CAJ | 학술논문

背景：如何利用组织工程学的方法促进膝关节软骨修复及缩短病程成为关节外科亟需解决的问题，而微骨折加干细胞移植疗法有可能为其开辟一条新的道路。目的：探讨关节镜下微骨折加自体骨髓间充质干细胞移植治疗膝关节软骨损伤的可行性。方法：2010年10月至2012年3月收治的膝关节软骨损伤患者16例，男12例，女4例；左膝11例、右膝5例；年龄16-52岁，平均38.6岁；所有病例软骨缺损均获得关节镜证实。治疗前2周抽取自体骨髓，分离骨髓间充质干细胞并行体外培养扩增，获取干细胞培养液3-5 mL(约107结果与结论：随访4-18个月，显效13例，有效2例，无效1例。Lysholm膝关节评分治疗前为42分(33-67分)，治疗4周后为89分(75-99分)，平均提高47分，随访均未出现症状反复和加重。结果可见关节镜下微骨折加自体骨髓间充质干细胞移植有效治疗膝关节软骨损伤，显著改善患者膝关节症状及恢复膝关节功能。个细胞)。膝关节镜下清理后微骨折尖锥于软骨缺损区钻孔，造成局部微骨折，排尽关节腔内积液，行微切口置入止血纱布贴覆软骨创面，注入制备好的骨髓间充质干细胞，弹力绷带加压包扎，早期CPM机锻炼。
배경：여하이용조직공정학적방법촉진슬관절연골수복급축단병정성위관절외과극수해결적문제，이미골절가간세포이식요법유가능위기개벽일조신적도로。목적：탐토관절경하미골절가자체골수간충질간세포이식치료슬관절연골손상적가행성。방법：2010년10월지2012년3월수치적슬관절연골손상환자16례，남12례，녀4례；좌슬11례、우슬5례；년령16-52세，평균38.6세；소유병례연골결손균획득관절경증실。치료전2주추취자체골수，분리골수간충질간세포병행체외배양확증，획취간세포배양액3-5 mL(약107결과여결론：수방4-18개월，현효13례，유효2례，무효1례。Lysholm슬관절평분치료전위42분(33-67분)，치료4주후위89분(75-99분)，평균제고47분，수방균미출현증상반복화가중。결과가견관절경하미골절가자체골수간충질간세포이식유효치료슬관절연골손상，현저개선환자슬관절증상급회복슬관절공능。개세포)。슬관절경하청리후미골절첨추우연골결손구찬공，조성국부미골절，배진관절강내적액，행미절구치입지혈사포첩복연골창면，주입제비호적골수간충질간세포，탄력붕대가압포찰，조기CPM궤단련。
BACKGROUND:It has been an urgent problem of how to promote cartilage repair of the knee and shorten the total course through a tissue engineering approach. Fortunately, microfracture plus stem cel transplantation may open up a new path for this issue. OBJECTIVE:To investigate the clinic feasibility of arthroscopic microfracture technique plus stem cel transplantation for repair of articular cartilage injury of the knee. METHODS:From October 2010 to March 2012, a total of 16 patients with articular cartilage injury of the knee were enrol ed, including 12 males and 4 females, with the average age of 38.6 years (16-52). Al cases of cartilage injury were confirmed by arthroscopy. Autologous bone marrow was extracted from patients at 2 weeks before treatment to isolate, culture and amplify bone marrow mesenchymal stem cel s in vitro. The cel culture solution of 3-5 mL (about 107 cel s) was harvested. The articular cavity was clean by arthroscopy and microfracture technique was performed at the area of cartilage injury that was then covered with hemostatic gauze through a minimal y invasive incision and the prepared bone marrow mesenchymal stem cel s were injected. The knee was bandaged with the elastic bandage after aspirating the joint cavity effusion by vacuum suction. Functional exercises were performed early by CPM.RESULTS AND CONCLUSION:After fol ow-up of 4-18 months, there were 13 cases of excel ent, 2 cases of valid and 1 case of ineffective. According to Lysholm knee scores, the average scores were improved from 42 points (33-67 points) to 89 points (75-99 points) at 4 weeks after treatment. The function was satisfied and al patients were fol owed up without recurrence or worse. Under the arthroscopy, the combination of microfracture technique and autologous bone marrow mesenchymal stem cel transplantation is proved to be effective for articular cartilage injury of the knee and it can notably improve the clinic symptoms and recover the function of the knee.