髕骨軟骨傷害者植入透明質酸支架成功長出自體軟骨細胞


  Feb. 28, 2005 - 一項先期性的試驗發現,在33位髕骨軟骨傷害的患者身上,植入透明質酸支架(Hyalograft-C)後,成功的長出了自體軟骨細胞。
  
  來自義大利米蘭Orthopaedic Arthroscopic Surgery International的Alberto Gobbi醫師,在美國骨科運動醫學會的72屆年會中,作出以上表示。
  
  紐約婦女運動醫學中心的Beth E. Shubin Stein醫師指出,如果這項技術可以在更多人身上成功運作,那將會是一項很先進的技術,因為支架具有多方面的好處。
  
  Stein醫師向Medscape表示,這對髕骨傷害的患者可能很有幫助,因為這類患者無法以自體軟骨細胞移植(ACI)的方式作有效治療;而運用本項技術,不須打開膝蓋的手術,可以利用關節鏡手術法進行;另外,ACI需要顯微縫合技術,但支架法卻不用,你只要把它貼附上去就好。
  
  目前為止,Gobbi醫師已經以支架法治療了33位患者,平均年齡為30.5歲;因外傷而髕骨受傷的有16位,因骨間偏離造成者有14位,關節軟骨損傷者(OCD)有3位;其中的三位曾經進行過手術,至少有一位引發側邊病變;平均的受傷範圍為7平方公分。
  
  外科醫師以關節鏡對其中22位患者進行手術,其餘的則使用小型關節切開術;所有的患者皆在第12個月時,接受核磁共振(MRI)檢查,其中的6位患者則另行追加第二次關節鏡手術及切片檢查。
  
  平均追蹤期為28個月,其中,Gobbi醫師進行疼痛評估時,發現到效果有著明顯的進步,80%的患者生活品質獲得明顯的改善;使用ICRS-IKDC評估系統後發現,改善的幅度非常的明顯;在MRI檢查中,在12個月以後,33位患者中有24位的軟骨平面已接近正常,而這些觀察到的狀況和後來的結果皆相符;另外,8個月以後所進行的第二次關節鏡手術顯示,植入物已和周圍的軟骨組織融合;切片檢查也顯示,軟骨已呈透明狀。
  
  Gobbi醫師指出,在2000年到2005年間,支架法已經運用在3465位患者身上,研究人員針對其中的450位患者發表過文章;但是,本研究有何新意?Stein醫師表示,這是因為這項材料被用在這項特定的膝蓋病變上。
  
  根據Gobbi醫師的說法,本研究未發現有發炎或主要的併發症狀;但是,Stein醫師對術後可能產生的問題表示關心;她指出,如果把細胞注入在支架上,那它們就會固定得比較好,但問題是,為什麼還要做第二次的關節鏡術?難道看到了和ACI一樣的併發症?這些併發症包含植入物及間隙的過度生長,這樣會阻礙到活動。

Autologous Chondrocytes From H

By Karla Harby
Medscape Medical News

Feb. 28, 2005 (Washington) — At more than two years of follow-up, autologous chrondrocytes grown on a three-dimensional, hyaluronan-based scaffold (Hyalograft-C) have been found to be successful in a prospective series of 33 patients with patellofemoral chondral lesions.

Alberto Gobbi, MD, director of Orthopaedic Arthroscopic Surgery International in Milan, Italy, described his work during a scientific session at the American Orthopaedic Society for Sports Medicine. The session was held here in conjunction with the 72nd annual meeting of the American Academy of Orthopaedic Surgeons.

If this technology proves successful in more patients, it would be an advance because the scaffolding "has a lot of advantages," said Beth E. Shubin Stein, MD, staff surgeon at the Women's Sports Medicine Center of the Hospital for Special Surgery in New York City. She served as comoderator of the session.

"This may be useful in patellofemoral defects because patients with these defects do not do well with ACI [autologous chondrocyte implantation]," Dr. Stein told Medscape. "With this you don't have to open the knee, it can be done arthroscopically. And ACI requires a microsuturing technique, but this does not; you basically just stick it in place."

To date, Dr. Gobbi and colleagues have treated 33 patients, mean age of 30.5 years, with the scaffold. The chondral lesion was secondary to trauma in 16 patients, caused by misalignment or similar problems in 14 patients, and caused by osteochondritis dissecans (OCD) in three patients. Three patients had undergone previous surgery, and at least one had concomitant lateral disease. The average size of the defect was 7 cm2.

The surgeons performed the operation arthroscopically in 22 patients and used a mini-arthrotomy in the remainder. All patients were examined with magnetic resonance imaging (MRI) at 12 months, and in six patients a second-look arthroscopy and biopsy were performed.

At a mean follow-up of 28 months, Dr. Gobbi found a significant improvement as measured by the visual analog scale (P < .0001), and more than 80% of patients experienced an improvement in their quality of life. Under the ICRS-IKDC scoring systems, a statistically significant improvement (P < .05) was observed. With MRI, 24 of 33 patients showed near-normal chondral surfaces at 12 months, and these observations correlated well with outcome measures. Dr. Gobbi also said that the second-look arthroscopies, performed at eight months of follow-up, revealed integration of the graft with the surrounding cartilage. Biopsy specimens were described as having hyaline-like cartilage.

This scaffolding has been placed in 3,465 patients from 2000 to 2005, Dr. Gobbi noted, and researchers have published studies on their results in about 450 patients. What is new about this study, Dr. Stein said, is that this material has been applied to this particular knee disorder.

Dr. Gobbi reported no incidences of inflammation or major complications, but Dr. Stein expressed caution about the possibility of problems postsurgery. "The idea is that if you impregnate these cells in a scaffold, they'll stay in place better," she told Medscape. "But the real question is, why did some patients have second-look arthroscopy? Are the complications we see with ACI the same as with this?" These complications include overgrowth of the graft and clefts that interfere with movement, she added.

Dr. Gobbi receives research or institutional support from CSC Pharmaceuticals. Dr. Stein has no relevant financial relationships to disclose.

AAOSM presentation, in affiliation with the AAOS 72nd Annual Meeting. Presented Feb. 26, 2005.

Reviewed by Gary D. Vogin, MD

    
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