关节软骨损伤的治疗进展.pptVIP

* * 曹永平 关节软骨损伤的治疗进展 北京大学第一医院骨科 Periosteum Cartilage Subchondral bone Concerns about their technique in ACI Re-differentiation of de-differentiated chondrocytes Leakage of chondrocytes Uneven distribution of chondrocytes Cartilage 三维立体培养 3D-ACI Cartilage defect chondrocytes Subchondral bone Cartilage Cartilage-like tissue made by tissue-engineering technique Isolated chondrocytes Scaffold (Atelocollagen) Ham F-12 medium Patient’s serum＋antibiotics 5% CO2 / 95% air 3 weeks 1) Curettage 2) Extraction of 　the periosteum 4) Implantation 5) Suture of the 　　 　remaining periosteum 3) Pull out suture of the periosteum Defect Demographic data of patients (since 1996) 73 patients (70 knees, 2 elbows, 1 ankle) Age: 14-45 years (average, 26 years) Cause: Trauma 40 Osteochondritis dissecans 26 Osteoarthritis 2 Chondromalasia patellae 1 Recurent dislocation of patella 4 Lesion: medial femoral condyle 30 lateral femoral condyle 24 patella 11 med. Femoral condyle + patella 1 elbow 2 ankle 1 Size: 0.7 – 16.0 cm2 (average 2.9 cm2 ) Isolated chondrocytes: 0.1 – 42 x 106 (average, 1.99 x 106)) Demographic data followed up for at least 2 years Follow-up: 24-63 months (average 35 months) 48 knees (46 patients, 26 men 20 women) Age: 12-45 years (average, 23.9 years) Cause: Trauma　 32 Anterior Cruciate Ligament injury 12 Osteochondritis dissecans (OCD) 13 Osteoarthritis (OA) 2 Chondromalacia patellae 1 Lesion: medial femoral condyle 20 lateral femoral condyle 16 patella 10 patellar groove 1 med. Femoral condyle + patella 1 Size: 0.7 – 16.0 cm2 (average 2.8 cm2 ) Grade: Outerbridge III, IV Lysholm score points ＊：p0.05 0 20 40 60 80 100 Preop. 2 yrs postop. Lat. FC Patella ＊ Med. FC Arthroscopic assessment following to a rating system of International Cartilage Repai