Bone Marrow-derived Cells and Biophysical Stimulation for Talar Osteochondral Lesions: A Randomized Controlled Study
Bone Marrow-derived Cells and Biophysical Stimulation for Talar Osteochondral Lesions: A Randomized Controlled Study
复制标题
DOI：
10.1177/1071100714539660
复制
发表时间：
2014-10-01
影响因子：
2.7
通讯作者：
Giannini, Sandro
中科院分区：
文献类型：
--
作者：
Cadossi, Matteo;Buda, Roberto Emanuele;Giannini, Sandro
背景：参加体育活动的年轻患者踝关节扭伤后常发生距骨软骨病变。这些损伤可能导致慢性疼痛、关节肿胀，最终导致骨关节炎，因此经常需要手术修复。胶原支架植入骨髓来源细胞（bmdc），通过单一关节镜手术植入患者髂嵴，最近被认为是一种有效的治疗选择。然而，嵌入炎症环境中的BMDCs倾向于向成纤维细胞表型分化，从而导致机械特性的丧失。生物物理刺激脉冲电磁场（pemf）已被证明可以促进合成代谢软骨细胞的活性，刺激蛋白多糖的合成，并减少最相关的促炎细胞因子的释放。这项随机对照试验的目的是评估pemf对接受骨髓干细胞移植进行OLT患者临床结果的影响。方法：30例III级和IV级Outerbridge OLT患者行BMDCs移植。手术后，患者被随机分配到实验组（术后3天内开始，每天4小时，持续60天）或对照组。采用（美国骨科足踝学会）AOFAS评分、视觉模拟量表（VAS）和SF-36量表评估临床结果。结果：实验组在随访6个月和12个月时的AOFAS评分均显著高于对照组。在60天和6、12个月的随访中，实验组疼痛明显减轻。各组间SF-36无显著差异。结论：实验组临床预后较对照组好，终末随访时AOFAS评分提高10分以上。手术后不久开始的生物物理刺激有助于患者恢复，导致疼痛控制和更好的临床结果，这些改善持续手术后1年多。
Background: Osteochondral lesions of the talus (OLT) frequently occur after ankle sprains in young patients participating in sports activities. These injuries may lead to chronic pain, joint swelling, and finally osteoarthritis, therefore, surgical repair is frequently needed. A collagen scaffold seeded with bone marrow-derived cells (BMDCs) harvested from patient's iliac crest and implanted into the OLT through a single arthroscopic procedure has been recently proposed as an effective treatment option. Nevertheless, BMDCs, embedded in an inflammatory environment, tend to differentiate toward a fibroblast phenotype with a consequential loss of mechanical characteristics. Biophysical stimulation with pulsed electromagnetic fields (PEMFs) has been shown to promote anabolic chondrocyte activity, stimulate proteoglycan synthesis, and reduce the release of the most relevant pro-inflammatory cytokines. The aim of this randomized controlled trial was to evaluate the effects of PEMFs on clinical outcome in patients who underwent BMDCs transplantation for OLT.Methods: Thirty patients affected by grade III and IV Outerbridge OLT underwent BMDCs transplantation. After surgery, patients were randomly assigned to either experimental group (PEMFs 4 hours per day for 60 days starting within 3 days after operation) or control group. Clinical outcome was evaluated with (American Orthopaedic Foot and Ankle Society) AOFAS score, Visual Analog Scale (VAS), and Short Form-36 (SF-36).Results: Significantly higher AOFAS score was recorded in the experimental group both at 6 or 12 months follow-up. At 60 days and 6 and 12 months follow-up, significant lower pain was observed in the experimental group. No significant difference was found in SF-36 between groups.Conclusion: A superior clinical outcome was found in the experimental group with more than 10 points higher AOFAS score at final follow-up. Biophysical stimulation started soon after surgery aided patient recovery leading to pain control and a better clinical outcome with these improvements lasting more than 1 year after surgery.