刘训志 何华宾 项卫卫 何澄

[摘要]目的 探讨自体脂肪及滑膜间充质干细胞联合治疗膝骨关节炎的临床效果。方法 选取我院2018年1～11月收治的30例膝骨关节炎患者作为研究对象，依据治疗方式不同分为脂肪来源间充质干细胞（ADMSCs）组（10例）、滑膜来源间充质干细胞（SDMSCs）组（10例）及联合组（10例），ADMSCs组采用自体ADMSCs进行关节腔注射，SDMSCs组采用自体SDMSCs进行关节腔注射，联合组采用上述两种间充质干细胞联合的治疗方式。比较三组治疗前后的视觉模拟疼痛量表（VAS）评分、膝关节评分、骨关节炎指数（WOMAC）评分、治疗效果以及治疗后并发症发生情况。结果 治疗前三组VAS评分及膝关节评分比较，差异无统计学意义（P>0.05）;治疗后三组VAS评分均低于治疗前，膝关节评分均高于治疗前，差异有统计学意义（P<0.05）;治疗后联合组VAS评分均低于ADMSCs组及SDMSCs组，而膝关节评分则高于ADMSCs组及SDMSCs组，差异有统计学意义（P<0.05）;治疗后ADMSCs组及SDMSCs组VAS及膝关节评分比较，差异无统计学意义（P>0.05）。三组注射前的WOMAC评分比较，差异无统计学意义（P>0.05）;三组注射后6、12个月的WOMAC评分低于注射前，差异均有统计学意义（P<0.05）;联合组注射后6、12个月的WOMAC评分低于ADMSCs组及SDMSCs组，差异有统计学意义（P<0.05），而治疗后ADMSCs组及SDMSCs组WOMAC评分组间比较，差异无统计学意义（P>0.05）。联合组患者并发症总发生率均低于ADMSCs组及SDMSCs组，差异有统计学意义（P<0.05），ADMSCs組与SDMSCs组的并发症总发生率比较，差异无统计学意义（P>0.05）。联合组优良率高于ADMSCs组及SDMSCs组，差异均有统计学意义（P<0.05），ADMSCs组与SDMSCs组优良率比较，差异无统计学意义（P>0.05）。结论 采用自体ADMSCs联合SDMSCs治疗，能够促使膝骨关节炎患者膝关节功能改善，缓解疼痛，提高疗效。

[关键词]人脂肪;滑膜;充质干细胞;膝骨关节炎

[中图分类号] R683.42          [文献标识码] A          [文章编号] 1674-4721（2020）7（b）-0080-04

Clinical effect of combined treatment of autologous fat and synovial mesenchymal stem cells on knee osteoarthritis

LIU Xun-zhi   HE Hua-bin   XIANG Wei-wei   HE Cheng

Department of Orthopedics， the First Affiliated Hospital of Gannan Medical University， Jiangxi Province， Ganzhou   341000， China

[Abstract] Objective To investigate the clinical effect of human adipose tissue and synovial mesenchymal stem cells in the treatment of knee osteoarthritis. Methods A total of 30 patients admitted in our hospital from January to November in 2018 were selected as the research objects. They were divided into adipose-derived mesenchymal stem cells （ADMSCs） group （10 cases）， synovial-derived mesenchymal stem cells （SDMSCs） group （10 cases）， and combined treatment group （10 cases） according to different treatment methods. Adipose-derived mesenchymal stem cells were injected into the articular cavity. The SDMSCs group was injected with autologous synovial mesenchymal stem cells. The combination group used the above two types of mesenchymal stem cells combined therapy. The visual pain scale （VAS） score， knee joint score， osteoarthritis index （WOMAC） score， treatment effect， and postoperative complications were compared between the three groups of patients. Results There were no significant differences in the VAS scores and knee scores of the three groups before treatment （P>0.05）; the VAS scores of the three groups after treatment were lower than before treatment， and the knee scores were higher than before treatment， the differences were statistically significant （P<0.05）; after treatment， the VAS score of the combined group was lower than that of the ADMSCs group and SDMSCs group， and the knee score was higher than that of the ADMSCs group and SDMSCs group， the differences were statistically significant （P<0.05）; after treatment， there were no significant differences in the scores of VAS and knee joints in ADMSCs group and SDMSCs group （P>0.05）. There were no statistically significant differences in the WOMAC score before injection among the three groups （P>0.05）; the WOMAC scores at 6 and 12 months after injection in the three groups were lower than before injection， and the differences were statistically significant （P<0.05）; the combination 6 and 12 months after injection， the WOMAC scores were lower than that in the ADMSCs group and SDMSCs group， the differences were statistically significant （P<0.05） ， but there was no significant difference in the WOMAC scores between the ADMSCs group and the SDMSCs group after treatment （P>0.05）. The total incidence of complications in the combined group was lower than that in the ADMSCs group and the SDMSCs group， and the differences were statistically significant （P<0.05）. Compared with the total incidence of complications in the ADMSCs group and the SDMSCs group， the difference was not statistically significant （P>0.05）. The rate of excellence in the combined group was lower than that in the ADMSCs group and the SDMSCs group， and the differences were statistically significant （P<0.05）. Compared with the rate of excellence in the ADMSCs group and the SDMSCs group， the difference was not statistically significant （P>0.05）. Conclusion The use of autologous ADMSCs combined with SDMSCs can promote the improvement of knee function， relieve pain and improve the efficacy of knee osteoarthritis patients.

[Key words] Human fat; Synovial membrane; Stem cells; Knee osteoarthritis

膝骨关节炎是骨科临床较为常见的多发病，是关节软骨出现退行性病变的一类疾病，主要由致炎因素引起的关节透明软骨合成及分解代谢平衡破坏而导致透明软骨不断下降，最终发生骨性关节炎，对患者的日常生活以及身体健康产生严重影响[1-2]。目前主要……