摘要
目的 评估关节腔内注射自体脂肪干细胞(adipose derived stem cells,ADSCs)或联合透明质酸(hyaluronic acid,HA)治疗膝关节骨关节炎的临床疗效.方法 采用随机对照研究方法,选取2013年5月至2015年5月膝关节骨关节炎患者108例,Kellgren-Lawrence分级1~3级.随机分为ADSCs组、HA组、ADSCs+HA组,每组36例,分别于关节腔内注射相应的药物3次,每周1次.采用视觉模拟评分(visual analogue scale,VAS)、西安大略和麦克马斯特大学(Western Ontario and McMaster University,WOMAC)骨关节炎指数、全器官磁共振评分体系(whole-organ magnetic resonance imaging score,WORMS)评估注射前和注射完成后3、6、12、24、36个月的临床表现和关节损伤的影像学表现.结果 所有患者均完成36个月随访.治疗及随访期间未见不良反应.ADSCs组和ADSCs+HA组注射后各时点VAS评分和WOMAC总分均小于HA组(P<0.05).与注射前比较,注射后36个月ADSCs组VAS评分从(4.14±1.42)分下降至(2.39±1.74)分,WOMAC总分从(42.86±31.24)分下降至(27.17±27.99)分;ADSCs+HA组VAS评分从(4.25±1.13)分下降至(2.31±1.74)分,WOMAC总分从(34.92±22.62)分下降至(21.33±21.38)分;HA组VAS评分和WOMAC评分均高于注射前.ADSCs+HA组注射后3个月VAS评分小于ADSCs组(P<0.05),注射后各时点ADSCs组和ADSCs+HA组WOMAC评分的差异均无统计学意义(P>0.05).10例ADSCs组患者注射前后WORMS软骨损伤评分改善(P<0.05),软骨下骨磨损评分改善(P<0.05).注射前后WORMS软骨损伤评分差值与WOMAC总分差值呈正相关(r=0.790,P=0.007),与VAS评分差值呈正相关(r=0.800,P=0.005).结论 单纯自体ADSCs或联合HA关节腔内注射能有效减轻患者疼痛并改善患者活动功能,并在注射后36个月得到较好的维持,ADSCs联合HA在短期内缓解疼痛效果更明显.软骨的修复有利于关节功能的改善.
Objective To evaluate the clinical effects of intra-articular injection of autologous adipose derived stem cells (ADSCs) or ADSCs combined with hyaluronate acid (HA) for knee osteoarthritis.Methods From May 2013 to May 2015,a total of 108 patients with knee osteoarthritis (Kellgren-Lawrence grades:1-3) were recruited in the present study.The patients were randomly divided into three groups:ADSCs,HA and ADSCs+HA.All patients (36 cases in each group) were injected with the drug in the joint cavity once a week for three weeks.The methods used for evaluating the clinical manifestations and joint damage on MRI included visual analogue scale (VAS),Western Ontario and McMaster University (WOMAC) osteoarthritis index and whole-organ magnetic resonance imaging score (WORMS).Evaluations were conducted before injection and at 3,6,12,24 and 36 months after injection.Results All patients were followed up for 36 months without any dissociation.No adverse reaction was observed during the treatment and at the follow-up duration.The VAS score and WOMAC total score of the ADSCs group and the ADSCs+HA group were better than those in the HA group at each time point after injection (P<0.05).The average VAS of the ADSCs group decreased from 4.14±1.42 at pre-injection to 2.39±1.74 at 36 months after injection.The WOMAC total score decreased from 42.86± 31.24 to 27.17±27.99.The average VAS in the ADSCs+HA group decreased from 4.25±1.13 to 2.31±1.74,and the WOMAC total score decreased from 34.92±22.62 to 21.33±21.38.However,the average VAS and WOMAC total score of the HA group at 36 months after injection were higher than those before the injection.In terms of the VAS at 3 months after injection,the ADSCs+HA group scored better than that of the ADSCs group (P<0.05).There was no significant difference in WOMAC scores between the ADSCs and ADSCs+HA groups at each time point after injection (P>0.05).The WORMS cartilage injury score improved in 10 patients with ADSCs after injection (P<0.05).The subchondral bone wear score improved a
作者
张圣扬
吕帅洁
丁权威
范梦强
童培建
Zhang Shengyang;Lyu Shuaijie;Ding Quanwei;Fan Mengqiang;Tong Peijian(Zhejiang Chinese Medical University,Hangzhou 310053,China;Department of Traumatic Ortho-paedics,First Afiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2018年第23期1426-1434,共9页
Chinese Journal of Orthopaedics
基金
国家自然科学基金(81673997,81873324)
关键词
干细胞
透明质酸
骨关节炎
膝
软骨
Stem cells
Hyaluronic acid
Osteoarthritis,knee
Cartilage
