至 2000年 6月, 拟在我: 手术治疗的 21例髌软骨软化症患者经术前和术中评估, 接受骨-骨膜原位翻转术治疗 13例。男 3例, 女 10例;年龄 47~65岁, 平均 59岁。采用 HSS和 Lysholm 膝关节功能评分标准进行评分。结果 术后随访 114~162个月(平均 133.2个月), 13例患者中 1例患 者死亡, 余12例获随访。按照 HSS膝关节功能评分标准: 术前 20~58(34.2±3.8)分, 术后 1年为 55~70 (60.0±7.0)分, 术后 3年 55~82(64.1±5.9)分, 术后 5年 60~90(70.1±3.2)分, 术后 7年 50~85(63.1±4.1) 分, 术后 9年 50~75(57.3±2.9)分。 Lysholm膝关节功能评分: 术前 34~48(37.2±1.5)分, 术后 1年为 45~ 65 (54.0±5.5)分, 术后 3年 55~70(60.1±3.7)分, 术后 5年 55~80(67.1±2.4)分, 术后 7年 55~70(62.5± 1.8)分, 术后 9年 50~70(58.5±3.1)分。两种评分术前与术后各随访时间点差异均有统计学意义(HSS评分: F=32.816, P=0.000;Lysholm评分: F=41.793, P=0.000)。骨-骨膜移植组织与缺损周围组织完全愈合, 功能恢复良好。 1例患者因膝内翻畸形于术后 13年行人工膝关节置换术, 术中见髌骨软骨表面光滑, 白色且质韧, 修复区域与周围软骨无界限。结论 原位翻转的骨-骨膜具有成软骨能力, 修复手术后髌骨 关节面恢复良好, 疗效满意。此原位翻转术仅可以修复髌骨关节软骨, 对膝关节畸形不具有矫形作用。     

自体骨软骨移植联合富血小板血浆技术治疗膝关节软骨缺损初步随访结果

目的探讨自体骨软骨移植联合富血小板血浆技术治疗膝关节内软骨缺损的安全性及临床效果。方法回顾性分析自2016-01—2016-12采用自体骨软骨移植联合富血小板血浆技术治疗的12例股骨髁软骨缺损,10例软骨缺损位于内侧髁负重区,2例软骨缺损位于外侧髁负重区,软骨缺损面积为1.0~3.5 cm2。比较术前及术后3、6个月时膝关节功能Lysholm评分。结果 12例均获得随访,随访时间平均9(6~13)个月。术后6个月时所有患者MRI显示骨软骨条与周围骨愈合,缺损区表面有符合关节面曲度的软骨样组织覆盖。术前膝关节功能Lysholm评分(55.1±9.2)分,术后3个月为(89.8±7.1)分,术后6个月为(95.2±8.7)分;术后3个月、6个月Lysholm评分明显高于术前,差异有统计学意义(P0.05);但术后3个月与6个月Lysholm评分差异无统计学意义(P0.05)。结论对于膝关节负重区小面积的软骨缺损,自体骨软骨移植联合富血小板血浆技术是安全有效的治疗方法之一。     

自体软骨细胞结合Ⅰ型胶原蛋白三维支架治疗膝关节软骨缺损的护理

目的探讨自体软骨细胞结合I型胶原蛋白三维支架植入术治疗膝关节软骨缺损患者的围手术期护理经验。方法回顾性分析2013年1月至2014年5月我科连续收治并采用自体软骨细胞结合Ⅰ型胶原蛋白三维支架,移植治疗膝关节软骨缺损患者共9例。术前协助完善患者有关检查及临床功能评估,做好感染预防和心理护理;术后从深静脉血栓预防、疼痛管理、患膝冷敷治疗、膝关节持续被动运动治疗及康复计划的制定等方面进行护理干预。结果术后2年根据国际膝关节文献委员会(international knee documentation committee,IKDC)(93.7±3.6)分、Lysholm评分(94.5±6.7)分、软骨修复组织的核磁共振评分(75.6±5.8)分。结论合理护理和康复是自体软骨细胞结合I型胶原蛋白三维支架植入治疗膝关节软骨缺损的重要组成部分,本方法并发症少,能有效改善患者膝关节功能。     

自体软骨细胞移植术治疗膝关节剥脱性骨软骨炎

目的探讨自体软骨细胞移植术治疗膝关节剥脱性骨软骨炎的临床疗效。方法回顾性分析自2017-01—2017-10诊治的膝关节剥脱性骨软骨炎,采用自体软骨细胞移植术治疗。随访期间采用Lysholm评分与IKDC主观评分表综合评价膝关节功能。结果 10例均获得随访,随访时间5～10个月,平均8个月。术后切口均一期愈合,未出现感染。术后X线片显示移植软骨面平整,关节间隙正常。术后MRI显示植入的胶原膜与周围健康软骨整合良好。末次随访时膝关节活动范围恢复正常。末次随访时膝关节功能Lysholm评分为(88.7±4.0)分,较术前明显提高,差异有统计学意义(t=-22.973,P 0.001)。末次随访时膝关节功能IKDC评分为(90.8±5.0)分,较术前明显提高,差异有统计学意义(t=-11.724,P 0.001)。结论自体软骨细胞移植术治疗膝关节剥脱性骨软骨炎可取得满意疗效,值得临床推广应用。     

关节镜下行膝关节自体软骨移植术后早期个体化康复训练疗效分析

目的分析关节镜下行膝关节自体软骨移植术后早期个体化康复训练的疗效。 方法选取2016年1月至2017年1月在湖州市第一人民医院接受关节镜下软骨移植修复膝关节软骨缺损治疗的37例患者。其中股骨内髁负重面软骨损伤27例,股骨外髁负重面软骨损伤10例;按照国际软骨修复协会标准分级,软骨缺损深度分别为Ⅱ级3例、Ⅲ级34例;34例软骨损伤面积为1.5～3.0 cm²,3例大于3 cm²。术前通过评估建立功能档案,参与康复学堂,制定个体化康复训练方案。术后按训练方案进行早期功能锻炼。采用Brittberg-Peterson功能评定标准评估患者自体软骨移植前后膝关节功能。采用配对t检验比较患者自体软骨移植前后Brittberg-Peterson功能评分。P<0.05为差异有统计学意义。 结果截至2017年1月,37例患者术后随访12～20个月,均无失访。术后12个月行膝关节MRI检查,示原软骨缺损区软骨表面平整,移植骨软骨柱位置良好。经康复训练后,37例患者膝关节Brittberg-Peterson功能评定标准评分平均为(62.2±1.4)分,低于术前(81.6±1.2)分,差异有统计学意义(t＝63.21,P<0.05);其中关节绞锁、关节肿胀、跑步困难、关节疼痛等13项指标较术前均有明显改善(P均<0.05)。 结论早期个体化康复训练对关节镜下膝关节自体软骨移植术后膝关节功能的恢复有显著作用。     

基质诱导自体软骨细胞移植修复膝关节软骨损伤的早期疗效

目的探讨基质诱导自体软骨细胞移植修复膝关节软骨损伤的早期疗效。方法基质诱导自体软骨细胞移植修复50例膝关节软骨损伤患者,全程关注治疗情况。结果患者均获12个月随访。术后6个月36例疾病症状显著改善。术后12个月,膝关节功能主观评分表(IKDC) 2000分值、关节活动度均较术前明显提高(P 0. 01),MRI、关节镜检查显示关节软骨以及软骨下骨修复明显。结论对膝关节软骨损伤患者实施基质诱导自体软骨细胞移植,操作简便,安全且创伤轻。     

Ilizarov技术治疗创伤性膝关节屈曲挛缩畸形

 目的 探讨采用Ilizarov 技术治疗创伤性膝关节屈曲挛缩畸形的疗效。 方法回顾性分 析 2006 年1 月至2010 年12 月采用Ilizarov 技术治疗6 例创伤后膝关节屈曲挛缩畸形男性患者的资料, 年龄9~43 岁, 平均24.5 岁;术前膝关节屈曲畸形35°~85°, 平均47.6°;膝关节活动度0°~70°, 平均 15.8°。其中5 例为膝关节陈旧性骨折伴马蹄足畸形, 畸形角度为25°~37°, 平均31.8°;1 例为股骨髁上骨 折。采用环型外固定架逐渐矫正屈膝和马蹄足畸形, 其中4 例因膝关节骨性结构严重破坏且软组织条 件差, 在膝关节恢复伸直位后行膝关节融合术;另2 例膝关节恢复伸直位后, 白天松开螺母活动膝关 节, 睡觉时将膝关节固定在伸直位, 1 个月后去除外固定架改长腿支具保护3 个月。 结果 术后随访 12~22个月, 平均18 个月。6 例患者膝关节屈曲角度由术前47.67°±18.63°恢复到屈曲9.33°±3.50°。5 例 伴马蹄足畸形患者踝关节跖屈角度由术前31.80°±4.65°恢复到术后3.00°±4.47°。4 例患者术后膝关节成 功融合, 2 例膝关节活动度分别为30°和75°。术后6 例患者均可拄手杖行走。术后2~4 个月, 4 例患者出 现针道感染, 经口服抗生素及使用双氧水清洁针道后约2 周感染控制。 结论 采用Ilizarov 技术可有效 治疗创伤后膝关节屈曲畸形。对膝关节骨性结构损伤且软组织条件较差的患者可行膝关节融合术。     

关节镜下微骨折术联合自体骨软骨移植治疗膝关节股骨髁大面积软骨损伤

目的探讨关节镜下微骨折术联合自体骨软骨移植(osteochondral autologous transplantation,OAT)治疗膝关节股骨髁大面积(4~6 cm^2)软骨损伤的疗效。方法2016年3月-2017年6月,采用关节镜下微骨折术联合OAT治疗22例膝关节股骨髁大面积软骨损伤患者。其中男16例,女6例;年龄22~60岁,平均38.6岁。致伤原因:交通事故伤8例,运动损伤14例。病程1~6个月,平均3.4个月。股骨内侧髁损伤15例,外侧髁损伤7例;软骨损伤面积4~6 cm^2,平均4.98 cm^2。软骨损伤国际软骨修复协会(ICRS)分级:Ⅲ级9例,Ⅳ级13例。伴半月板损伤18例。术前疼痛视觉模拟评分(VAS)为(6.36±1.25)分,Lysholm评分为(36.00±7.77)分。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间2~3年,平均2.3年。术后2年时VAS评分为(1.27±0.94)分,Lysholm评分为(77.82±6.21)分,均较术前明显改善(t=16.595,P=0.000;t=21.895,P=0.000)。术后2年,MRI显示软骨缺损区修复良好。结论关节镜下微骨折术联合OAT治疗膝关节股骨髁大面积软骨损伤早期疗效较好。     

同侧股骨髁内侧髌股关节面自体骨软骨移植治疗距骨骨软骨损伤

 目的 评价同侧股骨髁内侧髌股关节面自体骨软骨移植治疗距骨骨软骨损伤的疗效及相关因素。方法 回顾性分析2009年7月至2012年11月采用同侧股骨髁内侧髌股关节面自体骨软骨移植治疗15例距骨骨软骨损伤患者资料,男8例,女7例;年龄19~73岁,平均(49.6±17.2)岁。采用国际膝关节文献委员会(IKDC)及Lysholm评分系统对供区膝关节术前、术后功能进行评价;采用美国足踝外科协会(Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分及视觉模拟评分(visual analogue scale,VAS)对术前、术后踝关节功能及疼痛进行评价。年龄和随访时间两因素分别与各评分的改变量进行Spearman秩相关性检验。结果 12例患者获得随访,平均随访(21.8±10.4)个月。术前膝关节IKDC、Lysholm、AOFAS踝与后足评分及VAS评分分别为(90.91±6.44)分、(95.33±8.00)分、(63.58±18.50)分、(7.25±1.54)分,术后分别为(85.63±11.89)分、(90.75±11.83)分、(90.33±4.98)分、(2.17±1.19)分。术后AOFAS踝与后足评分、Lysholm评分、IKDC评分改变量与年龄之间的相关系数分别为-0.74、-0.63、-0.76。患者对手术非常满意4例(33%),满意5例(42%),一般3例(25%),满意率为75%。结论 取同侧膝关节非负重区股骨髁内侧髌股关节面骨软骨移植治疗距骨骨软骨损伤术后患者踝关节功能恢复良好。患者年龄与术后踝关节、膝关节功能恢复有相关性。     

慢速梯度降温冷冻保存同种异体骨软骨移植治疗膝关节全层软骨缺损(附三例报告)

目的总结冷冻保存同种异体骨软骨移植物治疗3例膝关节全层骨软骨缺损的手术方法及疗效。方法应用梯度降温冷冻保存的6枚同种异体骨软骨移植物治疗3例膝关节全层骨软骨缺损,2例在关节镜下同种异体骨软骨移植,1例行关节切开移植。膝关节股骨髁关节软骨全层缺损平均面积2.16 cm2。所有患者在手术后第1个月、第3个月时进行膝关节MRI检查,了解移植物与周围骨软骨组织的愈合情况。并于门诊复查时进行Brittberg-Peterson膝关节功能评分,了解功能恢复情况。结果随访4～6个月,平均4.7个月。所有患者术后疼痛消失;无排异反应发生。术后3个月时,MRI检查示术后移植物与宿主软骨下骨整合良好,移植软骨组织结构与内部信号良好。Brittberg-Peterson评分术后6个月比手术前明显降低。结论经梯度降温冷冻保存的同种异体骨软骨移植治疗膝关节软骨缺损早期效果满意。     

A prospective,randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee

Autologous chondrocyte implantation (ACI) and mosaicplasty are both claimed to be successful for the repair of defects of the articular cartilage of the knee but there has been no comparative study of the two methods. A total of 100 patients with a mean age of 31.3 years (16 to 49) and with a symptomatic lesion of the articular cartilage in the knee which was suitable for cartilage repair was randomised to undergo either ACI or mosaicplasty; 58 patients had ACI and 42 mosaicplasty. Most lesions were post-traumatic and the mean size of the defect was 4.66 cm2. The mean duration of symptoms was 7.2 years and the mean number of previous operations, excluding arthroscopy, was 1.5. The mean follow-up was 19 months (12 to 26). Functional assessment using the modified Cincinatti and Stanmore scores and objective clinical assessment showed that 88% had excellent or good results after ACI compared with 69% after mosaicplasty. Arthroscopy at one year demonstrated excellent or good repairs in 82% after ACI and in 34% after mosaicplasty. All five patellar mosaicplasties failed. Our prospective, randomised, clinical trial has shown significant superiority of ACI over mosaicplasty for the repair of articular defects in the knee. The results for ACI are comparable with those in other studies, but those for mosaicplasty suggest that its continued use is of dubious value.     

The detached osteochondral fragment as a source of cells for autologous chondrocyte implantation (ACI) in the ankle joint

OBJECTIVE: Autologous chondrocyte implantation (ACI) has been successfully used for the treatment of osteochondral lesions of the talus. One of the main problems of this surgical strategy is related to the harvesting of the cartilage slice from a healthy knee. The aim of this study was to examine the capacity of chondrocytes harvested from a detached osteochondral fragment to proliferate and to serve as a source of viable cells for ACI in the repair of ankle cartilage defects. METHODS: Detached osteochondral fragments harvested from the ankle joint of 20 patients with osteochondral lesions of the talus served as the source of human articular cartilage specimens. All of the osteochondral lesions were chronic and of traumatic origin. In all cases, the fragments were utilized to evaluate the viability and proliferation of the cells, the histological appearance of the cartilage tissue and the expression of specific cartilage markers by real-time polymerase chain reaction (PCR). In the 16 patients scheduled for ACI, the expanded chondrocytes were used for chondrocyte implantation. In the other 4 patients, with lesion size <1.5cm(2), microfractures were created during the initial arthroscopic step. As a control group, 7 patients with comparable osteochondral lesions underwent the same surgery, but received chondrocytes harvested from the ipsilateral knee. RESULTS: According to the American Orthopaedic Foot and Ankle Scoring (AOFAS) system, patients in the experimental group had a preoperative score of 54.2+/-16 points and a postoperative one of 89+/-9.6 points after a minimum follow-up time of 12 months (P<0.0005). The control group of patients had a preoperative score of 54.6+/-11.7 points and a postoperative one of 90.2+/-9.7 points at a minimum follow-up time of 12 months (P<0.0005). The clinical results of the two groups did not differ significantly from each other. Chondrocytes isolated from the detached fragments were highly viable, phenotypically stable, proliferated in culture and redifferentiated when grown within the three-dimensional scaffold used for ACI. The morphological and molecular characteristics of the cartilage samples obtained from the detached osteochondral fragments were similar to those of healthy hyaline articular cartilage. CONCLUSIONS: The good results achieved with this strategy indicate that cells derived from the lesioned area may be useful in the treatment of osteochondral defects of the talus.     

First successful autologous chondrocyte implantation in Pakistan

Osteochondritis dissecans entails a hyaline cartilage defect of the articular surface causing pain and functional restriction in young adults, sometimes resulting in early degenerative arthritis. Conventional treatment methods such as abrasion chondroplasty and mosaicplasty have limitations in terms of quality of the resultant cartilage and donor site morbidity. A more recent technique, autologous chondrocyte implantation (ACI) results in hyaline cartilage formation and gives good long-term outcome, but requires a high-level cell culture facility and two surgical procedures. The patient was a young female with knee pain, intermittent locking and feeling of "joint mouse". MRI scan and arthroscopy showed a 2 x 2 cm full thickness osteochondral defect in the medial femoral condyle. A free fragment of articular cartilage was found, which was extracted arthroscopically, and chondrocytes were cultured from it in the Juma laboratory. Subsequently, patient underwent surgery whereby the chondrocytes were injected under a periosteal patch sewn over the defect. Over six months, patient's symptoms completely resolved and she returned to full function. A repeat arthroscopy after one year revealed complete filling of the previous defect with normal appearing cartilage indicating success of the procedure. This technology can be utilized for treating patients with a variety of conditions affecting hyaline cartilage of joints.     

Patient experiences with interventions to reduce surgery cancellations: a qualitative study

Chondral defects of the articular surface are a common condition that can lead to osteoarthritis if not treated. Therapy of this condition is a topic of constant debate and a variety of chondral repair strategies are currently used. One strategy involves implantation of a cell-free matrix of type I collagen (COL1), to provide a scaffold for chondrocyte migration and proliferation and extracellular matrix production. Although several studies have suggested that chondrocytes can move, to the best of our knowledge there is still no proof of chondrocyte occurrence in a former cell-free scaffold for articular cartilage repair in humans. An 18-year-old male patient underwent arthroscopic surgery of the knee for patellar instability and a chondral defect of the femoral condyle. Clinical outcome scores were recorded pre-operatively, after 6 weeks and after 6, 12, 24 and 36 months. MRI was recorded after 6 weeks and after 6, 12, 24 and 36 months postoperatively. At 42 months after implantation of a cell-free type I collagen matrix and reconstruction of the medial patellofemoral ligament, the patient was again treated arthroscopically for a tear of the medial meniscus of the same knee. A biopsy of the previous chondral defect was taken during arthroscopy for histological examination. In addition to good clinical and radiological results reported for cell-free scaffolds for cartilage repair in several other studies, transformation of the scaffold could be observed during re-arthroscopy for the meniscal tear. Histological examination of the specimen revealed articular cartilage with vital chondrocytes and a strong staining reaction for type II collagen (COL II), but no reaction for type I collagen staining. This might indicate a complete transformation of the scaffold and supports the theory that cell free scaffolds could support cell migration. Although the cell source remains unclear, migrating chondrocytes from the periphery remain a possibility.     

Arthroscopic autologous chondrocyte implantation for the treatment of a chondral defect in the tibial plateau of the knee

The matrix-induced autologous chondrocyte implantation (MACI; Verigen, Leverküsen, Germany) is a tissue engineering technique for the treatment of deep chondral lesions. Cultured chondrocytes are seeded on a collagen membrane that can be implanted into the defect using exclusively fibrin glue. These features imply some surgical advantages with respect to the traditional ACI technique, such as the possibility of performing the procedure in articular sites, in which putting stitches for the periosteal patch is impossible. We report on the arthroscopic MACI technique for the treatment of a chondral defect of the knee. A 25-year-old man suffered persistent pain at the left knee after a violent direct trauma. Magnetic resonance imaging (MRI) and arthroscopic examination at the time of cartilage biopsy revealed a 2-cm² chondral lesion in the posterior portion of the lateral tibial plateau. The implantation procedure was performed through traditional arthroscopic portals, and the seeded membrane was fixed with fibrin glue, excluding water flow temporarily. Implant stability was verified intraoperatively, and filling of the defect was shown 12 months after surgery by MRI, which showed a hyaline-like cartilage signal. In this specific case, the arthroscopic approach allowed to achieve an optimal view of the lesion, without sacrificing any tendinous or ligamentous structure of the knee.     

Prospective clinical study of autologous chondrocyte implantation and correlation with MRI at three and 12 months

In order to determine the usefulness of MRI in assessing autologous chondrocyte implantation (ACI) the first 57 patients (81 chondral lesions) with a 12-month review were evaluated clinically and with specialised MRI at three and 12 months. Improvement 12 months after operation was found subjectively (37.6 to 51.9) and in knee function levels (from 85% International Cartilage Repair Society (ICRS) III/IV to 61% I/II). The International Knee Documentation Committee (IKDC) scores showed an initial deterioration at three months (56% IKDC A/B) but marked improvement at 12 months (88% A/B). The MRI at three months showed 82% of patients with at least 50% defect fill, 59% with a normal or nearly normal signal at repair sites, 71% with a mild or no effusion and 80% with a mild or no underlying bone-marrow oedema. These improved at 12 months to 93%, 93%, 94% and 91%, respectively. The overall MR score at 12 months suggested production of normal or nearly normal cartilage in 82%, corresponding to a subjective improvement in 81% of patients and 88% IKDC A/B scores. Second-look surgery and biopsies in 15 patients (22 lesions) showed a moderate correlation of MRI with visual scoring; 70% of biopsies showed hyaline and hyaline-like cartilage. Thus, MRI at 12 months is a reasonable non-invasive means of assessment of ACI.     

Treatment of a Focal Articular Cartilage Defect of the Talus with Polymer-Based Autologous Chondrocyte Implantation: A 12-Year Follow-Up Period

Autologous chondrocyte implantation (ACI) is a first-line treatment option for large articular cartilage defects. Although well-established for cartilage defects in the knee, studies of the long-term outcomes of matrix-assisted ACI to treat cartilage defects in the ankle are rare. In the present report, we describe for the first time the long-term clinical and radiologic results 12 years after polymer-based matrix-assisted ACI treat a full-thickness talar cartilage defect in a 25-year-old male patient. The clinical outcome was assessed using the visual analog scale and Freiburg ankle score, magnetic resonance imaging evaluation using the Henderson-Kreuz scoring system and T2 mapping. Clinical assessment revealed improved visual analog scale and Freiburg ankle scores. The radiologic analysis and T2 relaxation time values indicated the formation of hyaline-like repair tissue. Polymer-based autologous chondrocytes has been shown to be a safe and clinically effective long-term treatment of articular cartilage defects in the talus.     

Evaluation of autologous chondrocyte transplantation via a collagen membrane in equine articular defects: results at 12 and 18 months

OBJECTIVE: To evaluate a technique of autologous chondrocyte implantation (ACI) similar to the other techniques using cell-seeded resorbable collagen membranes in large articular defects. METHODS: Autologous cartilage was harvested arthroscopically from the lateral trochlear ridge of the femur in fifteen 3-year-old horses. After culture and expansion of chondrocytes the newly created ACI construct (autologous chondrocytes cultured expanded, seeded on a collagen membrane, porcine small intestine submucosa) was implanted into 15mm defects on the medial trochlear ridge of the femur in the opposite femoropatellar joint. Using two defects in each horse, the ACI technique was compared to collagen membrane alone (CMA) and empty cartilage defects (ECDs). RESULTS: Arthroscopic evaluations at 4, 8, 12 and 18 months demonstrated that CMA was significantly worse compared to ACI or ECD treatments, with ACI having the best overall subjective grade. Overall raw histological scores demonstrated a significant improvement with ACI compared to either CMA or ECD treated defects and ACI defects had significantly more immunohistochemical staining for aggrecan than CMA or ECD treated defects (with significantly more type II collagen in ACI and ECD compared to CMA defects) at 12 and 18 months. CONCLUSIONS: Histologic and immunohistochemistry results from this long-term randomized study are particularly encouraging and demonstrate superiority with the ACI technique. Although there is no comparable study published with the traditional ACI technique in the horse (or with such a large defect size in another animal model), the use of a solid autologous cell-seeded-constructed implant would appear to offer considerable clinical advantages.     

基质诱导的自体软骨细胞移植术修复膝关节软骨缺损1O例术后2年的随访

目的应用基质诱导的自体软骨细胞移植技术（MACI,Genzyme,America）对膝关节软骨损伤的患者进行治疗,通过对患者进行术后2年的随访分析,评价MACI治疗的安全性和有效性。方法从2004年至2008年11月,对10例患者实施MACI手术。患者平均年龄34.9岁（14～57岁）,缺损的平均面积（3.69±2.62）cm2/处（0.4～8cm2,n=20）。MACI技术是从患者非负重区取自体关节软骨,进行体外消化并分离出软骨细胞,培养扩增后接种在Ⅰ/Ⅲ型双层胶原膜上。移植前按缺损的部位修剪成相应形状,用生物蛋白胶将胶原膜粘贴在关节软骨缺损处。分别于术前1周、术后3个月、6个月、1年和2年使用KOOS评分问卷进行临床康复效果的评估并进行术后核磁共振的检测（MRI）。此外,术后对2例患者进行了3次关节镜检查和2次组织学检测。结果 10例患者术后均未发生并发症及与手术相关的不良事件。患者术后3个月KOOS评分显示疼痛明显改善（P〈0.05）;术后6个月KOOS评分显示：疼痛、症状、日常生活、运动及娱乐和生活质量5项均明显升高,5项评分间有统计学差异（P〈0.05）。术后1年和2年患者的情况得到了持续的改善（P〈0.05）。患者术后3个月的MRI显示软骨缺损部位得到大部分填充和修复;6个月移植软骨基本与周围软骨完全整合;1年后修复组织呈等信号,软骨下骨髓水肿消失;2年后大部分患者软骨修复组织信号与周围组织信号强度一致,软骨下骨无骨髓水肿。术后15个月和2年的组织学检查显示新生的软骨组织以透明软骨为主。MACI手术一般都能在2h内完成,术中出血量小于100ml。结论 MACI技术是修复关节软骨缺损安全、可靠和有效的治疗措施,具有操作简单、手术时间短和术中出血量少等特点。