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裴宝岩
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秦皇岛市第一医院 骨科
擅长:①股骨头坏死的治疗,进行髋关节置换及关节翻修手术;②老年性膝关节骨性关节炎的治疗,进行膝关节置换以及翻修手术。③解答有关髋、膝关节置换的有关问题。
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泰勒空间支架骨延长、骨搬移技术治疗开放骨折大段骨缺损,成功保肢
沈义东医生的科普号
AMIC Chondro-Gide软骨基质I/III型胶原纤维支架联合微骨折技术修复膝关节软骨缺损3
AMICChondro-Gide软骨基质I/III型胶原纤维支架联合微骨折技术修复膝关节软骨缺损3国际软骨再生与关节保留协会自体基质诱导的软骨再生(AMIC?)全层软骨损伤,即延伸到软骨下骨的损伤,很少自发愈合,通常需要延长的愈合期。大多数全层软骨病变需要介入治疗,通常是手术治疗。骨髓刺激技术,例如微骨折(本网站其他地方描述),用于将骨髓干细胞从下层的骨髓基质中释放出来。产生的上层血凝块中含有未分化的软骨细胞前体细胞,称为骨髓间充质干细胞(MSCs),可以帮助软骨再生。上层血凝块覆盖有一层膜,以保护MSC并将它们固定在适当的位置(这是AMIC设计的思路)。受到膜保护的上层血凝块是MSCs分化和生长以及以均匀和功能方式软骨再生的完美环境,在此期间膜可被再吸收。这种新组织最终可以形成透明状软骨,即使在专业运动人士中也能恢复正常活动。自体基质诱导的软骨再生(AMIC?)是一项首先在德国开发的技术,然后于2000年代初在瑞士率先使用,以帮助治愈软骨损伤。它具有自体软骨细胞植入等技术的一些优点,但避免了软骨细胞的冗长和复杂的体外培养和第二次外科手术的要求。AMIC?方法可用于承重关节,例如踝关节、膝关节和髋关节,临床研究显示良好的效果,在术后10年及以上有显着功能改善和疗效成功。结合骨移植,AMIC?甚至可用于病变可能涉及相当深度的软骨下骨的严重病例,例如剥离性骨软骨炎(OCD)。目标受众:本文适用于任何关节软骨受损的人士及其家人,他们想了解自体基质诱导的软骨形成,以及对软骨问题感兴趣的任何人。什么是自体基质诱导的软骨再生(AMIC?)?AMIC?是一种修复深层软骨和软骨下骨病变的一步法手术。如果您的外科医生认为AMIC?是您受损软骨的正确治疗方式,您将接受关节手术治疗。这种手术通常在全身麻醉或脊髓麻醉下进行。AMIC?可以通过关节镜或开放式手术进行。在此手术期间,您的外科医生将移除受损的软骨。然后将骨骼进行微骨折或钻孔,以促进受控水平的出血并从骨骼和骨髓中释放骨髓干细胞MSC。这一步称为骨髓刺激术。如果手术在此时停止,这种方法将是标准的微骨折。然而,在AMIC?中,一种特殊设计的猪胶原蛋白膜被切割成完美地贴合在准备好的软骨缺损内,被放置在出血的骨软骨表面上。根据外科医生的偏好、修复的目的和软骨下骨的受累程度,用纤维蛋白胶将其固定到位或在其周围缝合。在膜下,含有骨髓干细胞MSC的受保护上层血凝块随后在骨表面形成。这个由膜的存在建立的生物室有助于身体刺激软骨细胞的生长,并有利于软骨组织的再生。自体基质诱导软骨再生(AMIC?)的优势是什么??AMIC?是一步法手术操作。在实验室培养细胞没有延迟,不需要第二次外科操作。植入物会被身体自然吸收。?在许多情况下,AMIC?可以通过关节镜微创操作下进行。?AMIC?是一种成熟的治疗方法,具有持久、长期的效果。10年前接受治疗的患者仍然从治疗中受益,与手术前相比,疼痛减轻且症状更少。?不适合单独用微骨折处理的大面积软骨缺损可以用AMIC?处理。临床研究表明,在大面积软骨损伤中,AMIC?比单独使用微骨折产生更好的结果。?AMIC?是一种修复软骨损伤的经济有效的治疗方法。自体基质诱导软骨再生(AMIC?)的缺点是什么?AMIC?不适用于以下患者:?已知对猪胶原蛋白过敏。?手术部位的急性或慢性感染。?急性或慢性炎症性关节病。并发症:与所有外科手术一样,AMIC?手术期间可能会出现并发症。常见问题(FAQ)AMIC治疗将持续多长时间?研究表明,长达10年前接受AMIC?的患者仍然表现良好。我什么时候可以恢复正常活动?术后康复计划始终由医生制定,没有适用于所有患者的通用指南。在许多情况下,患者能够在手术后的几天内开始在手术关节上部分负重。大约6周后可以尝试完全负重。应逐渐增加活动量,大多数患者应能在6个月内恢复体育活动。AutologousMatrix-InducedChondrogenesis(AMIC?)Full-thicknesscartilagedamage,thatis,damagethatextendstotheunderlyingsubchondralbone,rarelyhealsspontaneouslyandoftenrequiresextendedhealingperiods.Mostfull-depthchondrallesionswillrequireaninterventionaltherapy,usuallysurgery.Bonemarrowstimulatingtechniques,suchasmicrofracturing(describedelsewhereonthiswebsite),areusedtofreecellsfromtheunderlyingbone.Theresultantsuperclotcontainsundifferentiatedchondrocyteprecursorcells,knownasmesenchymalstemcells(MSCs),whichcanhelpregeneratecartilage.ThesuperclotiscoveredwithamembranetoprotecttheMSCsandkeeptheminplace.Thesuperclot,protectedbythemembrane,isaperfectenvironmentforthedifferentiationandgrowthofMSCsandtheregenerationofthecartilageinanevenandfunctionalmanner,duringwhichtimethemembraneisresorbed.Thisnewtissuecaneventuallyformhyaline-likecartilage,allowingresumptionofnormalactivityeveninsportprofessionals.AutologousMatrix-InducedChondrogenesis(AMIC?)isatechniquefirstdevelopedinGermanyandthenpioneeredinSwitzerlandintheearly2000stohelphealcartilagedamage.Ithassomeoftheadvantagesoftechniquessuchasautologouschondrocyteimplantation,butavoidsthelengthyandcomplicatedinvitroculturingofcartilagecells(chondrocytes)andtherequirementforasecondsurgicalprocedure.TheAMIC?methodcanbeusedinload-bearingjoints,suchastheankle,kneeandhip,andclinicalstudieshaveshowngoodresultswithsignificantimprovementandsuccessouttoandbeyond10yearspost-surgery.Incombinationwithbonegrafting,AMIC?canevenbeusedinseverecaseswherealesionmayinvolvethesubchondralbonetoaconsiderabledepth,suchasosteochondritisdissecans(OCD).IntendedaudienceThisarticleisintendedforanyonesufferingfromdamagetotheirarticularcartilageandtheirfamilieswhowouldliketofindoutaboutautologousmatrix-inducedchondrogenesis,aswellasanyoneinterestedincartilageproblems.WhatisAutologousMatrix-InducedChondrogenesis(AMIC?)?AMIC?isasingle-stepsurgerytorepairdeepchondralandsubchondrallesions.IfyoursurgeonconsidersthatAMIC?isthecorrecttreatmentprocedureforyourinjury,youwillundergosurgeryonyourjoint.Thissurgeryisusuallyperformedundergeneralorspinalanaesthetic.AMIC?maybeperformedarthroscopicallyorinanopensurgery.Duringthissurgery,yoursurgeonwillremovethedamagedcartilage.Thebonewillthenbemicrofractured,ordrilled,toencourageacontrolledlevelofbleedingandtoreleaseMSCsfromtheboneandbonemarrow.Thisstepiscalledbonemarrowstimulation.Ifthesurgeryweretostopatthispoint,thisapproachwouldbestandardmicrofracture.However,inAMIC?,aspeciallydesignedporcinecollagenmembrane,cuttofitperfectlywithinthepreparedchondraldefect,isplacedoverthebleedingbonesurface.Itisheldinplacewithfibringlueorissuturedarounditsperiphery,dependinguponsurgeonpreference,theintentoftherepair,andthelevelofinvolvementofthesubchondralbone.UnderthemembraneaprotectedsuperclotcontainingMSCsthenformsonthebonesurface.Thisbiologicalchamber,establishedbythepresenceofthemembrane,helpsthebodytostimulatechondrocytegrowthandisconducivetotheregenerationofcartilagetissue.FiguresAMICWhataretheadvantagesanddisadvantagesofAutologousMatrix-InducedChondrogenesis(AMIC?)?WhataretheadvantagesofAutologousMatrix-InducedChondrogenesis(AMIC?)?·AMIC?isaone-stepprocedure.Thereisnodelaywhilecellsareculturedinalaboratory,andnosecondoperationisneeded.Theimplantisnaturallyresorbedbythebody.·AMIC?canbeperformedarthroscopicallyinmanycases.·AMIC?isanestablishedtreatmentwithdurable,long-termresults.Patientswhoweretreatedupto10yearsagoarestillbenefittingfromthetreatment,withreducedpainandfewersymptomscomparedwithbeforethesurgery.·LargedefectswhicharenotsuitablefortreatmentwithmicrofracturealonecanbetreatedwithAMIC?.ClinicalstudieshaveshownthatAMIC?resultsinbetteroutcomesthanmicrofracturealoneinlargecartilagelesions.·AMIC?isacost-effectivetreatmentforrepairingcartilagelesions.WhatarethedisadvantagesofAutologousMatrix-InducedChondrogenesis(AMIC?)?AMIC?shouldnotbeusedinpatientswith:·aknownallergytoporcinecollagen·acuteorchronicinfectionatsurgicalsite·acuteorchronicinflammatoryjointdiseaseComplications:Aswithallsurgicalprocedures,complicationscanoccurduringtheAMIC?procedure.FrequentlyAskedQuestions(FAQs)HowlongwilltheAMICtreatmentlast?StudieshaveshownthatpatientswhounderwentAMIC?upto10yearsagoarestilldoingwell.WhencanIresumemynormalactivities?Therehabilitationprogramisalwayscustomizedbythephysician,therearenogeneralguidelinesthatcanbeappliedtoallpatients.Inmanycasespatientsareabletobeginpartialweightbearingontheoperatedjointwithinafewdaysofsurgery.Fullweightbearingcanbeattemptedafterapproximately6weeks.Activityshouldbeincreasedgradually,andmostpatientsshouldbeabletoresumesportingactivitieswithin6months.进一步阅读FurtherreadingTherehavebeenanumberofstudiesevaluatingtheoutcomesofAMIC?.Somekeypapersarelistedbelow:·KaiserN,JacobiM,KusanoT,JakobR,GautierE,PetekD.Clinicalresults10yearsafterAMICintheknee.SwissMedWkly2015;145(Suppl.219):FM145.·KusanoT,JakobRP,GautierE,MagnussenRA,HoogewoudH,JacobiM.Treatmentofisolatedchondralandosteochondraldefectsinthekneebyautologousmatrix-inducedchondrogenesis.KneeSurgSportsTraumatolArthrosc2012;20:2109–15.·LeeYHD,SuzerF,ThermannH.Autologousmatrix-inducedchondrogenesisintheknee:Areview.Cartilage2014;5:145–53.·WiewiorskiM,WernerL,PaulJ,AndersonAE,BargA,ValderrabanoV.Sportsactivityafterreconstructionofosteochondrallesionsofthetaluswithautologousspongiosagraftsandautologousmatrix-inducedchondrogenesis.AmJSportsMed2016;44:2651–8.·VolzM,SchaumburgerJ,FrickH,GrifkaJ,AndersS.Arandomizedcontrolledtrialdemonstratingsustainedbenefitofautologousmatrix-inducedchondrogenesisovermicrofractureatfiveyears.IntOrthop2017;41:797–804.KeywordsAMIC,autologousmatrix-inducedchondrogenesis,Cartilage图片与文字来源ICRS:https://cartilage.org/patient/about-cartilage/cartilage-repair/amic/AutologousMatrix-InducedChondrogenesis(AMIC?)|PatientEducation(cartilage.org).
陶可医生的科普号
AMIC Chondro-Gide软骨基质I/III型胶原纤维支架联合微骨折技术修复膝关节软骨缺损2
AMICChondro-Gide软骨基质I/III型胶原纤维支架联合微骨折技术修复膝关节软骨缺损22个手术案例自体基质诱导的软骨再生(Autologousmatrix-inducedchondrogenesis,AMIC)手术是一步法修复软骨缺损的技术。在关节镜下评估软骨损伤并决定进行AMIC手术后,进行微创膝关节切开术。用于修复膝关节软骨缺损的全关节镜AMIC手术已经报道。[4]AutologousMatrixInducedChondrogenesis(AMIC)surgeryisasinglestepprocedure.AfterarthroscopicevaluationofthecartilagedamageanddecisionforanAMICprocedureaminiarthrotomyisperformed.Anall-arthroscopicAMICprocedureforrepairofcartilagedefectsofthekneeisalsopossible.[4]?首先,暴露并清理成形原软骨缺损,目的是小心去除所有不稳定的退化软骨,包括钙化的软骨下层。然后,使用无菌可压模材料(例如铝箔)获取缺陷的印记(尺寸大小/形状),并将其转移到待切割成形的胶原膜上。接着,外科医生用特殊的锥子在软骨下骨板上制造微小的孔/骨折(微骨折手术)。血液和骨髓(含有骨髓基质干细胞)被释放形成含有软骨形成元素的血凝块。通过纤维蛋白胶(自体或市售)或缝合将正确尺寸的胶原膜贴附于微骨折区域。通过关节的屈曲,验证了胶原膜的稳定固定,最后关闭伤口。Firstthecartilagedefectisexposedandcleanedwherebyallunstabledegeneratedcartilage,includingthecalcifiedcartilagelayer,arecarefullyremoved.Animprintofthedefectisthentakenusingasterilemoldablematerial(e.g.aluminiumfoil)andtransferredtothecollagenmembranewhichiscuttoshape.Thesurgeonthencreatestinyholes/fracturesinthesubchondralboneplate(microfracturing)withaspecialawl.Bloodandbonemarrow(containingstemcells)arereleasedformingabloodclotwhichcontainscartilageformingelements.Thecorrectlysizedcollagenmembraneisaddedtothemicrofracturedareaeitherbyfibringlue(autologousorcommerciallyavailable)orsuturing.Throughflexionofthejoint,thestablepositioningofthemembraneisverifiedandthewoundisclosed.?1.暴露并清理成形原软骨缺损,目的是小心去除所有不稳定的退化软骨,包括钙化的软骨下层?2.使用无菌可压模材料(例如铝箔)获取缺陷的印记(尺寸大小/形状),并将其转移到待切割成形的胶原膜上?3.外科医生用特殊的锥子在软骨下骨板上制造微小的孔/骨折(微骨折手术)?4.通过纤维蛋白胶(自体或市售)或缝合将正确尺寸的胶原膜贴附于微骨折区域5.血液和骨髓(含有骨髓基质干细胞)被释放形成含有软骨形成元素的血凝块??AMIC手术满意结果的基本要求是遵守严格的治疗计划。存在指南和建议,尽管它们必须适应个体患者的需求。AnessentialrequirementforsatisfyingoutcomeoftheAMICsurgeryisthecompliancetoastrictphysicaltherapyprogram.Guidelinesandrecommendationsexist,thoughtheyhavetobeadaptedtotheindividualpatientsneeds.?AMIC手术由Behrens于2003年首次提出。它旨在将微骨折手术的使用范围扩大到>2.5cm2的较大软骨病变。[5]已经研究了AMIC在自体软骨细胞植入(ACI)中的临床效率,这是另一种用于较大软骨损伤的软骨修复技术。[6][7][8]HistoryTheAMICprocedurewasfirstproposedbyBehrensin2003.itaimstoextendtheuseofmicrofracturesurgerytolargercartilagelesions>2.5cm2.[5]Itsclinicalefficiencyinautologouschondrocyteimplantation(ACI),anothercartilagerepairtechniqueforlargercartilagelesions,hasbeenstudied.[6][7][8]?一般来说,无论使用何种技术,已经确定了各种已知会影响软骨修复后结果的因素。其中包括个体和年龄、关节软骨缺损的大小和位置、手术技术和术后康复方案。[9][10]后者被发现对于微骨折手术特别重要,对于AMIC也是会如此[11]Ingeneralvariousfactorshavebeenidentifiedknowntoinfluencetheresultaftercartilagerepairregardlessofthetechniqueused.Amongstthemarethespeciesandageoftheindividual,thesizeandlocalizationofthearticularcartilagedefect,thesurgicaltechnique,andthepostoperativerehabilitationprotocol.[9][10]ThelatterhasbeenfoundespeciallyimportantformicrofracturesurgeryandthereforeforAMIC.[11]?微骨折手术的基本程序是JRSteadman在80年代末和90年代初开发的。这是一种临床报告疗效确切的针对较小面积的软骨病变的软骨修复的一线治疗选择。[12][13][14]AMIC的发展旨在改善微骨折手术的一些不足之处,例如随着时间的推移修复软骨功能退化和软骨缺损面积较大的问题。[15]ThebasicprocedureofMicrofracturesurgerywasdevelopedbyJRSteadmaninthelate80’sandearly90’s.Itisawelldocumentedcartilagerepairtechniqueandfirstlinetreatmentoptionforsmallcartilagelesions.[12][13][14]AMICevolvedwiththeaimtoimprovesomeoftheshortfallsofmicrofracturesurgeryasforinstancevariablerepaircartilagevolumeandfunctionaldeteriorationovertime.[15]???????References?Shaikh,N;Seah,MKT;Khan,WS(18July2017)."Systematicreviewontheuseofautologousmatrix-inducedchondrogenesisfortherepairofarticularcartilagedefectsinpatients".WorldJournalofOrthopedics.8(7):588–601.doi:10.5312/wjo.v8.i7.588.PMC5534408.PMID28808630.?"DeutschePatent-undMarkenamt(DPMA),registration#30255356".2002-11-11.Retrieved2013-01-25.?"WorldIntellectualPropertyOrganization(WIPO),registration#840373".2004-08-18.Retrieved2013-01-25.?Piontek,Tomasz;Ciemniewska-GorzelaKinga;SzulcAndrzej;NaczkJakub;S?omczykowskiMicha?(30August2011)."All-arthroscopicAMICprocedureforrepairofcartilagedefectsoftheknee".KneeSurgery,SportsTraumatology,Arthroscopy.20(5):922–925.doi:10.1007/s00167-011-1657-z.ISSN0942-2056.PMC3332359.PMID21910000.?BehrensP.,P.(2005)."MatrixgekoppelteMikrofrakturierung".Arthroskopie.18(3):193–197.doi:10.1007/s00142-005-0316-0.S2CID30000568.?GomollAH,ProbstC,FarrJ,ColeBJ,MinasT(November2009)."UseofatypeI/IIIbilayercollagenmembranedecreasesreoperationratesforsymptomatichypertrophyafterautologouschondrocyteimplantation".AmJSportsMed.37Suppl1:20S–23S.doi:10.1177/0363546509348477.ISSN0363-5465.PMID19841142.S2CID206524323.?SteinwachsM,KreuzPC(April2007)."AutologouschondrocyteimplantationinchondraldefectsofthekneewithatypeI/IIIcollagenmembrane:Aprospectivestudywitha3-yearfollow-up".Arthroscopy.23(4):381–387.doi:10.1016/j.arthro.2006.12.003.ISSN1526-3231.PMID17418330.?GoodingCR,BartlettW,BentleyG,SkinnerJA,CarringtonR,FlanaganA(Jun2006)."Aprospective,randomisedstudycomparingtwotechniquesofautologouschondrocyteimplantationforosteochondraldefectsintheknee:PeriosteumcoveredversustypeI/IIIcollagencovered".Knee.13(3):203–10.doi:10.1016/j.knee.2006.02.011.ISSN0968-0160.PMID16644224.?AlfordJW,ColeBJ(Mar2005)."Cartilagerestoration,part2:techniques,outcomes,andfuturedirections".AmJ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