自体软骨细胞移植术后的失败、再手术和并发症——系统评价。
Failures, re-operations, and complications after autologous chondrocyte implantation--a systematic review.
机构信息
The Ohio State University Sports Medicine Center, Cartilage Restoration Program, Columbus, OH 43221, USA.
出版信息
Osteoarthritis Cartilage. 2011 Jul;19(7):779-91. doi: 10.1016/j.joca.2011.02.010. Epub 2011 Feb 17.
OBJECTIVE
To determine and compare failure, re-operation, and complication rates of all generations and techniques of autologous chondrocyte implantation (ACI).
METHODS
A systematic review of multiple medical databases was performed according to PRISMA guidelines. Levels I-IV evidence were included. Generations of ACI and complications after ACI were explicitly defined. All subject and defect demographic data were analyzed. Modified Coleman Methodology Scores (MCMSs) were calculated for all studies.
RESULTS
82 studies were identified for inclusion (5276 subjects were analyzed; 6080 defects). Ninety percent of the studies in this review were rated poor according to the MCMS. There were 305 failures overall (5.8% subjects; mean time to failure 22 months). Failure rate was highest with periosteal ACI (PACI). Failure rates after PACI, collagen-membrane cover ACI (CACI), second generation, and all-arthroscopic, second-generation ACI were 7.7%, 1.5%, 3.3%, and 0.83%, respectively. The failure rate of arthrotomy-based ACI was 6.1% vs 0.83% for all-arthroscopic ACI. Overall rate of re-operation was 33%. Re-operation rate after PACI, CACI, and second-generation ACI was 36%, 40%, and 18%, respectively. However, upon exclusion of planned second-look arthroscopy, re-operation rate was highest after PACI. Unplanned re-operation rates after PACI, CACI, second-generation, and all-arthroscopic second-generation ACI were 27%, 5%, 5%, and 1.4%, respectively. Low numbers of patients undergoing third-generation ACI precluded comparative analysis of this group.
CONCLUSIONS
Failure rate after all ACI generations is low (1.5-7.7%). Failure rate is highest with PACI, and lower with CACI and second-generation techniques. One out of three ACI patients underwent a re-operation. Unplanned re-operations are seen most often following PACI. Hypertrophy and delamination is most commonly seen after PACI. Arthrofibrosis is most commonly seen after arthrotomy-based ACI. Use of a collagen-membrane cover, second-generation techniques, and all-arthroscopic, second-generation approaches have reduced the failure, complication, and re-operation rate after ACI.
目的
确定并比较自体软骨细胞移植（ACI）所有代次和技术的失败率、再手术率和并发症率。
方法
根据 PRISMA 指南，对多个医学数据库进行了系统评价。纳入 I-IV 级证据。明确了 ACI 的代次和 ACI 后的并发症。分析所有受试者和缺陷的人口统计学数据。对所有研究进行改良科尔曼方法学评分（MCMS）计算。
结果
共纳入 82 项研究（分析了 5276 名受试者；6080 个缺陷）。根据 MCMS，本综述中的 90%研究被评为较差。总的来说，有 305 例失败（5.8%的受试者；平均失败时间为 22 个月）。骨膜 ACI（PACI）的失败率最高。PACI、胶原膜覆盖 ACI（CACI）、第二代和全关节镜下第二代 ACI 的失败率分别为 7.7%、1.5%、3.3%和 0.83%。关节切开术 ACI 的失败率为 6.1%，全关节镜下 ACI 为 0.83%。再手术率总体为 33%。PACI、CACI 和第二代 ACI 后的再手术率分别为 36%、40%和 18%。然而，排除计划中的二次关节镜检查后，PACI 的再手术率最高。PACI、CACI、第二代和全关节镜下第二代 ACI 的非计划性再手术率分别为 27%、5%、5%和 1.4%。接受第三代 ACI 的患者数量较少，无法对该组进行比较分析。
结论
所有 ACI 代次的失败率都较低（1.5-7.7%）。PACI 的失败率最高，CACI 和第二代技术的失败率较低。三分之一的 ACI 患者接受了再手术。最常发生非计划性再手术的是 PACI。PACI 后最常见的是肥大和分层。关节切开术 ACI 后最常见的是关节纤维化。使用胶原膜覆盖物、第二代技术和全关节镜下第二代方法降低了 ACI 后的失败率、并发症率和再手术率。
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