膝关节自体软骨细胞移植术后康复的研究进展

Research progress of rehabilitation after autologous chondrocyte implantation on knee

目的总结膝关节自体软骨细胞移植术(autologous chondrocyte implantation,ACI)术后康复的研究进展。方法查阅近年来国内外ACI术后康复相关的基础及临床研究,并进行总结分析。结果研究表明,ACI术后移植物成熟分为4个阶段:增生期(术后0～6周)、过渡期(术后6～12周)、重塑期(术后12～26周)、成熟期(术后26周～2年)。为了避免早期移植物损伤,适当刺激移植物和骨骼的整合过程,更快恢复关节功能,临床需针对术后不同阶段移植物的生物力学特性设计康复锻炼方案,主要体现在术后负重、运动范围、康复训练方式的过渡和调整。结论膝关节ACI术后应科学地逐步增加负重和运动范围,在不同阶段可借助相应的康复锻炼手段。但目前相关研究的证据等级较低,仍需更高质量、更大样本量的随机对照试验,进一步探讨完善康复方案。

Objective To summarize the research progress of rehabilitation after autologous chondrocyte implantation（ACI）. Methods The literature related to basic science and clinical practice about rehabilitation after ACI in recent years was searched, selected, and analyzed. Results Based on the included literature, the progress of the graft maturation consists of proliferation phase（0-6 weeks）, transition phase（6-12 weeks）, remodeling phase（12-26 weeks）,and maturation phase（26 weeks-2 years）. To achieve early protection, stimulate the maturation, and promote the graftbone integrity, rehabilitation protocol ought to be based on the biomechanical properties at different phases. Weightbearing program, range of motion（ROM）, and options or facilities of exercise are importance when considering a rehabilitation program. Conclusion It has been proved that the patients need a program with an increasingly progressive weight-bearing and ROM in principles of rehabilitation after ACI. Specific facilities can be taken at a certain phase.Evidences extracted in the present work are rather low and the high-quality and controlled trials still need to improve the rehabilitation protocol.