Vilá Y Rico Jesús, Dalmau Antonio, Chaqués Francisco Javier, Asunción Jordi
Department of Orthopaedics, Complutense University School of Medicine, Madrid, Spain; Department of Orthopaedic and Trauma Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain.
Department of Orthopedic and Trauma Surgery, Hospital ASEPEYO, Sant Cugat del Vallès, Spain.
Arthrosc Tech. 2015 Nov 9;4(6):e663-7. doi: 10.1016/j.eats.2015.07.008. eCollection 2015 Dec.
Bone marrow stimulation (BMS) techniques represent the first-line treatment for unstable osteochondral lesions of the talus or after conservative treatment failure. These techniques are intended to penetrate the subchondral bone to elicit bleeding and allow precursor cells and cytokines from bone marrow to populate the lesion. However, the fibrocartilaginous repair tissue arising after marrow stimulation confers inferior mechanical and biological properties compared with the original hyaline cartilage. The limitations of BMS can be overcome by the use of the soluble chitosan-based polymer BST-CarGel (Piramal Life Sciences, Laval, Quebec, Canada). When mixed with freshly drawn autologous whole blood and applied to a lesion surgically prepared by BMS, BST-CarGel acts as a natural bioscaffold that increases the quantity and improves the residency of the blood clot formed in the cartilage lesion, enhancing the local healing response. The use of BST-CarGel has been previously described in the knee and hip joints with successful results. We describe the arthroscopic technique for BST-CarGel application in combination with BMS techniques for the treatment of osteochondral lesions of the talus.
骨髓刺激（BMS）技术是距骨不稳定骨软骨损伤或保守治疗失败后的一线治疗方法。这些技术旨在穿透软骨下骨以引发出血，并使骨髓中的前体细胞和细胞因子聚集在损伤部位。然而，与原始透明软骨相比，骨髓刺激后产生的纤维软骨修复组织的机械和生物学特性较差。使用基于壳聚糖的可溶性聚合物BST-CarGel（加拿大魁北克省拉瓦尔市的Piramal生命科学公司）可以克服BMS的局限性。当与新鲜采集的自体全血混合并应用于通过BMS手术制备的损伤部位时，BST-CarGel作为一种天然生物支架，可增加软骨损伤处形成的血凝块数量并改善其驻留性，增强局部愈合反应。BST-CarGel的应用此前已在膝关节和髋关节中得到描述，并取得了成功结果。我们描述了结合BMS技术应用BST-CarGel治疗距骨骨软骨损伤的关节镜技术。
