Nehrer S, Domayer S, Dorotka R, Schatz K, Bindreiter U, Kotz R
Department of Orthopedics, Medical University of Vienna, Wien, Austria.
Eur J Radiol. 2006 Jan;57(1):3-8. doi: 10.1016/j.ejrad.2005.08.005. Epub 2005 Sep 26.
Repair of articular cartilage represents a significant clinical problem and although various new techniques - including the use of autologous chondrocytes - have been developed within the last century the clinical efficacy of these procedures is still discussed controversially. Although autologous chondrocyte transplantation (ACT) has been widely used with success, it has several inherent limitations, including its invasive nature and problems related to the use of the periosteal flap. To overcome these problems autologous chondrocytes transplantation combined with the use of biodegradable scaffolds has received wide attention. Among these, a hyaluronan-based scaffold has been found useful for inducing hyaline cartilage regeneration. In the present study, we have investigated the mid-term efficacy and safety of Hyalograft C grafts in a group of 36 patients undergoing surgery for chronic cartilage lesions of the knee. Clinical Outcome was assessed prospectively before and at 12, 24, and 36 months after surgery. No major adverse events have been reported during the 3-year follow-up. Significant improvements of the evaluated scores were observed (P < 0.02) at 1 year and a continued increase of clinical performance was evident at 2 and 3 years follow-up. Patients under 30 years of age with single lesions showed statistically significant improvements at all follow-up visits compared to those over 30 with multiple defects (P < 0.01). Hyalograft C compares favorably with classic ACT and is particularly indicated in younger patients with single lesions. The graft can be implanted through a miniarthrotomy and needs no additional fixation with sutures except optional fibrin gluing at the defect borders. These results suggest that Hyalograft C is a valid alternative to ACT.
关节软骨修复是一个重大的临床问题。尽管在上个世纪已经开发出了各种新技术,包括使用自体软骨细胞,但这些手术的临床疗效仍存在争议。虽然自体软骨细胞移植(ACT)已被广泛成功应用,但其存在一些固有局限性,包括其侵入性以及与使用骨膜瓣相关的问题。为了克服这些问题,自体软骨细胞移植与可生物降解支架的联合使用受到了广泛关注。其中,基于透明质酸的支架已被发现有助于诱导透明软骨再生。在本研究中,我们调查了Hyalograft C移植物在一组36例接受膝关节慢性软骨损伤手术患者中的中期疗效和安全性。在手术前以及术后12、24和36个月对临床结果进行了前瞻性评估。在3年的随访期间未报告重大不良事件。在1年时观察到评估分数有显著改善(P < 0.02),并且在2年和3年随访时临床性能持续提高。与30岁以上有多处缺损的患者相比,30岁以下有单一损伤的患者在所有随访中均显示出统计学上的显著改善(P < 0.01)。Hyalograft C与经典ACT相比具有优势,尤其适用于有单一损伤的年轻患者。该移植物可通过小切口关节切开术植入,除了在缺损边缘可选择使用纤维蛋白胶外,无需额外的缝线固定。这些结果表明Hyalograft C是ACT的有效替代方案。