自体软骨细胞移植技术治疗关节软骨退变  

Clinical application of autologous chondrocyte transplantation in the treatment of articular cartilage degeneration

作　　者：侯建雷 刘鹏卫 姜川 张仲文 HOU Jianlei;LIU Pengwei;JIANG Chuan;ZHANG Zhongwen(Department of Orthopedics,the Third Medical Center of PLA General Hospital,Beijing 100039,China)

机构地区：[1]中国人民解放军总医院第三医学中心骨科,北京100039

出　　处：《科技导报》2024年第22期15-22,共8页Science & Technology Review

基　　金：首都临床特色应用研究与成果推广项目(Z161100000516013)。

摘　　要：关节软骨退变是骨关节炎(OA)病理过程中的首要环节,组织工程技术是现阶段唯一可逆转OA的方式。以膝关节炎(KOA)软骨损伤患者为研究对象,通过前瞻性随机对照临床研究,比较单纯基质诱导的自体软骨细胞移植(MACI)与MACI联合富血小板血浆(PRP)治疗软骨损伤的疗效及新生软骨的质量,旨在寻找软骨修复的最佳临床模式。采用T2 Mapping评估新生软骨的生物学质量,采用T1加权三维梯度回波容积内插屏气呼吸检查(3D-T1WVibe)评估新生软骨的形态学质量,采用膝关节损伤和骨关节炎评分(KOOS)评估膝关节整体功能。结果显示,术后1~2 a时MACI+PRP组的T2 Mapping值均显著低于MACI组,术后6个月时MACI+PRP组的KOOS评分显著高于MACI组,而术后1~2 a时,2组的KOOS评分恢复至同一水平。说明MACI联合PRP技术修复KOA软骨缺损的新生软骨生物学质量更佳、更接近天然的透明软骨,术后膝关节功能恢复更快。Pathological process of osteoarthritis(OA)starts from cartilage degeneration,and tissue engineering technology is the only way to reverse OA at present.This study focuses on patients with knee osteoarthritis(KOA)and cartilage injury.Through a prospective randomized controlled clinical trial,the efficacy and quality of cartilage repair were compared between Matrix-induced Autologous Chondrocyte Implantation(MACI)alone and MACI combined with platelet rich plasma(PRP),aiming to identify the optimal clinical model for cartilage repair.T2 Mapping was used to evaluate the biological quality of newly formed cartilage,T1 weighted three-dimensional gradient echo volume interpolation breath holding examination(3D-TIW-Vibe)was used to evaluate the morphological quality of newly formed cartilage,and Knee Injury and Osteoarthritis Outcome Score(KOOS)was used to evaluate overall knee joint function.The results showed that the T2 Mapping values of the MACI+RP group were significantly lower than those of the MACI group at 1-2 years afer surgery.At 6 months afer surgery,the KOOS score of the MACI+RP group was significantly higher than that of the MACI group.However,at 1-2 years after surgery,the KOOS scores of both groups returned to the same level.The combination of MACI and PRP technology for repairing KOA cartilage defects achieves better biological quality of newly formed cartilage,closer to natural transparent cartilage,and faster postoperative recovery ofknee joint function.

关 键 词：软骨退变 膝关节炎 单纯基质诱导的自体软骨细胞移植 富血小板血浆 核磁软骨序列 T2 Mapping 

分 类 号：R687.4[医药卫生—骨科学]