自体软骨细胞结合Ⅰ型胶原蛋白支架治疗膝关节软骨缺损的近期疗效

被引：10

作者：

李梦远

马元琛

陈宏

廖俊星

郑秋坚

机构：

[1] 广州,广东省人民医院(广东省医学科学院)骨科

来源：

中华骨科杂志 | 2015年 / 35卷 / 09期

关键词：

移植, 自体; 软骨细胞; 膝关节;

D O I：

暂无

中图分类号：

R687.4 [关节手术];

学科分类号：

100220 [骨科学];

摘要：

目的探讨自体软骨细胞结合Ⅰ型胶原蛋白三维支架治疗膝关节软骨损伤的近期疗效。方法回顾性分析2013年1月至2014年3月采用自体软骨细胞结合Ⅰ型胶原三维支架移植治疗膝关节软骨缺损患者共9例(9膝), 男6例, 女3例;年龄18～41岁, 平均(30±7.8)岁。软骨缺损位于股骨髁4例、股骨滑车4例、髌骨1例, 缺损面积2.5～10 cm2, 平均(4.9±2.1)cm2。一期手术关节镜下在膝关节股骨髁非负重区获取全层软骨, 约0.5 cm×1.0 cm, 进行软骨细胞培养和体外扩增8～14 d;二期手术采用冻干人纤维蛋白胶将载有软骨细胞的冻胶原移植物黏附于缺损部位。术后进行严格的康复训练。术前及术后3、6、12个月进行国际膝关节文献委员会(International Knee Documentation Committee, IKDC)评分、Lysh?lm主观膝关节评分, 术后3天内、1、3、6及12个月进行膝关节MR检查及软骨修复组织的核磁共振评分(magnetic resonance observation of cartilage repair tissue, MOCART)。结果 9例患者均获得临床随访, 术前IKDC评分为(52.7±6.9)分, 术后3、6、12个月分别为(71.1±6.6)分、(83.3±2.9)分和(92.0±3.6)分, 差异有统计学意义;术前Lysh?lm评分为(55.8±8.7)分, 术后3、6、12个月分别为(74.8±7.0)分、(84.8±4.8)分和(93.1±5.7)分, 差异有统计学意义。8例患者获得MRI随访, 术后3天内、1、3、6及12个月MOCART评分为(43.6±6.0)分、(47.8±5.8)分、(57.8±5.8)分、(64.3±4.8)分和(72.1±4.9)分, 差异有统计学意义;术后12个月, T2 Mapping定量测量示移植物T2值为(48.7±3.2)ms, 与正常区域对照差异无统计学意义。结论自体软骨细胞结合Ⅰ型胶原蛋白三维支架治疗膝关节软骨损伤近期疗效满意。

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