专题:抗衰老与老年健康

自体软骨细胞移植技术治疗关节软骨退变

  • 侯建雷 ,
  • 刘鹏卫 ,
  • 姜川 ,
  • 张仲文
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  • 中国人民解放军总医院第三医学中心骨科, 北京 100039
侯建雷,主治医师,研究方向为骨科创伤和关节疾病,电子信箱:houjl0601@126.com;张仲文(通信作者),主任医师,教授,研究方向为软骨修复再生技术,电子信箱:zhang6816151@163.com

收稿日期: 2024-02-20

  修回日期: 2024-05-21

  网络出版日期: 2024-12-26

基金资助

首都临床特色应用研究与成果推广项目(Z161100000516013)

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

  • HOU Jianlei ,
  • LIU Pengwei ,
  • JIANG Chuan ,
  • ZHANG Zhongwen
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  • Department of Orthopedics, the Third Medical Center of PLA General Hospital, Beijing 100039, China

Received date: 2024-02-20

  Revised date: 2024-05-21

  Online published: 2024-12-26

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-T1W-Vibe)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。

本文引用格式

侯建雷 , 刘鹏卫 , 姜川 , 张仲文 . 自体软骨细胞移植技术治疗关节软骨退变[J]. 科技导报, 2024 , 42(22) : 15 -22 . DOI: 10.3981/j.issn.1000-7857.2024.08.01003

Abstract

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 Matrixinduced 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-T1W-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 after surgery. At 6 months after 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 of knee joint function.

参考文献

[1] Roelofs A J, De Bari C. Osteoarthritis year in review 2023: Biology[J]. Osteoarthritis and Cartilage, 2024, 32(2): 148-158.
[2] 王斌, 邢丹, 董圣杰, 等. 中国膝骨关节炎流行病学和疾病负担的系统评价[J]. 中国循证医学杂志, 2018, 18(2): 134-142.
[3] 许学猛, 刘文刚, 许树柴, 等. 膝骨关节炎(膝痹)中西医结合临床实践指南[J]. 实用医学杂志, 2021, 37(22): 2827-2833.
[4] Perruccio A V, Young J J, Wilfong J M, et al. Osteoarthritis year in review 2023: Epidemiology & therapy[J]. Osteoarthritis and Cartilage, 2024, 32(2): 159-165.
[5] 丁一, 郑静晨, 张仲文. 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[J]. 武警医学, 2018, 29(6): 599-602, 606.
[6] Triana J, Hughes A J, Rao N N, et al. Comparable clinical and functional outcomes between osteochondral allograft transplantation and autologous chondrocyte implantation for articular cartilage lesions in the patellofemoral joint at a mean follow-up of 5 years[J]. Arthroscopy, 2024: S0749-S8063(24)00395-5.
[7] Li J, Ma Q Z, Hou J L, et al. The efficacy of microfracture combined with extracorporeal shock wave therapy for treating osteochondral lesion of the talus and the quality of regenerated cartilage: A retrospective cohort study and MRI assessment[J]. Journal of Clinical Medicine, 2023, 12(8): 2966.
[8] Kang S H, Gao F Q, Han J, et al. Extracorporeal shock wave treatment can normalize painful bone marrow edema in knee osteoarthritis: A comparative historical cohort study[J]. Medicine, 2018, 97(5): e9796.
[9] Nieminen M T, Töyräs J, Rieppo J, et al. Quantitative MR microscopy of enzymatically degraded articular cartilage [J]. Magnetic Resonance in Medicine, 2000, 43(5): 676-681.
[10] Becher C, Driessen A, Hess T, et al. Microfracture for chondral defects of the talus: Maintenance of early results at midterm follow-up[J]. Knee Surgery, Sports Traumatology, Arthroscopy, 2010, 18(5): 656-663.
[11] 马巧稚, 张仲文, 刘腾腾, 等. 3D-T1-VIBE评价膝关节纤维蛋白凝胶型自体软骨细胞移植术后软骨修复[J]. 中国医学影像技术, 2020, 36(2): 271-275.
[12] 杜康佳, 颜梅, 温生宝, 等. MRI 3D-Vibe联合T2 mapping成像对腕关节三角纤维软骨复合体损伤的评价及定量分析[J]. 磁共振成像, 2023, 14(7): 115-120.
[13] 马秉贤, 包呼日查, 王一帆, 等. 国产3D打印矫形鞋垫治疗膝关节骨性关节炎的临床应用及疗效评价[J]. 科技导报, 2023, 41(16): 136-144.
[14] Roos E M, Roos H P, Lohmander L S, et al. Knee Injury and Osteoarthritis Outcome Score (KOOS): Development of a self-administered outcome measure[J]. The Journal of Orthopaedic and Sports Physical Therapy, 1998, 28(2): 88-96.
[15] 沈阳, 石秀秀, 赵喆, 等. 新型组织工程支架修复联合围术期康复治疗膝关节软骨损伤一例报告[J]. 中国骨与关节杂志, 2024, 13(4): 280-284.
[16] Harris J D, Siston R A, Brophy R H, et al. Failures, reoperations, and complications after autologous chondrocyte implantation-a systematic review[J]. Osteoarthritis and Cartilage, 2011, 19(7): 779-791.
[17] Munirah S, Samsudin O C, Chen H C, et al. Articular cartilage restoration in load-bearing osteochondral defects by implantation of autologous chondrocyte-fibrin constructs: An experimental study in sheep[J]. The Journal of Bone and Joint Surgery British Volume, 2007, 89(8): 1099-1109.
[18] Lee K T, Kim J S, Young K W, et al. The use of fibrin matrix-mixed gel-type autologous chondrocyte implantation in the treatment for osteochondral lesions of the talus[J]. Knee Surgery, Sports Traumatology, Arthroscopy, 2013, 21(6): 1251-1260.
[19] Boffa A, Previtali D, Altamura S A, et al. Platelet-rich plasma augmentation to microfracture provides a limited benefit for the treatment of cartilage lesions: A metaanalysis[J]. Orthopaedic Journal of Sports Medicine, 2020, 8(4): 2325967120910504.
[20] 中国医疗保健国际交流促进会骨科分会. 关节腔注射富血小板血浆治疗膝骨关节炎的临床实践指南(2018年版)[J]. 中华关节外科杂志(电子版), 2018, 12(4): 1-5.
[21] 刘文渤, 陈博鉴, 林跃玮, 等. 富血小板血浆治疗膝关节髌骨软化症的短期疗效观察[J]. 实用骨科杂志, 2020, 26(12): 1135-1138, 1147.
[22] 陈群群, 霍少川, 周驰, 等. 自体富血小板关节腔内注射治疗晚期膝骨关节炎对疼痛及疼痛介质的影响[J]. 川北医学院学报, 2019, 34(4): 415-418.
[23] 易庆丰, 胡华刚, 张天元, 等. 超声引导下PRP注射治疗肩袖损伤对局部炎症因子表达的影响[J]. 浙江临床医学, 2021, 23(3): 383-385.
[24] 陈卫华, 庄卫生, 黄韶辉. 关节腔内PRP注射治疗膝骨关节炎对患者炎症及疼痛因子水平和预后的影响[J]. 海南医学, 2024, 35(10): 1415-1419.
[25] 中华医学会骨科学分会关节外科学组, 中国医师协会骨科医师分会骨关节炎学组, 国家老年疾病临床医学研究中心(湘雅医院), 等. 中国骨关节炎诊疗指南(2021年 版) [J]. 中华 骨科 杂志, 2021, 41(18): 1291-1314.
[26] 国务院办公厅关于印发中国防治慢性病中长期规划(2017-2025年)的通知[A/OL] (2017-01-22)[2023-11-20]. http://www.gov.cn/xinwen/2019-07/31/content_5417631.htm.
[27] 国家统计局, 国务院第七次全国人口普查领导小组办公室. 第七次全国人口普查公报(第五号) [EB/OL]. (2021-05-11)[2023-11-20]. https://www.gov.cn/guoqing/2021-05/13/content_5606149.htm.
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