臨床整形外科52巻7号

2017年07月発行

Lecture

関節軟骨の修復再生

著者： 佐藤正人¹

所属機関： ¹東海大学医学部外科学系整形外科学

ページ範囲：P.647 - P.653

はじめに

　関節軟骨欠損の治療は多種多様である．従来実施されてきた方法はマイクロフラクチャー法などによる骨髄刺激法，モザイクプラスティ法，そして自家軟骨細胞移植(autologous chondrocyte implantation：ACI)である．しかしながら，これらの方法は変形性膝関節症(膝OA)の患者には本来適応外であり，外傷性の軟骨欠損や離断性骨軟骨炎が主な適応となる．例えば，高位脛骨骨切り術の際に合併する関節軟骨欠損に対してこれらの方法を同時に適応すると，多くは医療保険上減額査定されるといった状況であり，患者さんのために行った治療がすべて病院負担で実施されているという現状は異常であり，膝OAの軟骨欠損に対する標準治療の確立が急務と考える．

　本稿では，関節軟骨欠損の治療に関する従来の軟骨修復法としてマイクロフラクチャー法とモザイクプラスティ法を概説するが，実はこれらの手法は，内在性の間葉系幹細胞を導入または併用する先駆的な治療である．また，本学で現在実施している細胞シートを用いた膝OAの軟骨欠損を適応とした臨床研究の概要も紹介する．

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