自体软骨细胞移植的临床应用与研究

Clinical application and research of autologous chondrocyte implant

目的探讨和研究自体软骨细胞移植技术治疗膝关节软骨缺损的临床效果和临床应用的可行性。方法2007年11月至2009年6月，共6例膝关节软骨损伤患者。男2例，女4例；年龄19-55岁，平均39．5岁；均为膝关节股骨髁关节面软骨缺损，缺损面积为3．8-11．6cm2，平均7．3cm2。利用自体软骨细胞移植术进行治疗：关节镜下在膝关节股骨髁间非负重区获取软骨组织0．2g，送临床细胞培养室进行软骨细胞的培养和体外扩增2-3周；第二次手术，利用骨膜缝合覆盖，生物蛋白胶封闭，将扩增的软骨细胞悬浮液移植至软骨缺损区；术后进行严格的康复训练。术后定期进行随访，术前及术后6、12个月进行Lysholm主观评分、国际膝关节文献委员会（International Knee Documentation Committee，IKDC）客观等级评定和膝关节MRI扫描。结果6例患者均获得随访。术前Lysholm评分（63．0±8．1）分，术后6和12个月分别为（83．7±10．6）分和（86．3±10．3）分，获得明显改善；术前IKDC等级均为C或D级，术后等级逐步获得改善。术后6个月和12个月MR检查显示所有病例软骨缺损区基本得到修复，无一例出现术后感染等严重并发症。一例患者由于未能按指导完成康复锻炼，术后患侧关节疼痛症状虽有缓解，但出现粘连，活动度部分丢失。结论自体软骨细胞移植治疗膝关节软骨缺损初步疗效基本满意；术前需严格控制适应证，术后需高度重视康复锻炼，以保证手术疗效。

Objective To investigate and evaluate the result and the possibility of the clinical ap- plication of autologous chondrocyte implant （ACI）. Methods From November 2007 to June 2009, 6 cases of knee articular cartilage defect were treated with ACI, including 2 males and 4 females with an average age of 39.5 years （range, 19-55）. All the defects were located on the condyles of femur with a mean size of 7.3 cm2 （range, 3.8-11.6）. ACI comprises a two-stage procedure： chondrocytes are first harvested from the non-load bearing area of the joint, expand in vitro to acquire enough cells, and then the chondrocytes are implanted. The defect of cartilage were covered with bone membrane and fixed with sutures and fibrin albumen glue. Lysholm score system, International Knee Documentation Committee （IKDC） grading system, and MRI were used to evaluate the effect of ACI, 6 and 12 months post-operatively. Results All the patients were followed up. The clinical outcomes of the 6 and 12 months follow-ups demonstrated increased of clinical scores. The MRI follow-up showed good filling of the defect with tissue having the imaging appearance of cartilage in all patients. Only one patient suffered adhesion, because she refused to finish rehabilitation exercises as our treatment advises. Conclusion As the clinical effect of ACI for knee cartilage defect is satisfied, the ACI may be a good choice for treating knee cartilage defect in future. It is very important to control the indications strictly and guarantee to finish the post-operative rehabilitation exercises.