中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (30): 4769-4774.doi: 10.3969/j.issn.2095-4344.1415

• 复合支架材料 composite scaffold materials • 上一篇    下一篇

自体软骨细胞结合Ⅰ型胶原蛋白三维支架治疗膝关节剥脱性骨软骨炎

李  政，李长树，卢  贺，王  平
  

  1. 深圳平乐骨伤科医院(深圳市坪山区中医院)骨关节科，广东省深圳市  518010
  • 收稿日期:2019-05-09 出版日期:2019-10-28 发布日期:2019-10-28
  • 通讯作者: 王平，主任医师，副院长，深圳平乐骨伤科医院(深圳市坪山区中医院)骨关节科，广东省深圳市 518010
  • 作者简介:李政，男，1981年生，安徽省宿州市人，汉族，2009年福建中医药大学毕业，硕士，主治医师，主要从事骨关节病与运动医学研究。

Autologous chondrocytes combined with collagen I three-dimensional scaffold for treatment of osteochondritis dissecans of the knee

Li Zheng, Li Changshu, Lu He, Wang Ping
  

  1. Department of Bone and Joint Diseases, Shenzhen Pingle Orthopedic Hospital (Pingshan District Hospital of Traditional Chinese Medicine), Shenzhen 518010, Guangdong Province, China
  • Received:2019-05-09 Online:2019-10-28 Published:2019-10-28
  • Contact: Wang Ping, Chief physician, Department of Bone and Joint Diseases, Shenzhen Pingle Orthopedic Hospital (Pingshan District Hospital of Traditional Chinese Medicine), Shenzhen 518010, Guangdong Province, China
  • About author:Li Zheng, Master, Attending physician, Department of Bone and Joint Diseases, Shenzhen Pingle Orthopedic Hospital (Pingshan District Hospital of Traditional Chinese Medicine), Shenzhen 518010, Guangdong Province, China

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摘要：

文章快速阅读：

 

文题释义：
大面积剥脱性骨软骨炎：由异常骨化、局部反复创伤、骨质内异常的微循环及先天遗传等各种原因引发的局灶性软骨病变，导致软骨及软骨下骨不稳定，与周围正常骨分离、脱落的一类面积大于3.0 cm2特发性关节疾病。由于剥脱性骨软骨炎损伤关节软骨的面积较大而致软骨难以自行修复，传统临床治疗如关节镜下清理射频治疗、软骨下钻孔、微骨折等骨髓刺激技术均难以达到满意的临床疗效。
自体软骨细胞培养移植技术：一种将自体软骨细胞培养扩增后移植到软骨缺损区域治疗软骨损伤的技术。
 
 
背景：近年的研究表明，自体软骨细胞结合Ⅰ型胶原蛋白三维支架修复软骨损伤可达到接近正常透明软骨的临床疗效。
目的：分析自体软骨细胞结合Ⅰ型胶原蛋白三维支架治疗膝关节大面积(大于3.0 cm2)剥脱性骨软骨炎的临床疗效。
方法：纳入深圳平乐骨伤科医院2014年3月至2017年1月收治的7例膝关节大面积剥脱性骨软骨炎患者，其中男4例，女3例，年龄21-39岁，剥脱性骨软骨缺损面积3.62-12.51 cm2，均进行自体软骨细胞结合Ⅰ型胶原三维支架移植治疗，术后进行严格的康复训练。治疗前、治疗后3，9，12个月及末次随访时，通过Lysholm主观膝关节评分、国际膝关节文献委员会IKDC评分、疼痛评分、患者治疗满意度及定期复查MRI来评估治疗效果。试验获得深圳平乐骨伤科医院伦理委员会批准，批准号：20140105。
结果与结论：①7例患者均获得12-24个月的临床随访，未出现感染、关节僵硬等并发症；②7例患者治疗后12个月及末次随访的Lysholm主观膝关节评分、IKDC评分明显高于治疗前[Lysholm：(92.1±3.3)，(93.4±5.2)，(54.8±6.4)分；IKDC：(91.2±3.2)，(92.2±3.7)，(52.3±6.3)分，P < 0.05]，治疗后12个月与末次随访时的Lysholm主观膝关节评分、IKDC评分比较差异无显著性意义(P > 0.05)；③7例患者治疗后12个月及末次随访的疼痛评分低于治疗前[(1.2±1.5)，(0.8±1.1)，(6.7±2.2)分，P < 0.05]，治疗后12个月与末次随访时的疼痛评分比较差异无显著性意义(P > 0.05)；④治疗后随访12个月，6例患者对治疗满意或非常满意，1例对治疗欠满意；⑤治疗后12个月复查MRI，显示移植软骨恢复良好，未出现脱落或局部水肿等；⑥结果表明，自体软骨细胞结合Ⅰ型胶原蛋白三维支架治疗膝关节大面积剥脱性骨软骨炎是一种安全、有效的治疗方法，其可显著改善患肢功能和缓解疼痛。

关键词: 剥脱性骨软骨炎, 自体软骨细胞, 胶原蛋白, 膝关节, 移植, 功能, 疼痛, 三维支架

Abstract:

BACKGROUND: Recent studies have shown that autologous chondrocytes combined with collagen I three-dimensional scaffold for treatment of cartilage injury can achieve the clinical efficacy similar to that of normal hyaline cartilage.
OBJECTIVE: To analyze the clinical effect of autologous chondrocytes combined with collagen I three-dimensional scaffold in the treatment of large area (greater than 3.0 cm2) of osteochondritis dissecans of the knee joint.
METHODS: Seven patients with larger area of knee osteochondritis dissecans who received treatment in Shenzhen Pingle Orthopedic Hospital between March 2014 and January 2017. These patients consisted of 4 males and 3 females, aged 21-39 years. The area of osteochondritis dissecans was 3.62-12.51 cm2. All patients underwent autologous chondrocytes combined with type I collagen three-dimensional scaffold transplantation and strict rehabilitation training after surgery. The therapeutic effect was evaluated by Lysholm subjective knee score, IKDC score of the International Knee Documentation Committee, pain score, patient satisfaction with treatment and MRI examination before treatment and 3, 9, 12 months after treatment as well as at the last follow up.
RESULTS AND CONCLUSION: All of the seven patients were followed up for 12-24 months and no complications, such as infection and stiffness of joints were observed. The Lysholm subjective knee score and IKDC score at 12 months after treatment and at the last follow up were significantly higher than those before treatment [Lysholm subjective knee score: (92.1±3.3), (93.4±5.2): (54.8±6.4); IKDC: (91.2±3.2), (92.2±3.7), (52.3±6.3), P < 0.05]. There were no significant differences in the Lysholm subjective knee score and IKDC score between 12 months after treatment and the last follow-up (P > 0.05). At 12 months after treatment and at the last follow-up, pain score in seven patients was significantly lower than that before treatment [(1.2±1.5), (0.8±1.1), (6.7±2.2), P < 0.05]. There was no significant difference in pain score between 12 months after treatment and the last follow up (P > 0.05). Six patients were satisfied or very satisfied with the treatment and one patient was not satisfied with the treatment at 12 months after treatment. MRI revealed that at 12 months after treatment, the transplanted cartilage recovered well, with no shedding or local edema. These results suggest that autologous chondrocytes combined with type I collagen three-dimensional scaffold is a safe and effective treatment for osteochondritis dissecans of the knee joint, which can significantly improve the function of affected limb and relieve pain.

Key words: osteochondritis dissecans, autologous chondrocyte, collagen, knee joint, function, pain, three-dimensional scaffold

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