Development of a Tool to Predict Outcome of Autologous Chondrocyte Implantation.
Development of a Tool to Predict Outcome of Autologous Chondrocyte Implantation.
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DOI：
10.1177/1947603516650002
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发表时间：
2017-04
期刊：
影响因子：
2.8
通讯作者：
Richardson JB
中科院分区：
文献类型：
--
作者：
Dugard MN;Kuiper JH;Parker J;Roberts S;Robinson E;Harrison P;Richardson JB
该研究有2个目的：首先，评价自体软骨细胞植入（ACI）在手术再干预（包括关节成形术）发生率方面的成功率，并研究成功治疗结局的预测因素。第二个目标是获得一种预测ACI后患者关节成形术风险的工具。在这项II级预后研究中，170例ACI治疗患者（110例男性[年龄36.8 ± 9.4岁]; 60例女性[年龄38.1 ± 10.2岁]）完成了一份关于10.9 ± 3.5年前接受ACI治疗的膝关节进一步手术的问卷调查。在回归分析中，术前通常评估的因素（年龄、性别、缺损位置和数量、该部位的既往手术史和术前Lysholm评分）被用作独立因素。在最终随访时（ACI后最长19年），40例患者（23.5%）在ACI后接受了手术再介入。26例患者（15.3%）接受了关节置换术，女性（25%）比男性（10%; P = 0.001）更常见。考克斯回归分析确定了4个与再次介入相关的因素：ACI时的年龄、ACI前多次手术、髌骨缺损和治疗前Lysholm评分较低（Nagelkerke's R2 = 0.20）。与ACI后关节置换术风险相关的6个预测项目（Nagelkerke R2 = 0.34）用于开发奥斯韦斯特里膝关节置换术风险指数，并进行内部交叉验证。在一项单中心研究中，我们确定了6个因素（年龄、性别、缺损部位和数量、既往手术次数和ACI前Lysholm评分），这些因素似乎会影响ACI患者进行关节置换术的可能性。我们已经利用这些信息提出了一个公式或“工具”，可以帮助治疗决策和改善ACI患者的选择。
The study had 2 objectives: first, to evaluate the success of autologous chondrocyte implantation (ACI) in terms of incidence of surgical re-intervention, including arthroplasty, and investigate predictors of successful treatment outcome. The second objective was to derive a tool predicting a patient’s arthroplasty risk following ACI. In this Level II, prognostic study, 170 ACI-treated patients (110 males [aged 36.8 ± 9.4 years]; 60 females [aged 38.1 ± 10.2 years]) completed a questionnaire about further surgery on their knee treated with ACI 10.9 ± 3.5 years previously. Factors commonly assessed preoperatively (age, gender, defect location and number, previous surgery at this site, and the preoperative Lysholm score) were used as independent factors in regression analyses. At final follow-up (maximum of 19 years post-ACI), 40 patients (23.5%) had undergone surgical re-intervention following ACI. Twenty-six patients (15.3%) underwent arthroplasty, more commonly females (25%) than males (10%; P = 0.001). Cox regression analyses identified 4 factors associated with re-intervention: age at ACI, multiple operations before ACI, patellar defects, and lower pretreatment Lysholm scores (Nagelkerke’s R2 = 0.20). Six predictive items associated with risk of arthroplasty following ACI (Nagelkerke’s R2 = 0.34) were used to develop the Oswestry Risk of Knee Arthroplasty index with internal cross-validation. In a single-center study, we have identified 6 factors (age, gender, location and number of defects, number of previous operations, and Lysholm score before ACI) that appear to influence the likelihood of ACI patients progressing to arthroplasty. We have used this information to propose a formula or “tool” that could aid treatment decisions and improve patient selection for ACI.