关节镜清理联合自体骨髓间充质干细胞移植治疗膝骨关节炎的疗效观察

Therapeutic effect of arthroscopy combined with autologous bone marrow stem cell grafting on knee osteoarthritis

目的:观察关节镜清理联合自体骨髓间充质干细胞移植治疗膝骨关节炎的临床疗效。方法:将符合要求的72例膝骨关节炎患者随机分为治疗组和对照组,每组36例。治疗组采用关节镜清理联合自体骨髓干细胞移植治疗,对照组仅采用关节镜清理治疗。分别于治疗前和关节镜清理术后12个月采用磁共振成像扫描仪测定患者膝关节软骨厚度,并采用Lequesne骨关节炎严重程度和病情活动指数评定患者的膝关节功能。结果:①膝关节软骨厚度。治疗前2组患者膝关节软骨厚度比较,差异无统计学意义[(3.80±0.24)mm,(3.85±0.23)mm,t=0.576,P=0.793];关节镜清理术后12个月,治疗组膝关节软骨厚度增加[(4.60±0.15)mm,t=53.748,P=0.000],对照组膝关节软骨厚度与治疗前相比,差异无统计学意义[(3.75±0.26)mm,t=0.712,P=0.365];治疗组关节镜清理术后12个月与治疗前膝关节软骨厚度的差值大于对照组[(1.06±0.16)mm,(0.46±0.08)mm,t=3.486,P=0.000]。②Lequesne指数。治疗前2组患者Lequesne指数比较,差异无统计学意义[(19.72±1.34),(19.86±1.58),t=0.278,P=0.638];关节镜清理术后12个月,2组患者膝关节Lequesne指数均减小[(5.19±1.12),t=25.894,P=0.000;(10.42±1.08),t=5.427,P=0.000],治疗组减小更明显[(14.28±1.16),(8.96±1.38),t=5.879,P=0.000]。结论:关节镜清理联合自体骨髓间充质干细胞移植可明显增加膝骨关节炎患者的膝关节软骨厚度,有效改善膝关节功能,是治疗膝骨关节炎的有效方法。

Objective：To observe the therapeutic effect of arthroscopy combined with autologous bone marrow stem cell（BMSC） grafting on knee osteoarthritis （KOA）.Methods：Seventy-two patients with KOA enrolled in the study were randomly divided into treatment group and control group,36 cases in each group.Patients in treatment group were treated with arthroscopy combined with autologous BMSC grafting,while the others in control group were treated with arthroscopy.Magnetic resonance imaging（MRI） were performed and the thickness of knee articular cartilage were measured in all patients before treatment and 12 months after arthroscopy respectively.The knee joint function was assessed by using the indices of severity and disease activity for osteoarthritis.Results：There was no statistical difference in the thickness of knee articular cartilage between the 2 groups before the treatment（3.80 ＋/-0.24 vs 3.85 ＋/-0.23 mm,t =0.576,P =0.793）.The thickness of knee articular cartilage increased in treatment group 12 months after arthroscopy （4.60 ＋/-0.15 mm,t =53.748,P =0.000）,and there was no statistical difference in the thickness of knee articular cartilage between pre-treatment and post-treatment in control group （3.75 ＋/-0.26 mm,t =0.712,P =0.365）.The differences between pre-treatment and post-treatment of treatment group were larger than that of control group in the thickness of knee articular cartilage （1.06 ＋/-0.16 vs 0.46 ＋/-0.08 mm,t =3.486,P =0.000）.There was no statistical difference in the Lequesne indices between the 2 groups before the treatment（19.72 ＋/-1.34 vs 19.86 ＋/-1.58,t =0.278,P =0.638）.The Lcquesne indices of the 2 groups declined 12 months after arthroscopy （5.19 ＋/-1.12,t =25.894,P =0.000 ; 10.42 ＋/-1.08,t =5.427,P =0.000）,and there was a bigger decline in treatment group compared to control group（14.28 ＋/-1.16 vs 8.96 ＋/-1.38,t =5.879,P =0.000）.Conclusion：The therapy of arthroscopy combined with autologous BMSC grafting performs well on KOA for obvious increase in the thickness of knee articular cartilage and improvement in knee joint functions.