CAJ | 학술논문

目的：探讨自体软骨细胞结合Ⅰ型胶原蛋白三维支架治疗膝关节软骨损伤的近期疗效。方法回顾性分析2013年1月至2014年3月采用自体软骨细胞结合Ⅰ型胶原三维支架移植治疗膝关节软骨缺损患者共9例（9膝），男6例，女3例；年龄18~41岁，平均（30±7.8）岁。软骨缺损位于股骨髁4例、股骨滑车4例、髌骨1例，缺损面积2.5~10 cm2，平均（4.9±2.1）cm2。一期手术关节镜下在膝关节股骨髁非负重区获取全层软骨，约0.5 cm×1.0 cm，进行软骨细胞培养和体外扩增8~14 d；二期手术采用冻干人纤维蛋白胶将载有软骨细胞的冻胶原移植物黏附于缺损部位。术后进行严格的康复训练。术前及术后3、6、12个月进行国际膝关节文献委员会（International Knee Documentation Committee，IKDC）评分、Lysh?lm主观膝关节评分，术后3天内、1、3、6及12个月进行膝关节MR检查及软骨修复组织的核磁共振评分（magnetic res?onance observation of cartilage repair tissue, MOCART）。结果9例患者均获得临床随访，术前IKDC评分为（52.7±6.9）分，术后3、6、12个月分别为（71.1±6.6）分、（83.3±2.9）分和（92.0±3.6）分，差异有统计学意义；术前Lysh?lm评分为（55.8±8.7）分，术后3、6、12个月分别为（74.8±7.0）分、（84.8±4.8）分和（93.1±5.7）分，差异有统计学意义。8例患者获得MRI随访，术后3天内、1、3、6及12个月MOCART评分为（43.6±6.0）分、（47.8±5.8）分、（57.8±5.8）分、（64.3±4.8）分和（72.1±4.9）分，差异有统计学意义；术后12个月，T2 Mapping定量测量示移植物T2值为（48.7±3.2）ms，与正常区域对照差异无统计学意义。结论自体软骨细胞结合Ⅰ型胶原蛋白三维支架治疗膝关节软骨损伤近期疗效满意。
목적：탐토자체연골세포결합Ⅰ형효원단백삼유지가치료슬관절연골손상적근기료효。방법회고성분석2013년1월지2014년3월채용자체연골세포결합Ⅰ형효원삼유지가이식치료슬관절연골결손환자공9례（9슬），남6례，녀3례；년령18~41세，평균（30±7.8）세。연골결손위우고골과4례、고골활차4례、빈골1례，결손면적2.5~10 cm2，평균（4.9±2.1）cm2。일기수술관절경하재슬관절고골과비부중구획취전층연골，약0.5 cm×1.0 cm，진행연골세포배양화체외확증8~14 d；이기수술채용동간인섬유단백효장재유연골세포적동효원이식물점부우결손부위。술후진행엄격적강복훈련。술전급술후3、6、12개월진행국제슬관절문헌위원회（International Knee Documentation Committee，IKDC）평분、Lysh?lm주관슬관절평분，술후3천내、1、3、6급12개월진행슬관절MR검사급연골수복조직적핵자공진평분（magnetic res?onance observation of cartilage repair tissue, MOCART）。결과9례환자균획득림상수방，술전IKDC평분위（52.7±6.9）분，술후3、6、12개월분별위（71.1±6.6）분、（83.3±2.9）분화（92.0±3.6）분，차이유통계학의의；술전Lysh?lm평분위（55.8±8.7）분，술후3、6、12개월분별위（74.8±7.0）분、（84.8±4.8）분화（93.1±5.7）분，차이유통계학의의。8례환자획득MRI수방，술후3천내、1、3、6급12개월MOCART평분위（43.6±6.0）분、（47.8±5.8）분、（57.8±5.8）분、（64.3±4.8）분화（72.1±4.9）분，차이유통계학의의；술후12개월，T2 Mapping정량측량시이식물T2치위（48.7±3.2）ms，여정상구역대조차이무통계학의의。결론자체연골세포결합Ⅰ형효원단백삼유지가치료슬관절연골손상근기료효만의。
Objective To evaluate the clinical effectiveness of 3?dimensional scaffold of typeⅠcollagen based autolo?gous chondrocyte implantation (ACI). Methods Nine patients of knee articular cartilage defect treated with 3?dimensional scaf?fold of type Ⅰcollagen based ACI from January 2013 to March 2014 was analyzed retrospectively, including 6 males and 3 fe?males with an average age of 30 years old. 4 defects located in femoral condyle, 4 in trochlea and 1 in patellae with a mean size of 4.9 ± 2.1cm2 (range, 2.5-10). ACI comprises 2?stage procedure:chondrocytes were first harvested from non?load bearing area of femoral condyle, then chondrocytes expand in vitro for 8-14 days to get enough cells. On second stage, cartilage defects were cov?ered by the grafts and fixed with fibrin albumen glue. All patients received strict rehabilitation protocol. International Knee Docu?mentation Committee (IKDC) scores and Lysh?lm scores were compared pre?operatively and 3, 6, 12 months post?operatively. MR and magnetic resonance observation of cartilage repair tissue (MOCART) scores were analyzed within 3 days, 3, 6, 12 months post?operatively. Results All the patients were followed up. IKDC score was 52.7 ± 6.9 pre?operatively and respectively 71.1 ± 6.6, 83.3±2.9 and 92.0±3.6 3, 6, 12 months post?operatively with significant differences. The Lysh?m score was 55.8±8.7 pre?oper?atively and respectively 74.8±7.0, 84.8±4.8 and 93.1±5.7 3, 6, 12 months post?operatively with significant differences. 8 patients had MRI. The mean MOCART score 3 days, 3, 6, 12 months post?operatively was respectively 43.6±6.0, 47.8±5.8, 57.8±5.8, 64.3± 4.8 and 72.1±4.9 with significant differences. T2 value of transplanted area was 48.7±3.2 12 months post?operatively with no sig?nificant differences compared to normal area. Conclusion Three?dimensional scaffold of typeⅠcollagen based ACI could re?pair knee articular cartilage defect. It may be a good choice for treating articular cartilage defect which shows satisfactory results.