Two years follow-up results of arthroscopic autologous chondrocyte transplantation in the treatment of degenerative knee articular cartilage injury
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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="" 3="" 6="" mri="" 6="" 19="" 12="" 6="" 24="" 2="" 43="" 11="" logistic="">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。 -
关键词:
- 退行性膝关节软骨损伤 /
- 关节镜 /
- 自体软骨细胞移植
Abstract:ObjectiveTo explore the 2 years follow-up results of arthroscopic autologous chondrocyte transplantation in the treatment of degenerative knee articular cartilage injury. MethodsFifty-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. ResultsThe 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. ConclusionArthroscopic 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. -
表 1 手术前后浮髌试验及研磨试验阳性率比较[n(%)]
指标 术前 术后 χ2 P 浮髌试验阳性 23(42.59%) 9(16.67%) 8.704 0.003 研磨试验阳性 19(35.19%) 6(11.11%) 8.796 0.003 表 2 手术前后VAS、HSS、Tegner及膝关节屈曲度比较(Mean±SD)
时间 VAS(分) HSS(分) Tegner(分) 膝关节活动度(°) 术前 7.52±1.33 43.29±5.37 1.75±0.94 115.60±2.13 术后3月 5.19±1.67** 66.15±6.24** 4.33±1.17** 109.25±3.89** 术后6月 3.54±1.29** 79.24±5.88** 5.26±0.89** 125.82±3.86** 术后12月 2.01±1.46** 85.43±5.15** 5.99±1.24** 133.29±4.05** 术后24月 1.97±1.55** 89.94±6.21** 6.31±1.15** 135.10±3.97** F 137.457 605.449 168.257 561.246 P 0.000 0.000 0.000 **P<0.01 vs术前. 表 3 影响手术效果的单因素分析
影响因素 有效(n=43) 无效(n=11) χ2 P 年龄(岁) ≤ 70 10 6 3.907 0.048 >70 33 5 病程(年) ≤ 1 9 8 10.895 0.001 >1 34 3 手术时间(h)) ≤ 1 34 8 0.204 0.652 >1 9 3 软骨损伤程度 Ⅱ级 32 2 11.879 0.001 Ⅲ~Ⅳ级 11 9 术后关节负重 遵医嘱 40 5 14.271 0.000 过度负重 3 6 术后关节活动 遵医嘱 38 4 13.708 0.000 过早或过少 5 7 主刀医生年资 高年资医生 35 9 0.001 0.974 低年资医生 8 2 表 4 Logistic多因素回归分析
影响因素 β(回归系数) S.E.(标准误) Wald X2 P OR 95%CI 年龄>70岁 0.225 0.0097 538.049 0.025 1.252 1.229 1.276 病程>1年 0.023 0.002 132.250 0.002 1.023 1.019 1.027 软骨损伤Ⅲ~Ⅳ级 0.521 0.016 1060.316 0.000 1.684 1.632 1.737 术后关节过度负重 0.329 0.061 29.089 0.000 1.390 1.233 1.566 术后关节活动过早或过少 0.172 0.024 51.361 0.005 1.188 1.133 1.245 -
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