Autologous culture expanded bone marrow stromal cell transplantation for capitellar osteochondritis dissecans

镶嵌成形术目前已用于15岁以下学龄儿童反复投掷运动引起的剥脱性肱骨小头骨软骨炎（COCD）的骨软骨修复。根据我们的回顾性研究（Am J Sport Med，2007），我们指出镶嵌成形术有几个缺点。我们已经开发了这些细胞移植来修复青少年剥脱性肱骨小头骨软骨炎患者的关节软骨缺损。用人自身血清培养14天。在手术前三天，收集细胞（平均细胞数为1.3 × 107），并包埋在2 ml来自猪肌腱的0.25%I型酸溶性胶原（Cellmatrix type I-A，Nitta gelatin Inc.，Osaka，Japan），置于胶原蛋白片（Koken Inc.，Tokyo，Japan）并凝胶化。这个凝胶？细胞复合物在补充有15%自体血清和抗生素的DMEM中培养两天。在手术中，凝胶。将细胞复合物置于手肘关节软骨缺损处，用自体骨膜覆盖。我们用4-0尼龙线缝合包皮，并对4例青少年晚期剥脱性肱骨小头骨软骨炎患者的4个肘关节采用我们的方法进行治疗。所有患者在治疗后随访18个月以上。所有患者均无手肘疼痛。手肘关节术前平均乔亚评分为44分，术后平均乔亚评分为71分。术后MRS显示所有病例手肘关节骨软骨缺损均被骨软骨组织填充。无一例感染、癌变、功能障碍等并发症发生，提示自体培养扩增骨髓间充质干细胞移植修复关节软骨缺损的可行性。

Mosaicplasty has been currently performed for osteocartilagenous repair in capittelar osteochondritis dissecans(COCD) which is occurred by repetitive throwing motion in schoolchild less than 15 years of age. We have indicated that mosaicplasty has several disadvantages based on our retrospective study (Am J Sport Med,2007). We have developed ply these cell transplantations to repair human articular cartilage defects in capitellar osteochindritis dissecans in teenage patients.Ten mil of heparinized bone marrow blood was aspirated from the iliac. Adhreent cells were cultured by human own serum for 14 days. Three days before surgery, the cells were collected (mean cell number was 1.3 x 107), and embedded in 2 ml of 0.25% type I acid soluble collagen from porcine tendon (Cellmatrix type I-A, Nitta gelatin Inc., Osaka, Japan), put onto a collagen sheet (Koken Inc., Tokyo, Japan) and gelated. This gel?cell composite was cultured for two days in DMEM supplemented with 15% autologous serum and antibiotics. At the surgery, the gel. Cell composite was put on the defect of the osetocartilagenous defect in the elbow joint and it was covered by the auto periosteum. We sutured the periouteum by 4-0 nylon using our original instruments.Four elbows of 4 patients with advanced capitellar osteochindritis dissecans in teenage patients were treated by our original method. All patients were followed more than 18 months after the treatment. All patients had no pain at the elbow. Mean preoperative JOA score of the elbow was 44 points and mean postoperative JOA score was 71 points. Postoperative MRS demonstrated osteochondral defect of the elbow joint was filled with osteocartilagenous tissue in all cases. There were no case with infection, canceration, functional disturbance.This procedure highlights the availability of autologous culture expanded bone marrow mesenchymal stromal cell transplantation for the repair of articular cartilage defects in humans.