国内首例凝胶基质自体软骨细胞移植治疗膝关节软骨损伤及文献回顾  

Fibrin matrix-mixed gel-type autologous chondrocyte implantation for knee cartilage repair in China:the first case report and literature review

作　　者：丁一[1,2] 郑静晨[2] 张仲文[1] DING Yi;ZHENG Jingchen;ZHANG Zhongwen(Department of Orthopeadics;Institute of Disaster Medicine, General Hospital of Chinese People＇ s Armed Police Force, Beijing 100039, China)

机构地区：[1]武警总医院骨软骨科,北京100039 [2]武警总医院灾害救援医学研究所,北京100039

出　　处：《武警医学》2018年第6期599-602,606,共5页Medical Journal of the Chinese People's Armed Police Force

基　　金：首都特色基金(Z161100000516013)

摘　　要：目的评价纤维蛋白凝胶型自体软骨细胞移植(fibrin matrix-mixed gel-type ACI,G-ACI)术后软骨修复的程度及其临床疗效。方法 2016-04-18本团队在国内首次开展G-ACI手术,患者为48岁女性,髌骨软骨缺损面积为1.8 cm×3.0 cm,股骨内髁缺损面积为0.5 cm×0.5 cm,达到Outerbridge/ICRSⅢ-Ⅳ度。先在关节镜下采集患膝非负重区健康关节软骨约50 mg,送至武警总医院GMP细胞实验室进行培养与扩增。6周后再以手术的方式,将凝胶支架与自体软骨细胞移植到膝关节软骨缺损部位。分别于术后1、3、6、12个月进行T_1 Vibe MRI、T_2 Mapping MRI和KOOS(knee osteoarthritis outcome score)评分。结果 T_1 Vibe MRI示最早在术后6个月可见新生软骨信号,至术后1.5年软骨修复至正常厚度;术后T2Mapping MRI示新生软骨逐渐改建,T_2 Mapping值逐渐降低并趋向正常;术后KOOS评分较术前逐渐提高,主观改善的最快阶段处于术后6~12个月。结论 G-ACI技术操作简便快捷,不受缺损部位、形状、深度所限,可在全关节镜下操作,利用G-ACI技术治疗膝关节软骨缺损的短期疗效理想,G-ACI作为第三代ACI技术在国内临床应用中具有一定的优势和前景。Objective To evaluate the clinical results of fibrin matrix-mixed gel-type ACI（ G-ACI） during postoperative cartilage repair. Methods A 48-year-old female patient who had cartilage defects in the patella（ 1. 8 cm × 3. 0 cm） and medial condyle（ 0. 5 cm × 0. 5 cm） was selected. Both defects belonged to Outerbridge/ICRS Ⅲ-Ⅳ. We began by harvesting 50 mg cartilage from the non-bearing region and had it cultured at the GMP lab of the General Hospital. After 6 months,the autologous chondrocytes and gel scafford were implanted into the defective region by arthrotomy. T1 Vibe MRI,T2 Mapping MRI and Knee Injury and Osteoarthritis Outcome Score（ KOOS） were used to evaluate the result of clinical rehabilitation in 6 mon,1 y and 1. 5 y postoperatively. Results The earliest signs of proliferation of chondrocytes in the transplant area were seen 6 mon postoperatively as shown by T1 Vibe MRI. Newborn chondrocytes filled the transplant area completely till 1. 5 years after operation. T2 Mapping MRI showed a reconstruction process of newborn chondrocytes. T2 Mapping values decreased after operation. All the items in KOOS progressively improved after G-ACI operation,but faster recovery occurred between six months and one year postoperatively. Conclusions G-ACI can reduce surgical difficulties without cutting and suturing while facilitating attachment,thus it can be easily performed under arthroscopy regardless of the site,shape and depth of defects. We have achieved good outcomes postoperatively during early follow-up. G-ACI appears to be a safe and effective method to repair cartilage defects of knees.

关 键 词：纤维蛋白凝胶型自体软骨细胞移植 软骨修复 MRI KOOS评分 

分 类 号：R684.3[医药卫生—骨科学]