关节镜下髁间窝微骨折术与髌下脂肪垫粉碎术在半月板损伤中的应用研究 *

目的研究关节镜下髁间窝微骨折术与髌下脂肪垫粉碎术在修复半月板损伤中的疗效。方法 (1)将微骨折术及脂肪垫粉碎术中释放的样本转移至实验室,培养并鉴定其中细胞的特性;(2)所取病例来自于该院2014年1月-2016年1月确诊为半月板损伤并行手术治疗的患者,共计75例。根据治疗方式的不同,将病例分为A组(微骨折术)、B组(脂肪垫粉碎术)及C组(对照组)。所有患者术前及随访时采用Lysholm、视觉模拟评分法(VAS)及不良事件(关节肿胀及膝前区疼痛)评估。结果 (1)基础实验中,微骨折术释放的细胞为成纤维状细胞状,生长迅速,旋涡辐射样生长;脂肪垫粉碎术释放的细胞大多类似成纤维细胞,含有少量杂质及坏死细胞,呈长梭状。干细胞试剂盒鉴定两种细胞均符合干细胞特性,考虑其分别为骨髓间充质干细胞(BMSCs)与髌下脂肪垫来源干细胞(IPFPSCs);(2)临床研究中,所有患者均获平均10个月(8~11个月)随访,无神经血管损伤、感染等并发症。术前,A、B、C组的Lysholm及VAS评分的组间差异无统计学意义(P0.05),不良事件大致相同。术后末次随访中,各组末次随访的结果较治疗前均有明显改善,差异有统计学意义(P0.05);A组与C组、B组与C组间的Lysholm及VAS评分差异有统计学意义(P0.05);A与B组间的差异无统计学意义(P0.05)。B组的不良事件早期发生率高于A组及C组,末次随访时无明显差异。结论髁间窝微骨折术与髌下脂肪垫粉碎术均对半月板损伤修复具有良好的效果,后者早期不良事件发生率可能较高。

Effect of micro-fracture and comminution of fat pad on meniscal tear healing under arthroscopy*

Abstract: Objective To analyze the curative effect of fossa intercondyloidea of micro-fracture and comminution of subcutaneous fat pad on meniscal tear healing under arthroscopy. Methods During the clinical operation, the samples of the micro-fracture and fat pad comminution were attracted to the outside of the joint. The source and properties of cells were identified based on preclinical medicine experiment in vitro. In clinical research, 75 cases of the simple meniscus injury were selected from January 2014 to January 2016 and divided into three groups refer to treatment: Group A, B and C. Different treatments were used in the three groups. Group A - micro-fracture group; Group B - fat pad group; Group C - blank group. All patients’ conditions were assessed with Lysholm, VAS score and adverse event (Swelling, anterior knee pain). Results In the preclinical medicine experiment, cells released by micro fracture were fibroblast-like cells which tend to grow more rapidly in vortex shape. Cells released by comminution of fat pad contained a small amount of impurities and necrotic cells and are mostly similar to fibroblast in long spindle shape. Besides, the Human MSC Analysis Kit was used to authenticate two cells which were considered to be as BMSCs and IPFPSCs. In clinical research, all patients received an average of 10 (8 ~ 11) months follow-up visit. No severe complication, such as blood-vessel and nerve injury, infection occurred after operations in the patients followed. Before receiving the treatment, difference in Lysholm, VAS score and general condition of joint of Group A and B, C showed no statistical difference (P > 0.05). Compared with those before operation and after operation in both of four groups, the Lysholm and VAS score were improved (P < 0.05). Besides, there had significantly difference between group A and C, B and C after post treatment in Lysholm and VAS score (P < 0.05), however, group A and B did not. Compared group A and C, the early prevalence of adverse event of group B was higher, but last follow-up show no difference between three groups. Conclusion Combined with basic experimental and clinical studies, our research suggest that micro-fracture and comminution of fat pad have good effect on the repair of meniscus injuries. Nevertheless, it should be concerned that early prevalence of increased swelling amd anterior knee pain of comminution of fat pad.