髌骨骨-骨膜原位翻转修复软骨缺损的基础研究及临床应用

目的 探讨治疗髌骨软骨缺损的简便、有效的方法，并分析新生软骨退变的原因。方法 （1）设计动物实验，将家兔附骨骨－骨膜块植入股骨髁间人为形成的缺损处。（2）取人体髌前及胫骨上段骨－骨膜块标本进行组织学对比。（3）选择适合病人7例，用环锯将髌骨软骨病变区全层髌骨与骨膜完整切取，翻转后原位再植。结果 （1）动物实验示骨膜演化为软骨的过程分为间充质细胞增殖分化、软骨细胞形成有新生软骨改造塑形、透明软骨组织成熟三个阶段。（2）人体髌前骨膜生发层未分化间充质细胞分布较密集。（3）要后临床随访5－53个月，平均26．7个,膝关节功能恢复良好。结论 手术操作是否得当对新生软骨的形成影响很大。导致新生软骨退变的主要因素有：（1）未能注射修复的“完整性原则”；（2）骨膜生发层朝向关节腔。

Basic study and clinical application of repair of cartilage defect by patellar osteo-periosteum turned over orthotopically

Objective To explore a simple and effective method to treat patellar cartilage defect. Methods Osteo periosteal tissues from tarsales of healthy rabbits were implanted into the man made defects between the femur condyles in the joints of both knees. The osteo periosteal complex tissues from human patella and upper tibia were resected, and a histological comparison was made between them. Seven patients with patellar cartilage defect were selected. The lesions were explored and cleaned after their knees had been cut open. Full thickness of patella in the lesion area of patellar cartilage was resected with trepan after delamination was made between the patellar osteo periosteum and anterior tendinous tissues. Being turned over orthotopically, the patella was implanted in the original position. Results The evolution process from periosteum into hyaline was divided into 3 stages, proliferation and differentiation of the mesenchymal stem stem cells, formation of the cartilage and moulding and remoulding of the new cartilage, and maturation of the hyaline cartilage tissues. The anterior periosteal undifferentiated mesenchymal cells of human patella were denser than that of the upper tibias. Followed up for 5 to 53 months, with an average of 26.7 months, the functions of the joints of 6 patients were restored to some degree. Conclusions Proper operation technique plays an important role in the formation of cartilage and there are 2 causes of the early stage disintegration of newborn cartilage, little attention paid to the intact principle and the cambium layer of periosteum facing to the articular cavity.