Department for Foot and Ankle Surgery Nuremberg and Rummelsberg, Hospital location Rummelsberg, Rummelsberg 71, 90592, Schwarzenbruck, Germany.
Oper Orthop Traumatol. 2021 Dec;33(6):471-479. doi: 10.1007/s00064-021-00742-7. Epub 2021 Nov 3.
Chondral restoration in chondral defects of the 1st metatarsophalangeal joint (MTP1) using autologous matrix-induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC).
Chondral defects MTP1.
Acute infection.
Thigh tourniquet. Medial approach. Tenolysis of all tendons, arthrolysis, synovectomy. Bursectomy in case of bursitis. Resection osteophytes, optional cheilectomy. Debridement of chondral defects until surrounding cartilage stable. Microfracturing with 1.6 mm K‑wire. 15 cc peripheral venous blood harvested with double lumina syringe. Centrifugation (10 min, 1500 RPM). Aspiration of supernatant including the entire fluid layer directly above the erythrocyte layer (peripheral blood concentrate [PBC]). Chondro-Gide matrix was cut to size and impregnated in PBC 3 min (impregnation). Fixation of the matrix into the chondral defect with fibrin glue (AMIC+PBC). Joint motion to ensure stable fixation. Insertion drainage and wound infiltration catheter. Layer wise closure.
Full weightbearing in a dressing shoe. Joint motion exercise starting at the day of surgery.
The aim of the study was to compare matrix-associated stem cell transplantation (MAST) with AMIC+PBC. Patients who were treated with MAST from October 1, 2011 to July 15, 2016 (n = 623) or with AMIC+PBC from July 17, 2016 to March 19, 2018 (n = 230) were included. In all, 480 (89%)/176 (89%) patients (MAST/AMIC+PBC) completed 2‑year follow-up. The average degree of osteoarthritis was 2.1/2.2. The chondral defect size was 0.9/1.0 cm on average. Visual Analogue Scale Foot and Ankle (VAS FA) and European Foot and Ankle Society score (EFAS score) improved to 72.4/74.1//16.8/17.1 (MAST//AMIC+PBC) at follow-up, respectively. No parameter significantly differed between the MAST and AMIC+PBC cohorts.
使用自体诱导软骨再生联合外周血浓缩物（AMIC+PBC）修复第一跖趾关节（MTP1）的软骨缺损。
MTP1 软骨缺损。
急性感染。
大腿止血带。内侧入路。所有肌腱松解、关节松解、滑膜切除术。如有滑囊炎行滑囊切除术。切除骨赘，选择性行趾甲切除术。软骨缺损处清创至周围软骨稳定。用 1.6mm K 线进行微骨折。用双腔注射器采集 15cc 外周静脉血。离心（10min，1500RPM）。抽吸包括红细胞层正上方整个液层的上清液（外周血浓缩物[PBC]）。将软骨 -Gide 基质切成合适的大小并在 PBC 中浸泡 3 分钟（浸泡）。用纤维蛋白胶将基质固定在软骨缺损处（AMIC+PBC）。关节运动以确保稳定固定。插入引流和浸润导管。分层缝合。
穿敷料鞋完全负重。术后当天开始关节运动练习。
该研究的目的是比较基质相关干细胞移植（MAST）与 AMIC+PBC。2011 年 10 月 1 日至 2016 年 7 月 15 日接受 MAST 治疗的患者（n=623）或 2016 年 7 月 17 日至 2018 年 3 月 19 日接受 AMIC+PBC 治疗的患者（n=230）被纳入研究。共有 480 例（89%）/176 例（89%）患者（MAST/AMIC+PBC）完成了 2 年随访。平均骨关节炎程度为 2.1/2.2。平均软骨缺损大小为 0.9/1.0cm。视觉模拟评分足踝（VAS FA）和欧洲足踝协会评分（EFAS 评分）在随访时分别改善至 72.4/74.1/16.8/17.1（MAST/AMIC+PBC）。MAST 和 AMIC+PBC 两组之间没有显著差异。
