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

剥脱性头状骨软骨炎(COCD)是15岁以下学龄儿童反复投掷运动所致，目前已对COCD进行了马赛克成形术。根据我们的回溯性研究，我们已经指出马赛克成形术有几个缺点(Am J Sports Med，2007)。我们已经开发了这些细胞移植来修复青少年剥脱性头骨滑膜炎患者的关节软骨缺损。从髂骨抽出1000万肝素化的骨髓血。贴壁细胞用人血清培养14天。手术前3天收集细胞(平均细胞数为1.3×107)，包埋于2ml0.25%酸溶的猪肌腱胶原蛋白(日本大阪Nitta Gelatin Inc.，CellmatrixI-A型)中，放在胶原片(Koken Inc.，日本东京)上并凝胶。将这种凝胶细胞复合材料在DMEM中培养两天，并添加15%的自体血清和抗生素。在手术中，凝胶。在肘关节骨关节缺损处植入细胞复合材料，自体骨膜覆盖。我们用我们原来的器械用4-0尼龙缝合外膜。对4例青少年晚期剥脱性头状骨软骨炎患者的4个肘部，用我们原来的方法进行治疗。所有患者在治疗后18个月以上进行随访。所有患者肘部均无疼痛。术前肘关节JOA评分平均44分，术后平均71分。术后MRS显示所有病例肘关节骨软骨缺损区均被骨软骨组织填充。无一例发生感染、癌变、功能障碍。该方法强调了自体培养扩增骨髓间充质干细胞移植修复人类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.