浓缩骨髓抽吸术可能降低自体骨软骨移植治疗距骨骨软骨病变术后囊肿发生率。
Concentrated Bone Marrow Aspirate May Decrease Postoperative Cyst Occurrence Rate in Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus.
机构信息
Hospital for Special Surgery, New York, New York, U.S.A.; Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan; Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
出版信息
Arthroscopy. 2019 Jan;35(1):99-105. doi: 10.1016/j.arthro.2018.06.047. Epub 2018 Nov 10.
PURPOSE
To clarify if the use of concentrated bone marrow aspirate (CBMA) would affect both postoperative functional outcomes and magnetic resonance imaging (MRI) outcomes compared with those of autologous osteochondral transplantation (AOT) alone; in addition, to assess the efficacy of CBMA reducing the presence of postoperative cyst formation following AOT in the treatment of osteochondral lesions of the talus.
METHODS
Fifty-four (92%) of 59 eligible patients who underwent AOT between 2004 and 2008 were retrospectively assessed at a minimum of 5-year follow-up. Twenty-eight patients were treated with AOT and CBMA (AOT/CBMA group) and 26 patients were treated with AOT alone (AOT-alone group). Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12) preoperatively and at final follow-up. Postoperative MRI was evaluated with the modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. Cyst formation was also evaluated on postoperative MRI.
RESULTS
The mean FAOS and SF-12 significantly improved in both the AOT/CBMA and AOT-alone groups, but there were no statistical differences between groups in FAOS (80.5 vs 75.5, P = .225) and SF-12 (71.1 vs 69.6, P = .756) at final follow-up. Additionally, there was no difference in the mean MOCART score (80.4 vs 84.3, P = .484); however, AOT/CBMA did result in a statistically lower rate of cyst formation (46.4% vs 76.9%, P = .022). No significant differences were found in the mean postoperative FAOS and SF-12 between patients with and without cysts postoperatively.
CONCLUSIONS
CBMA reduced postoperative cyst occurrence rate in patients treated with AOT; however, CBMA did not result in significant differences in medium term functional outcomes and MOCART score in patients who underwent AOT.
LEVEL OF EVIDENCE
Level III, retrospective comparative trial.
目的
明确与单纯自体软骨移植（AOT）相比，使用浓缩骨髓抽吸物（CBMA）是否会同时影响术后功能结果和磁共振成像（MRI）结果；此外，评估 CBMA 在治疗距骨骨软骨病变中减少 AOT 术后囊肿形成的效果。
方法
2004 年至 2008 年间，对 59 例符合条件的患者中，有 54 例（92%）在至少 5 年的随访后进行回顾性评估。28 例患者接受 AOT 和 CBMA 联合治疗（AOT/CBMA 组），26 例患者仅接受 AOT 治疗（AOT 组）。术前和最终随访时采用足踝结局评分（FAOS）和简短形式 12 项健康调查量表（SF-12）评估临床结果。术后 MRI 采用改良的磁共振软骨修复组织观察评分系统（MOCART）进行评估。术后 MRI 还评估了囊肿形成情况。
结果
AOT/CBMA 组和 AOT 组的 FAOS 和 SF-12 均有显著改善，但组间 FAOS（80.5 对 75.5，P=0.225）和 SF-12（71.1 对 69.6，P=0.756）无统计学差异。此外，MOCART 评分均值（80.4 对 84.3，P=0.484）也无差异；但 AOT/CBMA 组囊肿形成率显著较低（46.4%对 76.9%，P=0.022）。术后有囊肿的患者和无囊肿的患者术后 FAOS 和 SF-12 均值无显著差异。
结论
AOT 中添加 CBMA 可降低术后囊肿发生率，但在接受 AOT 的患者中，在中期功能结果和 MOCART 评分方面并无显著差异。
证据等级
III 级，回顾性对比试验。
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