Vascellari Alberto, Rebuzzi Enrico, Schiavetti Stefano, Coletti Nicolò
Department of Orthopaedic and Traumatology, Oderzo Hospital, Oderzo, Treviso, Italy,
Knee Surg Sports Traumatol Arthrosc. 2014 Jan;22(1):219-25. doi: 10.1007/s00167-013-2361-y. Epub 2013 Jan 16.
The purpose of this study was to determine the safety of a new arthroscopic Matrix-induced autologous chondrocyte implant (MACI) technique with carbon dioxide insufflation utilized to improve visualization during the dry phase of the scaffold implant.
Between 2004 and 2007, thirty patients were treated for symptomatic focal chondral lesions of the medial femoral condyle. All patients were monitored during surgery for gas embolism signs and symptoms and were evaluated preoperatively and at a median follow-up of 70.5 months (range 48-93 months) using the KOOS subjective evaluation score, the Lysholm function score, the Tegner activity scale for the knee, and the IKDC objective score.
No cases of intraoperative or postoperative symptoms or signs related to gas embolism or persistent subcutaneous emphysema were registered. Each subscale of the KOOS subjective score improved from preoperative to follow-up. The median Lysholm score was 50 (range 15-66) at baseline and 87.5 (range 54-100) at follow-up (p < 0.05). The median Tegner score was 2 (range 1-4) at baseline to 5 (range 2-7) at follow-up (p < 0.05).
No complications registered, and the satisfactory clinical results achieved in this series suggest that carbon dioxide insufflation during arthroscopic MACI is a safe and accessible option to improve visualization during the dry phase of the scaffold implant on medial femoral condyles.
本研究的目的是确定一种新的关节镜下基质诱导自体软骨细胞植入（MACI）技术的安全性，该技术采用二氧化碳充气以改善支架植入干燥阶段的视野。
在2004年至2007年期间，对30例有症状的股骨内侧髁局灶性软骨损伤患者进行了治疗。所有患者在手术期间均监测气体栓塞的体征和症状，并在术前以及中位随访70.5个月（范围48 - 93个月）时，使用膝关节损伤与骨关节炎疗效评分（KOOS）主观评估评分、Lysholm功能评分、膝关节Tegner活动量表以及国际膝关节文献委员会（IKDC）客观评分进行评估。
未记录到与气体栓塞或持续性皮下气肿相关的术中或术后症状或体征。KOOS主观评分的每个子量表从术前到随访均有所改善。Lysholm评分中位数在基线时为50（范围15 - 66），随访时为87.5（范围54 - 100）（p < 0.05）。Tegner评分中位数在基线时为2（范围1 - 4），随访时为5（范围2 - 7）（p < 0.05）。
未出现并发症，本系列取得的满意临床结果表明，关节镜下MACI手术期间的二氧化碳充气是一种安全且可行的选择，可改善股骨内侧髁支架植入干燥阶段的视野。
