膝关节症

对变形性关节病的干细胞关节内投与治疗

knee_stem

干细胞能够抑制关节内的发炎、促进软骨的修复,使关节内构造能够再生,减轻因为关节老化等带来的疼痛与不便。韧带与肌肉也能得到一定程度的修复作用,在国外是明星及国家级的运动员们会接受的治疗法

在日本国内东京医科齿科大学整形外科正在开展「对变形性膝关节症的滑膜干细胞投与」治疗,损伤软骨的再生有着显著的进展。

变形性膝关节症

image_bone01

作为原因有一下两种:膝关节软骨损伤和在软骨和软骨之间有着缓冲作用的半月板损伤。最主要的原因是因为年龄增长老化或是过度激烈的运动所造成的外部因素。变形性膝关节症的大多数同时伴有软骨损伤和半月板损伤。

kneestem cartige

使用干细胞再生磨损,损伤的关节软骨

膝关节痛的常规治疗大多数是以透明质酸注射和肌肉锻炼为主。这些从根本上解决不了损伤部位,只是治标不治本。 膝关节的再生治疗是培养自身的干细胞(治疗的流程参照如下)把它和透明质酸一样注入膝关节内。在海外以注入1亿个数的治疗例较多,不过在本院根据软骨损伤的程度可以提高到注射10亿个数。

治疗实绩论文

Transplantation. 2013 Jun 27;95(12):1535-41. doi: 10.1097/TP.0b013e318291a2da.
Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study.
Orozco L1, Munar A, Soler R, Alberca M, Soler F, Huguet M, Sentís J, Sánchez A, García-Sancho J.
BACKGROUND:
Osteoarthritis is the most prevalent joint disease and a frequent cause of joint pain, functional loss, and disability. Osteoarthritis often becomes chronic, and conventional treatments have demonstrated only modest clinical benefits without lesion reversal. Cell-based therapies have shown encouraging results in both animal studies and a few human case reports. We designed a pilot study to assess the feasibility and safety of osteoarthritis treatment with mesenchymal stromal cells (MSCs) in humans and to obtain early efficacy information for this treatment.
METHODS:
Twelve patients with chronic knee pain unresponsive to conservative treatments and radiologic evidence of osteoarthritis were treated with autologous expanded bone marrow MSCs by intra-articular injection (40×10^6 cells). Clinical outcomes were followed for 1 year and included evaluations of pain, disability, and quality of life. Articular cartilage quality was assessed by quantitative magnetic resonance imaging T2 mapping.
RESULTS:
Feasibility and safety were confirmed, and strong indications of clinical efficacy were identified. Patients exhibited rapid and progressive improvement of algofunctional indices that approached 65% to 78% by 1 year. This outcome compares favorably with the results of conventional treatments. Additionally, quantification of cartilage quality by T2 relaxation measurements demonstrated a highly significant decrease of poor cartilage areas (on average, 27%), with improvement of cartilage quality in 11 of the 12 patients.
CONCLUSIONS:
MSC therapy may be a valid alternative treatment for chronic knee osteoarthritis. The intervention is simple, does not require hospitalization or surgery, provides pain relief, and significantly improves cartilage quality.


Arthroscopy. 2013 Apr;29(4):748-55. doi: 10.1016/j.arthro.2012.11.017. 2013 Jan 29.
Mesenchymal stem cell injections improve symptoms of knee osteoarthritis.
Koh YG1, Jo SB, Kwon OR, Suh DS, Lee SW, Park SH, Choi YJ.
PURPOSE:
The purpose of this study was to evaluate the clinical and imaging results of patients who received intra-articular injections of autologous mesenchymal stem cells for the treatment of knee osteoarthritis.
METHODS:
The study group comprised 18 patients (6 men and 12 women), among whom the mean age was 54.6 years (range, 41 to 69 years). In each patient the adipose synovium was harvested from the inner side of the infrapatellar fat pad by skin incision extension at the arthroscopic lateral portal site after the patient underwent arthroscopic debridement. After stem cells were isolated, a mean of 1.18 × 10(6) stem cells (range, 0.3 × 10(6) to 2.7 × 10(6) stem cells) were prepared with approximately 3.0 mL of platelet-rich plasma (with a mean of 1.28 × 10(6) platelets per microliter) and injected into the selected knees of patients. Clinical outcome was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index, the Lysholm score, and the visual analog scale (VAS) for grading knee pain. We also compared magnetic resonance imaging (MRI) data collected both preoperatively and at the final follow-up.
RESULTS:
Western Ontario and McMaster Universities Osteoarthritis Index scores decreased significantly (P < .001) from 49.9 points preoperatively to 30.3 points at the final follow-up (mean follow-up, 24.3 months; range, 24 to 26 months). Lysholm scores also improved significantly (P < .001) by the last follow-up visit, increasing from a mean preoperative value of 40.1 points to 73.4 points by the end of the study. Likewise, changes in VAS scores throughout the follow-up period were also significant (P = .005); the mean VAS score decreased from 4.8 preoperatively to 2.0 at the last follow-up visit. Radiography showed that, at the final follow-up point, the whole-organ MRI score had significantly improved from 60.0 points to 48.3 points (P < .001). Particularly notable was the change in cartilage whole-organ MRI score, which improved from 28.3 points to 21.7 points (P < .001). Further analysis showed that improvements in clinical and MRI results were positively related to the number of stem cells injected.
CONCLUSIONS:
The results of our study are encouraging and show that intra-articular injection of infrapatellar fat pad-derived mesenchymal stem cells is effective for reducing pain and improving knee function in patients being treated for knee osteoarthritis.

有膝专门整形外科医生担任


01
整形外科专门医 磐田振一郎

1971年出生 膝专门医 整形外科专门医
1996年 庆应义塾大学医学部 毕业
〜2001年 庆应义塾关联医院工作(足利红十字医院、小田原市立医院、伊势庆应医院、川崎市立医川崎院、日野市立病院)
2004年 留学于斯坦福大学
2006年 国立医院机构村山医疗中心
2009年 设立 NPO(非营利组织)腰痛・膝痛团队医疗研究所
2016年 表参道埃莱妮医院 膝关节再生医疗

诊疗费

施术 细胞数(sell数) 详细 诊疗费
膝关节内 自体培养干细胞投与
一个亿 细胞采取、细胞5年保管、关节内投与 与干细胞治疗量身专员连系