髋关节撞击综合征导致髋臼软骨损伤的修复  

Treatment of acetabular chondral lesions for femoroacetabular impingement syndrome

作　　者：黄轶刚[1] 高俊杰 张长青[1] Huang Yigang;Gao Junjie;Zhang Changqing(Shanghai Sixth People's Hospital,Shanghai 200233,China)

机构地区：[1]上海市第六人民医院,上海200233

出　　处：《生物医学转化》2023年第4期36-40,45,共6页Biomedical transformation

基　　金：国家自然科学基金项目(82072525);上海市市级医院临床管理优化项目(SHDC22021308);上海市卫健委重中之重重点学科项目(2022ZZ01014)。

摘　　要：髋关节撞击综合征导致的全层髋臼软骨损伤会影响髋关节镜手术疗效,因此应在处理原发髋关节病理改变的基础上,根据损伤的深度和面积,采取相应的治疗措施。非全层软骨缺损采用软骨成形术;全层缺损面积小于400 mm2,可行微骨折术;超过400 mm2的全层缺损,应在微骨折后加用自体基质诱导软骨生成技术、自体软骨细胞或干细胞移植以促进软骨再生。自体基质诱导软骨生成技术主要包括胶原支架和壳聚糖支架,通过稳定血凝块及骨髓干细胞,促进纤维软骨再生,其中,远期影像学及临床疗效优于微骨折术。自体软骨细胞及干细胞移植有望在缺损区域形成透明软骨,理论上可避免远期再生纤维软骨退化,但在髋关节软骨缺损中的应用尚处于早期阶段,还需进一步临床研究证实其有效性。Femoroacetabular impingement can lead to full-thickness acetabular cartilage lesions,which can affect the outcomes of hip arthroscopic surgery.After the correction of primary pathology of hip joint,therefore,it is essential to perform the appropriate therapeutic measurements base on the depth and area of the cartilage lesions.Partial-thickness cartilage defects can simply be treated with chondroplasty.When the full-thickness defect area is less than 400 mm2,microfracture should be performed.If the full-thickness defect exceeds 400 mm2,autologous matrix-induced chondrogenesis,autologous chondrocyte transplantation,or stem cell transplantation should be considered after microfracture to promote cartilage regeneration.Autologous matrix-induced chondrogenesis techniques primarily include collagen and chitosan scaffolds,which stabilize blood clots and bone marrow stem cells,promote fibrocartilage formation,and provide better long-term radiographic and clinical outcomes.Autologous chondrocyte and stem cell transplantation hold promise for forming hyaline cartilage in the defect area,which may theoretically avoid the late degeneration of fibrocartilage.However,their application in hip joint osteochondral defects is still in the early stages and requires further clinical research to confirm their effectiveness.

关 键 词：髋关节撞击症 软骨损伤 微骨折术 自体基质诱导软骨生成技术 细胞移植 

分 类 号：R684[医药卫生—骨科学]