Centre of Regenerative Medicine, Danube University, Krems, Austria.
Am J Sports Med. 2009 Nov;37 Suppl 1:81S-87S. doi: 10.1177/0363546509350704. Epub 2009 Oct 27.
Tissue engineering has become available for cartilage repair in clinical practice.
The treatment of full-thickness chondral defects in the knee with a hyaluronan-based scaffold seeded with autologous chondrocytes provides stable improvement of clinical outcome up to 7 years.
Case series; Level of evidence, 4.
Fifty-three patients with deep osteochondral defects in the knee were treated with Hyalograft C. The mean age at implantation was 32 +/- 12 years, the mean defect size was 4.4 +/- 1.9 cm(2), and the mean body mass index was 24.5 +/- 3.8 kg/m(2). Implantations were performed with miniarthrotomy or arthroscopy. The primary indications for implantation with Hyalograft C included young patients with a stable joint, normal knee alignment, and isolated chondral defects with otherwise healthy adjacent cartilage. The secondary indications were patients who did not meet the primary indication criteria or were salvage procedures. Forty-two patients with primary indications and 11 patients with secondary indications were evaluated. Outcome was evaluated with the International Cartilage Repair Society and International Knee Documentation Committee scales, the Lysholm score, the modified Cincinnati score, and with Kaplan-Meier survival analysis. Statistical analysis consisted of bivariate correlation analysis and unpaired, 2-tailed t tests.
A highly significant increase (P <.001) in all knee scores was found in patients treated for the primary indications. Nine of 11 secondary indication cases underwent total knee arthroplasty due to persisting pain between 2 and 5 years after implantation. Graft failure occurred in 3 of 42 patients with primary indication between 6 months and 5 years after implantation. Kaplan-Meier survival demonstrated significantly different chances for survival between primary and secondary outcome and between simple, complex, and salvage cases, respectively (P <.001).
Hyalograft C autograft provides clinical improvement in healthy young patients with single cartilage defects. Less complicated surgery and lower morbidity are considered advantages of the technique. The results of treatment with Hyalograft C as a salvage procedure or in patients with osteoarthritis are poor.
组织工程已应用于临床软骨修复。
用透明质酸支架接种自体软骨细胞治疗膝关节全层软骨缺损，可稳定改善临床结果，持续 7 年。
病例系列；证据水平，4 级。
53 例膝关节深骨软骨缺损患者接受 Hyalograft C 治疗。植入时的平均年龄为 32 ± 12 岁，平均缺损大小为 4.4 ± 1.9cm2，平均体重指数为 24.5 ± 3.8kg/m2。植入采用小关节切开术或关节镜。Hyalograft C 植入的主要适应证包括年轻、关节稳定、膝关节对线正常、孤立性软骨缺损且相邻软骨健康的患者。次要适应证包括不符合主要适应证标准或为挽救性手术的患者。原发性适应证 42 例，继发性适应证 11 例。采用国际软骨修复学会和国际膝关节文献委员会评分、Lysholm 评分、改良辛辛那提评分和 Kaplan-Meier 生存分析评估结果。统计分析包括双变量相关分析和非配对、双尾 t 检验。
原发性适应证患者的所有膝关节评分均显著升高（P <.001）。植入后 2-5 年，11 例继发性适应证患者中有 9 例因持续疼痛行全膝关节置换术。原发性适应证的 42 例患者中有 3 例在植入后 6 个月至 5 年内发生移植物失败。Kaplan-Meier 生存分析显示，原发性和继发性结果、单纯性、复杂性和挽救性病例的生存机会差异有统计学意义（P <.001）。
Hyalograft C 自体移植物可改善健康年轻患者的单一软骨缺损。该技术的优点是手术相对简单，发病率较低。Hyalograft C 作为挽救性手术或治疗骨关节炎患者的疗效较差。
