摘要
目的评价关节镜下自体软骨细胞移植治疗退行性膝关节软骨损伤2年的效果。方法对2014年10月~2016年10月期间在我院接受关节镜下自体软骨细胞移植治疗的54例退行性膝关节软骨损伤患者进行2年随访结果分析:记录所有患者手术显性失血量、住院时间,观察治疗有效率;比较术前及术后3、6、12、24月的膝关节疼痛视觉模拟评分(VAS)、HSS膝关节功能评分、Tegner运动功能评分及膝关节活动度;比较手术前后的MRI检查结果。根据治疗效果,将患者分为有效组(显效+有效)和无效组(无效),分析影响手术效果的因素。结果手术后48 h显性失血量为92.3±11.8 mL,住院时间为8.3±2.5 d。术后总有效率为79.63%。术后患者疼痛视觉模拟评分降低,HSS评分、Tegner评分增加(P<0.01)。术后3月膝关节活动度较术前有所降低,术后6月恢复正常。MRI检查显示,术后6月,19例患者出现修复组织厚度高于正常软骨厚度;术后12月,6例患者仍存在修复软骨肥厚;术后24月,2例患者存在软骨肥厚,后接受关节镜手术干预。术后检查未见其他与手术相关并发症。有效组患者43例,无效组患者11例。经单因素分析发现,年龄、病程、软骨损伤程度、术后关节负重、术后关节运动是影响手术效果的相关因素。经Logistic多因素回归分析显示,年龄>70岁、病程>1年、软骨损伤Ⅲ~Ⅳ级、术后关节过度负重、术后关节活动过早或过少是影响手术效果的独立危险因素。结论关节镜下自体软骨细胞移植治疗退行性膝关节软骨损伤效果较高,在术后应遵循康复训练计划进行康复训练,可有效提高治疗效果。
Objective To explore the 2 years follow-up results of arthroscopic autologous chondrocyte transplantation in the treatment of degenerative knee articular cartilage injury.Methods Fifty-four patients with degenerative knee articular cartilage injury who underwent arthroscopic autologous chondrocyte transplantation in our hospital from October 2014 to October 2016 were enrolled in this study.Two years follow-up results were analyzed.All patients were recorded the dominant blood loss in the operation,hospitalization time,observation treatment efficiency.The knee pain visual analog score(VAS),Hss knee function score,Tegner motor function score and knee joint activity at the time before surgery,3 months,6 months,12 months and 24 months after surgery were compared.MRI results before and after surgery were recorded.According to the treatment effect,the patients were divided into the effective group(effectiveness+improvement)and the ineffective group(ineffectiveness).The factors of the surgical effect were analyzed.Results The dominant blood loss was 92.3±11.8 mL at 48 h postoperatively.The hospital stay were 8.3±2.5 d.The total effective rate was 79.63%.After the operation,the patients'VAS scores were significantly decreased,HSS score and Tegner score were significantly increased(P<0.01).The knee joint activity was lower than that before surgery at the time of 3 months after surgery,and returned to normal at the time of 6 months after surgery.In 6 months after surgery,19 patients had a repaired tissue thickness,which was higher than the normal cartilage thickness.In 12 months after surgery,6 patients still had repaired cartilage hypertrophy.In 24 months after surgery,2 patients had cartilage hypertrophy and were treated with arthroscopic surgery.No other surgery-related complications were observed after the postoperative examination.There were 43 patients in the effective group and 11 patients in the ineffective group.Univariate analysis showed that age,duration of disease,degree of cartilage damage,postoperative joint weight,and postoperative joint motion were the relevant factors that affected the surgical outcome.Logistic multivariate regression analysis showed that age>70 years,disease course>1 year,cartilage injury III^IV,postoperative joint weight bearing,postoperative joint activity too early or too little were independent risk factors affecting the surgical outcome.Conclusion Arthroscopic autologous chondrocyte transplantation is effective in the treatment of degenerative knee articular cartilage injury.Rehabilitation training should be followed in the postoperative rehabilitation training,which can effectively improve the treatment effects.
作者
钟浩博
刘伟乐
孙春汉
郑少伟
ZHONG Haobo;LIU Weile;SUN Chunhan;ZHENG Shaowei(Huizhou First Hospital,Huizhou 516003,China)
出处
《分子影像学杂志》
2019年第4期444-448,共5页
Journal of Molecular Imaging
关键词
退行性膝关节软骨损伤
关节镜
自体软骨细胞移植
degenerative knee articular cartilage injury
arthroscopy
autologous chondrocyte transplantation
