Clinical Outcomes of Mesenchymal Stem Cell Injection With Arthroscopic Treatment in Older Patients With Osteochondral Lesions of the Talus
Clinical Outcomes of Mesenchymal Stem Cell Injection With Arthroscopic Treatment in Older Patients With Osteochondral Lesions of the Talus
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DOI：
10.1177/0363546513479018
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发表时间：
2013-05-01
影响因子：
4.8
通讯作者：
Koh, Yong Gon
中科院分区：
文献类型：
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作者：
Kim, Yong Sang;Park, Eui Hyun;Koh, Yong Gon
背景：距骨骨软骨病变（OLTS）的理想治疗方法仍然存在争议，尤其是对于老年患者。最近，间充质干细胞（MSC）已被建议用于软骨病变的细胞治疗。目的：比较MSC注射和关节镜下骨髓刺激治疗与单独关节镜下骨髓刺激治疗老年患者OLT的临床结局。研究设计：队列研究;证据等级，3.方法：在107例接受关节镜治疗的OLT患者中，仅50岁以上的患者（65例患者）被纳入本研究。将患者分为2组：35例（37个踝关节）仅接受关节镜下骨髓刺激治疗（A组）和30例（31个踝关节）接受MSC注射沿着关节镜下骨髓刺激治疗（B组）。根据疼痛视觉模拟量表（VAS）、美国足踝矫形协会（AOFAS）踝-后足量表以及Roles和Maudsley评分评价临床结局。Tegner活动量表用于确定活动水平的结果。结果：各组的平均VAS评分显著改善（P <0.05），A组从7.2 +/- 1.1改善至4.0 +/- 0.7，B组从7.1 +/- 1.0改善至3.2 +/- 0.9。各组的平均AOFAS评分也显著改善（P <0.05），A组从68.0 +/- 5.5改善至77.2 +/- 4.8，B组从68.1 +/- 5.6改善至82.6 +/- 6.4。在最终随访时（平均21.8个月;范围12-44个月），两组的平均VAS和AOFAS评分存在显著差异（P < .001）。术后，B组的Roles和Maudsley评分改善显著大于A组（P = .040）。B组的Tegner活动量表评分显著改善（从3.5 +/- 0.7改善至3.8 +/- 0.7; P = 0.041），但A组无改善（从3.5 +/- 0.8改善至3.6 +/- 0.6; P = 0.645）。A组中，较大的病变尺寸（≥ 109 mm（2））和存在软骨下囊肿是临床结局不满意的重要预测因素（分别为P = .04和.03）。在B组中未观察到这些相关性。结论：与仅接受骨髓刺激治疗的患者相比，在50岁以上的患者中注射骨髓刺激治疗的MSC是令人鼓舞的，特别是当病变尺寸大于109 mm（2）或存在软骨下囊肿时。虽然仍处于应用的早期阶段，但MSC在治疗50岁以上患者的OLT中可能具有很大的潜力，应对其效果进行更多的评估。
Background: The ideal treatment for osteochondral lesions of the talus (OLTs) is still controversial, especially in older patients. Recently, mesenchymal stem cells (MSCs) have been suggested for use in the cell-based treatment of cartilage lesions.Purpose: To compare the clinical outcomes of MSC injection and arthroscopic marrow stimulation treatment with those of arthroscopic marrow stimulation treatment alone for the treatment of OLTs in older patients.Study Design: Cohort study; Level of evidence, 3.Methods: Among 107 patients with OLTs treated arthroscopically, only the patients older than 50 years (65 patients) were included in this study. Patients were divided into 2 groups: 35 patients (37 ankles) treated with arthroscopic marrow stimulation treatment alone (group A) and 30 patients (31 ankles) who underwent MSC injection along with arthroscopic marrow stimulation treatment (group B). Clinical outcomes were evaluated according to the visual analog scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and the Roles and Maudsley score. The Tegner activity scale was used to determine outcomes in activity levels.Results: The mean VAS score in each group was significantly improved (P < .05) from 7.2 +/- 1.1 to 4.0 +/- 0.7 in group A and from 7.1 +/- 1.0 to 3.2 +/- 0.9 in group B. The mean AOFAS score in each group was also significantly improved (P < .05) from 68.0 +/- 5.5 to 77.2 +/- 4.8 in group A and from 68.1 +/- 5.6 to 82.6 +/- 6.4 in group B. There were significant differences in mean VAS and AOFAS scores between the groups at final follow-up (mean, 21.8 months; range, 12-44 months) (P < .001). The Roles and Maudsley score showed significantly greater improvement in group B than in group A after surgery (P = .040). The Tegner activity scale score was significantly improved in group B (from 3.5 +/- 0.7 to 3.8 +/- 0.7; P = .041) but not in group A (from 3.5 +/- 0.8 to 3.6 +/- 0.6; P = .645). Large lesion size (>= 109 mm(2)) and the existence of subchondral cysts were significant predictors of unsatisfactory clinical outcomes in group A (P = .04 and .03, respectively). These correlations were not observed in group B.Conclusion: Injection of MSCs with marrow stimulation treatment was encouraging in patients older than 50 years compared with patients treated with marrow stimulation treatment alone, especially when the lesion size was larger than 109 mm(2) or a subchondral cyst existed. Although still in the early stages of application, MSCs may have great potential in the treatment of OLTs in patients older than 50 years, and more evaluations of its effect should be performed.