基质诱导自体软骨细胞移植术治疗距骨软骨损伤临床疗效观察

Matrix-induced autologous chondrocyte implantation of talus cartilage defect

【目的】探讨基质诱导自体软骨细胞移植术(matrix-induced autologous chondrocyte implantation,MACI)治疗距骨软骨损伤的临床疗效。方法 2012年3月至2014年9月,收治距骨软骨损伤并行MACI手术患者17例,男12例,女5例,平均年龄(32.6±1.4)岁(21～48岁),平均损伤面积(3.4±0.8)cm^2(1.6～5.8 cm^2),Hepple分型:Ⅰ型5例、Ⅱ型9例、Ⅲ型3例。第一次手术行软骨取样,经2～4周组织工程软骨制备后,返院行软骨回植手术。对比术前与术后VAS评分、AOFAS足踝功能评分、软骨修复核磁共振影像评分(magnetic resonance observation of cartilage repair tissue,MOCART)。结果患者随访时间(52.3±5.6)月(38～72月)。末次随访时VAS评分、AOFAS评分、MOCART评分与术前相比,均显著改善:(0.8±0.6)vs(7.8±1.4),(94.8±1.9)vs(69.2±2.7),(6.5±0.4)vs(3.6±0.8),(P<0.05)。末次随访时MRI显示:肥厚性软骨完全覆盖6例,正常厚度完全覆盖11例;与周边正常软骨信号强度一致4例,基本一致13例。结论 MACI手术治疗软骨下骨全层距骨软骨损伤中期临床效果良好,远期疗效还有待进一步观察。

Objective To evaluate clinical outcomes of Matrix-induced autologous chondrocyte implantation(MACI) in the treatment of talus cartilage defects. Methods From March 2012 to September2014, a retrospective analysis of MACI was performed on eleven patients who had sustained talus cartilage lesion. 17 cases(12 male and 5 female) were enrolled into the study with a mean age of(32.6±1.4) years old(ranging from 21 to 48 years old) and a mean defective area of(3.4±0.8) cm^2( ranging from 1.6 to 5.8 cm^2).Hepple classification: 5 cases of Hepple Ⅰ,9 cases of Hepple Ⅱ and 3 cases of Hepple Ⅲ. Arthroscopy,debridement and cartilage harvesting procedure were performed in the first operation. After 2 to 4 weeks of preparation of tissue engineering cartilage, autologous grafting and sealing of the defect with fibrin glue were performed. All patients were regularly followed up. VAS score, AOFAS score and magnetic resonance observation of cartilage repair tissue( MOCART) were adopted for assessment of clinical outcomes. Results All surgeries were performed successfully with a mean follow-up time of(52.3±5.6) months( ranging from 38 to 72 months). The VAS score, AOFAS score and MOCART score at the final follow-up were significantly improved compared with those prior to operation, i.e,(0.8±0.6) vs(7.8±1.4) points,(94.8±1.9)vs(69.2± 2.7)points,(6.5 ± 0.4)vs(3.6 ± 0.8) points, P<0.05). Complete filling of the defect at the level of the surrounding cartilage was found in 11 cases, and complete filling with a hypertrophic cartilage layer was found in 6 cases of the patients. Normal signal intensity of the repair tissue compared with the adjacent native cartilage was seen in 4 cases, with nearly normal activity in 13 cases. Conclusions MACI therapy for talus cartilage defects with normal subchondral bone can obtain good clinical outcomes, while the long term clinical outcomes remains to be seen.