摘要
背景:由于关节软骨具有复杂的生物学特性和高度的耐用性,自然退变或创伤引起的缺损都可能导致其结构和功能上不可逆的损害,因此关节软骨损伤后的修复治疗是临床上急需解决的问题。目的:报告关节软骨修复技术失败最常见的危险因素及其发生率,分析影响选择特定手术治疗方法来处理软骨修复失败最重要的因素。方法:以“articular cartilage,repair,clinic/clinical failure,surgery”为检索词,检索PubMed和MEDLINE数据库,时限为2007至2019年,语言限制为英文。初检得到文献约343篇,根据纳入排出标准筛选,共纳入38篇文章进行分析。结果与结论:①微骨折术和软骨镶嵌成形术在关节软骨修复后的前期和中期显示出不可忽视的失败率,而使用自体软骨细胞移植和异体骨软骨移植修复关节软骨的效果更好。②对于软骨修复失败的治疗:在以往软骨修复失败的患者中应用异体骨软骨移植可能是一个安全的选择,但对于失败的异体骨软骨移植的修复则有更高的失败率;而既往自体软骨细胞移植或基质诱导的自体软骨细胞移植失败的患者,经进一步的自体软骨细胞移植或基质诱导的自体软骨细胞移植治疗后,其治疗效果是可以接受的。此外,有软骨下骨髓刺激病史的患者,自体软骨细胞移植的失败率更高。③软骨修复失败的处理取决于手术治疗失败的类型以及软骨缺损的面积、部位的不同,异体骨软骨移植是治疗软骨下骨髓刺激患者软骨修复失败的最可靠的方法,而自体软骨细胞移植或基质诱导的自体软骨细胞移植在既往软骨修复失败的患者中显示出可以接受的治疗效果,在处理软骨修复失败的患者时,应该特别注意软骨下骨质的情况。
BACKGROUND:Articular cartilage has complex biological characteristics and high durability;therefore,natural degeneration or trauma may lead to irreversible damage of its structure and function.Repair and treatment of articular cartilage injury is an urgent problem in clinic.OBJECTIVE:To report the most common risk factors for failure of articular cartilage repair and their incidence,and to analyze the most important factors influencing the choice of specific surgical treatment for failure of cartilage repair.METHODS:The relevant articles were searched in PubMed and MEDLINE database from 2007 to 2019.The keywords were“articular cartilage,repair,clinic/clinical failure,surgery”in English.Initially,343 articles were retrieved,and 38 articles were included for final analysis.RESULTS AND CONCLUSION:(1)Microfracture and mosaicplasty have significant failure rates in the early and middle stages after articular cartilage repair,while autologous chondrocyte implantation(ACI)and osteochondral allograft(OCA)transplantation are two effective methods for articular cartilage repair.(2)For the failure of articular cartilage repair,OCA transplantation might be a safe choice in the past.However,a higher re-failure rate of articular cartilage repair has been found in patients undergoing a failed OCA transplantation.For the patients who have failed ACI or matrix-induced ACI,further treatment with ACI or matrix-induced ACI is acceptable.In addition,patients with a history of subchondral bone marrow stimulation have a higher failure rate of ACI.(3)Treatments for cartilage repair failure depend on the type of surgical failure and area and site of cartilage defect.OCA transplantation is the most reliable method for the treatment of cartilage repair failure in subchondral bone marrow stimulation patients.ACI or matrix-induced ACI have shown acceptable therapeutic effect in patients who have suffered cartilage repair failure.When dealing with cartilage repair failure,special attention should be paid to the conditions of subchondral b
作者
张宇
余城墙
吴有财
欧裕福
韦建勋
Zhang Yu;Yu Chengqiang;Wu Youcai;Ou Yufu;Wei Jianxun(Department of Orthopedics,People’s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,Guangxi Zhuang Autonomous Region,China)
出处
《中国组织工程研究》
CAS
北大核心
2020年第21期3387-3393,共7页
Chinese Journal of Tissue Engineering Research
关键词
关节软骨
修复
临床/临床失败
异体骨软骨移植
自体软骨细胞移植
微骨折术
articular cartilage
repair
clinic/clinical failure
osteochondral allograft
autologous chondrocyte transplantation
microfracture
