Handl M, Trc T, Hanus M, Stastný E, Fricová-Poulová M, Neuwirth J, Adler J, Havranová D, Varga F
Ortopedická klinika detí a dospelých 2. LF UK, FN Motol, Praha.
Acta Chir Orthop Traumatol Cech. 2007 Feb;74(1):29-36.
The authors present the results of surgical treatment of talar dome cartilage defects. They used the transplantation of autologous cultured chondrocytes in the form of a solid chondral graft.
Patients with chondral lesions categorized as grades II to IV by the Anderson classification or as grades II to IV by the Berndt and Harty classification were indicated for this treatment. After preoperative MRI examination, a small sample of healthy cartilage was harvested arthroscopically from the non-weight-bearing area of the talus and was sent to the Tissue Bank in Brno for chondrocyte cultivation. After 28 to 42 days the cultured chondrocytes were formed into a solid chondral graft, implanted at the damaged site of the talar dome and fixed with fibrin glue (Tissucol).
Between July 2003 and October 2005 five patients, three males and two females, were treated using this method. Their age ranged from 22 to 46 years. Follow-up was 6 to 24 months, with an average of 12.6 months, and the patients were examined by MRI at 2 weeks, 2 and 6 months and at 1 year. The clinical results were evaluated on the basis of the Mazur and Weber scoring systems.
A significant improvement in clinical function of the ankle joint was achieved in three patients and the condition remained unchanged in one patient. In one patient, the surgical outcome was too recent for evaluation, but the MRI results indicated tendency to good incorporation of the graft.
作者展示距骨穹窿软骨缺损的手术治疗结果。他们采用自体培养软骨细胞以固体软骨移植物的形式进行移植。
安德森分类法分类为Ⅱ至Ⅳ级或伯恩特和哈蒂分类法分类为Ⅱ至Ⅳ级的软骨损伤患者适合这种治疗。术前MRI检查后,通过关节镜从距骨非负重区域采集一小片健康软骨,送至布尔诺的组织库进行软骨细胞培养。28至42天后,将培养的软骨细胞制成固体软骨移植物,植入距骨穹窿的损伤部位,并用纤维蛋白胶(Tissucol)固定。
2003年7月至2005年10月,5例患者采用此方法治疗,其中男性3例,女性2例。年龄范围为22至46岁。随访时间为6至24个月,平均12.6个月,患者在2周、2个月、6个月和1年时接受MRI检查。临床结果根据马祖尔和韦伯评分系统进行评估。
3例患者踝关节临床功能有显著改善,1例患者病情未变。1例患者手术结果因时间过短无法评估,但MRI结果显示移植物有良好整合的趋势。