Wang Bin, Xi Zhijie, Liang Qianqian, Mi Kun, Feng Zhibin
The Second Department of Orthopaedics, the First Affiliated Hospital, University of Guangxi Traditional Chinese Medicine, Nanning Guangxi, 530023, P.R.China.
Department of Traumatic Surgery, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jan 15;31(1):98-104. doi: 10.7507/1002-1892.201607097.
To determine the short-term effectiveness of matrix-induced autologous chondrocyte implantation (MACI) for femoral trochlea cartilage injury.
A retrospective analysis was performed on the clinical data of 10 patients with femoral trochlea cartilage injury treated with MACI between June 2012 and October 2014. There were 6 males and 4 females, aged from 15 to 48 years (mean, 33 years). The left knee was involved in 3 cases and the right knee in 7 cases. Nine patients had a history of trauma, and 1 case suffered from osteochondritis dissecans. Combined injuries included meniscus injury in 1 case, anterior cruciate ligament injury in 3 cases, and lateral collateral ligament tear in 2 cases. The mean lesion depth was 2.80 mm (range, 2-7 mm), with the mean defect size of 84.85 mm (range, 28.26-153.86 mm ). The mean duration of definite diagnosis was 14 days (range, 5 days to 3 months). By using arthroscopic biopsy, 200-300 mg healthy articular cartilage at non weight-bearing area of the knee femoral trochlea was collected as a source of seed cells, which were isolated and cultured to prepare MACI membrane. The adhesion activity, growth rate, and mechanical properties of the chondrocytes on the Bio-gide collagen scaffold were evaluated. In addition, the stretch rate, tensile strength, and suture strength of scaffold were tested. MACI membrane was implanted after 2 weeks to 6 months. The visual analogou scale (VAS), Lysholm score, and Tegner movement level score at preoperation and last follow-up were used to assess the function.
The MACI membrane was successfully prepared, and the human chondrocytes adhered and grew well on the Bio-gide collagen scaffold. Mechanical test showed that MACI membrane had the stretch rate of 65.27%, the tensile strength of 26.81 MPa, and the suture strength of 6.49 N, indicating good mechanical properties. MACI membrane was successfully implanted. The mean operation time was 58.5 minutes (range, 43-99 minutes), and the mean hospitalization time was 7 days (range, 6-15 days). All incisions healed well. Ten cases were followed up 9 to 16 months (mean, 12 months). Four cases underwent iliac bone graft surgery. The mean healing time was 14 weeks (range, 12-16 weeks). No complications of osteochondrolysis, knee pain, nerve and vascular injury, deep vein thrombosis, and knee adhesion occurred during follow-up. The VAS score, Lysholm score, and Tegner score at last follow-up were significantly improved when compared with preoperative scores ( =12.060, =0.000; =-9.200, =0.000; =-14.000, =0.000).
MACI for femoral trochlea cartilage injury has good short-term effectiveness, with less injury and fast function recovery.
确定基质诱导自体软骨细胞植入术（MACI）治疗股骨滑车软骨损伤的短期疗效。
对2012年6月至2014年10月间接受MACI治疗的10例股骨滑车软骨损伤患者的临床资料进行回顾性分析。其中男性6例，女性4例，年龄15至48岁（平均33岁）。左膝3例，右膝7例。9例有外伤史，1例患有剥脱性骨软骨炎。合并损伤包括半月板损伤1例、前交叉韧带损伤3例、外侧副韧带撕裂2例。平均损伤深度为2.80mm（范围2 - 7mm），平均缺损面积为84.85mm²（范围28.26 - 153.86mm²）。明确诊断的平均时间为14天（范围5天至3个月）。通过关节镜活检，在膝关节股骨滑车非负重区采集200 - 300mg健康关节软骨作为种子细胞来源，进行分离培养以制备MACI膜。评估软骨细胞在Bio - gide胶原支架上的黏附活性、生长速率和力学性能。此外，测试支架的拉伸率、拉伸强度和缝合强度。2至6个月后植入MACI膜。采用术前及末次随访时的视觉模拟评分（VAS）、Lysholm评分和Tegner运动水平评分评估功能。
成功制备了MACI膜，人软骨细胞在Bio - gide胶原支架上黏附生长良好。力学测试显示MACI膜的拉伸率为65.27%，拉伸强度为26.81MPa，缝合强度为6.49N，表明力学性能良好。MACI膜成功植入。平均手术时间为58.5分钟（范围43 - 99分钟），平均住院时间为7天（范围6 - 15天）。所有切口愈合良好。10例患者随访9至16个月（平均12个月）。4例接受了髂骨移植手术。平均愈合时间为14周（范围12 - 16周）。随访期间未发生骨软骨溶解、膝关节疼痛、神经和血管损伤、深静脉血栓形成及膝关节粘连等并发症。末次随访时的VAS评分、Lysholm评分和Tegner评分与术前评分相比均显著改善（=12.060，=0.000；=-9.200，=0.000；=-14.000，=0.000）。
MACI治疗股骨滑车软骨损伤具有良好的短期疗效，损伤小且功能恢复快。
