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

柳海峰; 吴冰; 梁达强; 李皓; 陆伟

doi:10.13418/j.issn.1001-165x.2019.01.019

中国临床解剖学杂志 ›› 2019, Vol. 37 ›› Issue (1) : 91-96. DOI: 10.13418/j.issn.1001-165x.2019.01.019

临床研究

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

柳海峰，　吴冰，　梁达强，　李皓，　陆伟

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Matrix-induced autologous chondrocyte implantation of talus cartilage defect

LIU Hai-feng, WU Bing, LIANG Da-qiang, LI Hao, LU Wei

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文章历史 +

摘要

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)cm2（1.6~ 5.8 cm2），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。

Abstract

Objective　To evaluate clinical outcomes of Matrix-induced autologous chondrocyte implantation (MACI) in the treatment of talus cartilage defects.　Methods　From March 2012 to September 2014, 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) cm2( ranging from 1.6 to 5.8 cm2). Hepple classification: 5 cases of HeppleⅠ，9 cases of HeppleⅡ 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.

导出引用

柳海峰,吴冰,梁达强,李皓,陆伟. 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[J]. 中国临床解剖学杂志. 2019, 37(1): 91-96 https://doi.org/10.13418/j.issn.1001-165x.2019.01.019

LIU Hai-feng, WU Bing, LIANG Da-qiang, LI Hao, LU Wei. Matrix-induced autologous chondrocyte implantation of talus cartilage defect[J]. Chinese Journal of Clinical Anatomy. 2019, 37(1): 91-96 https://doi.org/10.13418/j.issn.1001-165x.2019.01.019

参考文献

[1] Orr JD, Dawson LK, Garcia EJ, et al. Incidence of osteochondral lesions of the talus in the United States military[J]. Foot Ankle Int, 2011, 32(10): 948- 954.
[2] Laffenêtre O. Osteochondral lesions of the talus: current concept[J]. Orthop Traumatol Surg Res, 2010, 96(5): 554- 566.
[3] Bazaz R, Ferkel RD. Treatment of osteochondral lesions of the talus with autologous chondrocyte implantation[J]. Techniques Foot Ankle Surgery, 2004, 3(3): 45- 52.
[4] Millington SA, Li B, Tang J, et al. Quantitative and topographical evaluation of ankle articular cartilage using highresolution MRI[J]. J Orthop Res, 2007, 25(2): 143- 151.
[5] Saxena A, Eakin C. Articular talar injuries in athletes: results of microfracture and autogenous bone graft [J]. Am J Sports Med, 2007, 35(10): 1680- 1687.
[6] Nelson AJ, Collins CL, Yard EE, et al. Ankle injuries among United States high school sports athletes, 2005-2006 [J]. J Athl Train, 2007, 42(3): 381- 387.
[7] Easley ME. Osteochondral lesions of the talus: diagnosis and treatment[J]. Curr Opin Orthop, 2003, 14(2): 69- 73.
[8] Hangody L, Füles P. Autologous osteochondral mosaicplasty for the treatment of full - thickness defects of weight-bearing joints: ten years of experimental and clinical experience[J]. J Bone Joint Surg(Am), 2003, 85 (Suppl 2): 25- 32.
[9] Haraguchi N, Ota K, Nishida N, etal. T1ρ mapping of articular cartilage grafts after autologous osteochondral transplantation for osteochondral lesions of the talus: a longitudinal evaluation[J]. J Magn Reson Imaging, 2018, 48(2): 398-403.
[10] Fraser EJ, Savage-Elliott I, Yasui Y, etal. Clinical and MRI donor site outcomes following autologous osteochondral transplantation for talar osteochondral lesions[J]. Foot Ankle Int, 2016, 37(9): 968-976.
[11] Giza E, Sullivan M, Ocel D, et al. Matrix-induced autologous chondrocyte implantation of talus articular defects[J]. Foot Ankle Int, 2010, 31(9): 747- 753.
[12] Kreulen C, Giza E, Walton J, et al. Seven-year follow-up of matrix-induced autologous implantation in talus articular defects[J]. Foot Ankle Spec, 2018, 11(2): 133-137.
[13] Desando G, Bartolotti I, Vannini F, et al. Repair potential of matrix-induced bone marrow aspirate concentrate and matrix-induced autologous chondrocyte implantation for talar osteochondral repair: patterns of some catabolic, inflammatory, and pain mediators[J]. Cartilage, 2017, 8(1): 50-60.
[14] Schneider TE, Karaikudi S. Matrix-induced autologous chondrocyte implantation (MACI) grafting for osteochondral lesions of the talus[J]. Foot Ankle Int, 2009, 30(9): 810-814.
[15]聂庆虎，张仲文，丁晨，等．基质诱导的自体软骨细胞移植术治疗距骨软骨损伤一例报道［J /CD］．中华关节外科杂志: 电子版，2015，9(3) : 425- 427．
[16] Hepple S, Winson IG, Glew D, et al. Osteochondral lesions of the talus: a revised classification[J]. Foot Ankle Int, 1999, 20(12): 789- 793.
[17] Marlovits S, Striessnig G, Resinger CT, et al. Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging[J]. Eur J Radiol, 2004, 52(3): 310- 319.
[18]郭秦炜，胡跃林，焦晨，等．踝关节距骨骨软骨损伤的影像学及关节镜下表现[J].中华关节外科杂志(电子版),2010,4(6):723-728.
[19] Guhl JF. Arthroscopic treatment of osteochondritis dissecans: preliminary report[J]. Orthop Clin North Am, 1979, 10(3): 671-683.
[20]Aurich M, Venbrocks RA, Fuhrmann RA. Autologous chondrocyte transplantation in the ankle joint. Rational or irrational[J]. Orthopade, 2008, 37(3): 190-195.
[21] Ateshian GA, Soslowsky LJ, Mow VC. Quantitation of articular surface topography and cartilage thickness in knee joints using stereophotogrammetry[J]. J Biomech, 1991, 24(8): 761-776.
[22] Al-Ali D, Graichen H, Faber S, et al. Quantitative cartilage imaging of the human hind foot: Precision and inter-subject variability[J]. J Orthop Res, 2002, 20(2): 249-256.
[23]Treppo S, Koepp H, Quan EC, et al. Comparison of biomechanical and biochemical properties of cartilage from human knee and ankle pairs [J]. J Orthop Res, 2000, 18 (5): 739-748.
[24] Zengerink M, Struijs PA, Tol JL, et al. Treatment of osteochondral lesions of the talus: a systematic review[J]. Knee Surg Sports Traumatol Arthrosc, 2010, 18(2): 238-246.
[25] Giannini S, Buda R, Ruffilli A, et al. Arthroscopic autologous chondrocyte implantation in the ankle joint[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(6): 1311-1319.
[26] Magnan B, Samaila E, Bondi M, et al. Three-dimensional matrix-induced autologous chondrocytes implantation for osteochondral lesions of the talus: midterm results[J]. Adv Orthop. 2012, 2012: 942174.

基金

广东省自然科学基金（2018A030313834）；广东省科技计划项目 (2014A020212656，2015A030401017)；广东省医学科研基金项目（A2018284）；深圳市科技计划项目(JCYJ20170306091150112)；深圳市卫生系统科研项目 (SZXJ2018061, SZXJ2017050)