OATS联合ADSCs、ACI修复膝关节大面积全层软骨缺损的效果分析

Effectiveness of OATS combined with ADSCs and ACI in repairing large full-thickness cartilage defects of the knee

摘要:

目的 探讨网状微钻孔自体骨软骨马赛克移植（OATS）联合自体脂肪干细胞（ADSCs）、软骨细胞移植（ACI）修复膝关节大面积全层软骨缺损的效果。方法 回顾性分析2019年1月—2023年6月华北医疗健康集团峰峰总医院邯郸院区收治的膝关节大面积全层软骨受损患者100例，按治疗方法分为对照组（48例）、观察组（52例）。对照组采取网状微钻孔联合OATS方法治疗；观察组在此基础上采取ACI+ADSCs技术促进修复。随访1年，对比两组患者膝关节疼痛程度、膝关节功能、生活质量和不良反应。结果 实验组与对照组术后1、3、6个月静息状态下视觉模拟评分（VAS）、国际膝关节文献委员会主观膝部评估表（IKDC）和Lysholm膝关节评分量表（Lysholm）评分比较，结果 ①不同时间点VAS、IKDC和Lysholm评分比较，差异均有统计学意义（P <0.05）；②实验组与对照组VAS、IKDC和Lysholm评分比较，差异有统计学意义（P <0.05），实验组VAS评分较低，IKDC和Lysholm评分较高；③两组VAS、IKDC和Lysholm评分变化趋势比较，差异有统计学意义（P <0.05）。实验组与对照组术前及术后6、12个月的生活质量调查量表（SF-36）评分比较，结果 ①不同时间点SF-36评分比较，差异有统计学意义（P <0.05）；②实验组与对照组SF-36评分比较，差异有统计学意义（P <0.05），实验组SF-36评分较高；③两组SF-36评分变化趋势比较，差异有统计学意义（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 NanoF+OATS联合ACI+ADSCs修复膝关节大面积全层软骨缺损能减轻患者术后疼痛，加快膝关节功能恢复，提高患者生活质量，且安全性较好。

Abstract:

Objective To investigate the effectiveness of the nanostructured microdrilling and osteochondral autograft transfer system (OATS) procedure combined with autologous adipose-derived stem cells (ADSCs) and autologous chondrocyte implantation (ACI) in repairing large full-thickness cartilage defects of the knee.Methods We retrospectively analyzed 100 patients with large full-thickness cartilage defects of the knee admitted to our hospital from January 2019 to June 2023, and divided them into the control group (48 cases) and the observation group (52 cases) according to the treatment method. The control group was treated with nanostructured microdrilling and the OATS procedure, while the observation group was additionally treated with ACI and ADSCs to promote the repairing. All patients were followed up for 1 year, and the knee pain severity, knee joint function, quality of life, and adverse events were compared between the two groups.Results The Visual Analogue Scale (VAS), International Knee Documentation Committee (IKDC) and Lysholm Knee Scoring Scale scores at rest in the observation group and the control group were compared at 1 month, 3 months and 6 months after operation, which exhibited that they were different across the time points (P < 0.05) and between the groups (P < 0.05), with lower VAS scores and higher IKDC and Lysholm Knee Scoring Scale scores in the observation group. The change trends of these scores were different between the two groups (P < 0.05). Comparison of 36-Item Short Form Health Survey (SF-36) scores in the observation group and the control group before and 3 and 6 months after operation showed that they were different across the time points (P < 0.05) and between the groups (P < 0.05), with higher SF-36 scores in the observation group. The change trend of the SF-36 scores was also different between the two groups (P < 0.05). There was no significant difference in the overall incidence of adverse reactions between the observation group and the control group (P > 0.05).Conclusion The nanostructured microdrilling and OATS combined with ACI and ADSCs for repairing large full-thickness cartilage defects of the knee can reduce postoperative pain, accelerate the recovery of knee function, and improve patients' quality of life with a high safety profile.