背景:骨性关节炎膝关节植入同种异体人脐带血间充质干细胞(hUCB-MSCs)后的临床结果鲜有报道。我们的研究旨在调查接受hUCB-MSC植入的骨关节炎患者的临床结果。
方法:在本案例系列中(证据级别:4),从2014年1月至2015年12月,我们对128例接受hUCB-MSC植入的全层软骨损伤(国际软骨修复学会4级和Kellgren-Lawrence≤3级)患者进行了回顾性评估,并至少随访2年.用关节镜下毛刺去除硬化的软骨下骨后,以2毫米的间隔创建4毫米直径的孔,随后将透明质酸和hUCB-MSCs混合并植入孔和其他关节缺损部位。术前评估临床结果,术后1年,术后2年(最低)使用视觉模拟量表(VAS),西安大略省和麦克马斯特大学骨关节炎指数(WOMAC),和国际膝关节文献委员会(IKDC)评分。为了评估临床结果,根据病变大小将患者分为两组或三组,病变位置,病变的数量,身体质量指数,和年龄;使用这些数据进行统计分析。
结果:平均值(±标准偏差)VAS,WOMAC,包括hUCB-MSC植入在内的术后1年和2年的IKDC评分与术前评分相比显着改善(P<0.001)。病变部位差异有统计学意义(P<0.05)。与股骨外侧髁和滑车病变相比,股骨内侧髁病变的预后较差。无不良反应及术后并发症发生。
结论:基于持续至少2年的随访,植入hUCB-MSCs可有效治疗膝骨关节炎。
BACKGROUND: Clinical outcomes after the implantation of allogenic human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) in osteoarthritic knees have been rarely reported. Our study aimed to investigate clinical outcomes of osteoarthritic patients who underwent hUCB-MSC implantation.
METHODS: In this case series (level of evidence: 4), from January 2014 to December 2015, 128 patients with full-thickness cartilage lesions (International Cartilage Repair Society grade 4 and Kellgren-Lawrence grade ≤3) who underwent hUCB-MSC implantation were retrospectively evaluated with a minimum of 2-year follow-up. After removing the sclerotic subchondral bone with an arthroscopic burr, 4-mm-diameter holes were created at 2-mm intervals, and hyaluronic acid and hUCB-MSCs were subsequently mixed and implanted in the holes and other articular defect sites.Clinical outcomes were evaluated preoperatively, 1 year postoperatively, and 2 years postoperatively (minimum) using visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC) scores. To assess clinical outcomes, patients were divided into two or three groups according to the lesion size, lesion location, number of lesions, body mass index, and age; statistical analyses were performed using these data.
RESULTS: The mean (±standard deviation) VAS, WOMAC, and IKDC scores at 1 and 2 years after surgery including hUCB-MSC implantation improved significantly compared to the preoperative scores (P < 0.001). There were significant differences in the lesion location (P < 0.05). Medial femoral condyle lesions resulted in worse outcomes compared with lateral femoral condyle and trochlea lesions. No adverse reactions or postoperative complications were noted.
CONCLUSIONS: Implantation of hUCB-MSCs is effective for treating knee osteoarthritis based on a follow-up lasting a minimum of 2 years.