自体软骨细胞移植技术治疗膝关节软骨缺损11例报告

Autologous chondrocyte implantation in the treatment of knee cartilage defects: long-term follow-up

目的评价自体软骨细胞移植技术(autologous chondrocytes implantation,ACI)治疗膝关节软骨缺损的有效性和安全性。方法 2012年6月至2014年6月,我院对11例(11处)膝关节软骨缺损患者实施ACI手术修复。患者平均年龄(26.91±6.92)岁,平均缺损面积(3.12±0.70)cm2。关节镜下检查确诊膝关节软骨缺损,取关节非负重区软骨进行体外消化分离培养,制成软骨细胞移植物。根据关节软骨缺损形状和范围裁剪软骨细胞膜片,覆盖于缺损处并固定,配合术后特定康复计划。分别于术前、术后3个月、术后2年、末次随访进行Lysholm评分和国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分,评价膝关节术后功能恢复情况。分别于术前、术后3个月、术后2年及末次随访时进行MRI检查,观察移植物修复情况,并进行软骨修复组织的磁共振观察(magnetic resonance observation of cartilage repair tissue,MOCART)评分。结果术后Lysholm评分、IKDC评分均较术前明显改善,差异有统计学意义(P < 0.05)。术后3个月MRI显示软骨缺损处可见填充但欠缺平整,可见骨髓下水肿信号;术后2年MRI显示软骨修复平整,与周围正常组织融合良好,骨髓下水肿信号消失;末次随访MRI显示缺损区修复平整,与正常结构无差别。MOCART评分随术后时间推移逐渐增高(P < 0.05)。11例均未发生并发症及与手术相关不良事件。结论 ACI是修复膝关节软骨缺损安全、有效的治疗手段,长期随访效果良好。

Objective To evaluate the safety and efficacy of autologous chondrocyte implantation (ACI) for patients with knee cartilage defects.Methods ACI was performed on 11 patients (11 knees) from June 2012 to June 2013.The average age was (26.91±6.92) years,and the average size of each defect was (3.12±0.70) cm~2.Knee cartilage defects were confirmed by arthroscope.Autologous chondrocyte grafts were harvested from non-weight bearing areas of the knee for proliferation in-vitro,and then used to produce chondrocyte grafts.Grafts were subsequently rimmed to match the exact shape and size of the cartilage defects,and then positioned and fixed in place.Lysholm,IKDC and MRI were used to evaluate the clinic outcomes preoperatively,3 month postoperatively,2 years postoperatively,and at the final follow-up following a specific postoperative rehabilitation program.MOCART evaluation was carried out.Results Lysholm and IKDC scores were significantly improved after operation (P < 0.05).MRI 3 months postoperatively showed that the newly generated cartilage had almost completely filled the defect area but with an uneven surface;MRI 2 years postoperatively showed that the smooth and fully repaired cartilage integrated well with surrounding tissues;MRI at the final follow-up indicated that the chondrocyte graft had totally integrated with normal surrounding tissues with a smooth surface but no effusion.MOCART scores significantly increased along with the time (P < 0.05).No postoperative complications or ACI-related adverse events were noted.Conclusions ACI is safe and effective to repair knee cartilage defects with satisfactory long-term effects.