自體移植軟骨細胞可有效治療腳踝的軟骨細胞損傷


  Feb. 10, 2003(紐奧良)-根據一個小型的前瞻性研究顯示,自體移植植入軟骨細胞不但證實可有效治療膝蓋的骨軟骨缺陷,還能促進腳踝的骨軟骨缺陷及早癒合。
  
  美國南加州Van Nuys整形外科研究院的Richard D. Ferkel博士在與第70屆美國矯形外科學會年會,同時舉行的第33屆美國腳和踝關節矯形外科學會(American Orthopaedic Foot and Ankle Society)年會中報告他的這個小型前瞻性研究結果。
  
  Ferkel表示,這個植入手術的效果已經確定,但仍有許多尚待瞭解的地方。Ferkel雖然總共完成了12位患者的植入手術,在會中只報告了其中11位患者的手術結果。
  
  這11位患者的平均年齡為35歲,其中5位為男性,且其中9位過去曾做過失敗的矯正手術,他們的傷口都很大,有9個病例的骨缺陷是發生在中間與兩側,但Ferkel博士將手術的使用限定於2 cm2的單極性傷害。
  
  研究中有6位患者進行一連串骨軟骨移植手術,以及在兩層骨膜組織中植入軟骨細胞的「三明治步驟」,這樣的技術可以達到最好的效果,患者也最滿意。
  
  在體外培養出來的自體移植軟骨細胞所進行的標準植入手術,是在分離的軟骨細胞擴張後,利用骨膜組織來覆蓋。
  
  開始時,可利用膝關節鏡來取得髁內凹的適當切片,或以腳踝的關節鏡來檢查整個腳踝的軟骨缺損情況,再利用踝骨切骨術將軟骨細胞植入踝骨下,但未來這部分應該也能以關節鏡來完成。
  
  後續平均追蹤期為25個月(13 - 44個月),11位參與研究的患者中,有10位施行了第2次的關節鏡檢查,結果都不錯,隨著追蹤時間的延長,骨骼硬度也逐漸增加,最大的臨床及組織學結果是在24個月後發生。併發症包括組織黏連、移植組織肥大。
  
  主持這節會議的Orthopedics國際公司Pierce E. Scranton, Jr.博士表示,自體移植植入軟骨細胞與其它生物技術被視為是整形外科下一個促進癒合的新時代,在此之前我們都無法修復這類的軟骨組織,如今有了自體移植植入軟骨細胞的技術,以後這類病例勢必會逐漸減少。
  
  但在能信心十足地應用這項技術前,仍需要有更大型、追蹤時間更久的前瞻性研究來確認其效果,甚至加入腳踝軟骨細胞缺陷的標準療程中。
  
  

Chondrocyte Implants May Be Ef

By Peggy Peck
Medscape Medical News

Feb. 10, 2003 (New Orleans) — Autologous chondrocyte implantation, which has already demonstrated efficacy for treatment of osteochondral defects in the knee, may be equally effective to promote healing of osteochondral lesions of the talus, according to the results of a small prospective study.

Richard D. Ferkel, MD, from the Southern California Orthopedic Institute in Van Nuys, California, presented results from his small prospective study at the American Orthopaedic Foot and Ankle Society 33rd Annual Meeting, which was held as part of the Specialty Day here at the 70th Annual Meeting of the American Academy of Orthopaedic Surgeons.

Dr. Ferkel told Medscape that the implant procedure is "promising but we are still learning about the role of implants." He reported results from 11 patients, although he said he has now completed implants on 12 patients.

Five patients were men, mean age was 35 years, and nine of the 11 patients had previously failed surgery to correct the defect. Nine lesions were medial and two lateral. He said that he has limited the procedure to "unipolar lesions with a focal defect of more than 2 cm2."

Six of the patients in the series underwent a bone graft and a "sandwich procedure" in which the chondrocytes are implanted between two layers of periosteal tissue. Dr. Ferkel said he thinks this technique achieves the best results and patient satisfaction is greatest with this technique. "These patients had very large lesions," he said.

The standard procedure implants in vitro cultured autologous chondrocytes using periosteal tissue cover after expansion of isolated chondrocytes.

Initially, arthroscopy of knee is performed to obtain an appropriate biopsy from the intracondylar notch. At the same time, a baseline ankle arthroscopy is performed to document the appearance of the entire ankle as well as the osteochondral lesion.

The multiplied cells are later implanted under the talus via a malleolar osteotomy. "But I think the future of this procedure will be arthroscopic implants," Dr. Ferkel said.

The average follow-up in this series was 25 months (range, 13 - 44 months), he said. Ten of the 11 patients have undergone second-look arthroscopy and the results generally have been good. "Firmness increased with follow-up and the maximum clinical and histological results are reached around 24 months," he said. Complications in the series included adhesions and graft hypertrophy.

Pierce E. Scranton, Jr., MD, from Orthopedics International, Ltd., in Seattle, Washington, told Medscape that autologous chondrocyte implantation and other biological techniques mark a new age of "enhanced healing that will be the next frontier in orthopaedics." Dr. Scranton, who chaired the session on innovations in foot and ankle surgery, said that "up until this time we were helpless when it came to repairing these types of defects or to repairing cartilage damage caused by arthritis. But that is no longer the case."

Dr. Ferkel, however, cautioned that a "much larger, prospective series of autologous chondrocyte implants must be done and we need longer follow-up before we can confidently add this procedure to the list of surgical treatments for osteochondral lesions of the talus."

AAOS 70th Annual Meeting: Specialty Day — AOFAS 33rd Annual Meeting. Presented Feb. 8, 2003.

Reviewed by Gary D. Vogin, MD

    
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