点种法移植软骨细胞修复关节软骨缺损

背景：生物性的重建虽能达到修复缺损,重建关节面的目的,但功能上难以与正常软骨一致。应用可降解的聚合物把移植的软骨细胞包埋起来进行移植,可能获得真正意义上的透明软骨。 目的：观察以同种异体兔软骨细胞胶原包埋后,点种法移植软骨细胞修复关节软骨缺损的效果。 方法：新西兰纯种兔制备膝关节全层软骨缺损后分为3组：分别进行胶原包埋软骨细胞点种法移植、单纯软骨细胞点种法移植和仅在大面积软骨缺损的软骨下钻孔。 结果与结论：术后2,4,12,24周观察组织学动态变化,发现胶原包埋软骨细胞点种法移植组能获得透明软骨修复,而软骨细胞点种法组和单纯软骨下骨钻孔组缺损区仅为纤维组织填充,并且胶原包埋软骨细胞点种法移植组兔各期平均组织学和组织化学得分均高于其他两组(P < 0.01)。说明胶原包埋点种法软骨细胞移植能获得透明软骨修复,尤其适用于大面积软骨缺损。     

骨膜移植修补全层骨关节软骨缺损—rhTGF—β1体外培养与关节内注射之比较

游离骨膜已被用于全层骨软骨缺损的修补，但新生软骨之早期退化使此方法无法广泛应用于临床。本实验乃利用转换成长激素之软骨生成效用，比较短时与游离骨膜体外培养或直接行关节腔内注射两种方法，以评估其软骨生成及提高全层骨软骨缺损修补的作用。６４只白兔分成５组：无骨膜移植缺损组、骨膜移植缺损组、激素短时培养骨膜移植缺损组、１００ｎｇ激素关节腔内注射骨膜移植缺损组和２００ｎｇ激素关节腔内注射骨膜移植缺损组。手术后２至１２周取下标本，脱钙后行ＳａｆｒａｎｉｎＯ染色。组织学观察结果，无骨膜移植缺损组未见软骨组织修补。骨膜移植缺损组，於术后４周达最大之透明软骨生成，但此透明软骨持续变薄。激素短时培养组，可加速软骨之生成，但亦加速新生软骨之退化。激素关节腔内注射组并未提高软骨修补品质，反而形成骨赘。     

冷冻保存胎兔周围神经异体移植

目的 :探讨胚胎兔周围神经经冷冻保存后 ,同种异体移植修复周围神经缺损的作用。方法 :以采用两步冷冻方法制备冷冻保存的胎兔坐骨神经 (维持温度值 - 4 0℃ )为供体 ,移植桥接成年兔腓总神经缺损区 ,并与自体神经移植、新鲜异体神经移植、空白缺损比较 ,16周后作再生神经电生理检测、神经断面图像分析及透射电镜观察。结果 :胎神经移植组神经再生效果不如自体神经好 ,但优于新鲜异体神经组。结论 :冷冻保存胎神经移植桥接周围神经缺损 ,可以促进和引到轴突再生 ,有可能代替自体神经移植     

多孔钽支架与磷酸三钙复合骨膜移植修复软骨缺损的比较

背景：早期实验证实骨膜含有潜在形成软骨或骨的间充质干细胞,在适当的条件下可向软骨细胞分化。 目的：比较观察多孔钽支架复合骨膜移植与磷酸三钙复合骨膜移植修复软骨缺损的效果。 方法：取雌性兔24只随机分为2组。建立膝关节软骨缺损模型,分别填入多孔钽支架和磷酸三钙支架,表面覆盖预处理的反置骨膜。石膏固定2周。于12周麻醉后处死兔,观察滑膜、关节液、股骨髁软骨大体观及股骨髁软骨病理表现。采用改良的Mankin骨关节炎的评分法。 结果与结论：多孔钽组滑膜增生明显,新生软骨表层呈蓝白色,周缘欠光滑,甲苯胺蓝染色可见软骨细胞排列稍紊乱,软骨细胞数目正常,多孔钽内骨长入良好,Mankin评分为7.35分。磷酸三钙组新生软骨表层呈蓝白色,周缘欠光滑,甲苯胺蓝染色可见软骨细胞排列稍紊乱,软骨细胞数目正常,磷酸三钙内骨长入可,Mankin评分为7.43分(P > 0.05)。表明多孔钽支架复合骨膜移植与磷酸三钙复合骨膜移植修复方式对软骨修复的结果无明显差别,但多孔钽支架与周围骨组织融合优于磷酸三钙。     

同种异体肌腱解剖重建修复慢性踝关节不稳

背景：同种异体肌腱解剖重建应用于踝关节修复重建的报道目前较少。 目的：分析运用深低温冷冻保存同种异体肌腱解剖重建修复慢性踝关节不稳的临床疗效。 方法：运用深低温冷冻保存同种异体肌腱解剖重建修复慢性踝关节不稳26例,其中跟腓韧带和距腓前韧带同时损伤或松弛18例,距腓前韧带单独损伤或松弛8例。采用美国足踝外科协定(AOFAS)评分及Good评级评估踝关节功能,并进行患侧与健侧踝关节背伸、跖屈活动度、后足活动度比较。 结果与结论：所有患者治疗后均获得随访,随访时间9-24个月,平均15个月。所有患者均未出现复发性踝关节外侧不稳,美国足踝外科协定(AOFAS)评分：同时修复跟腓韧带和距腓前韧带组,治疗前(48.4±3.7)分,治疗后(88.2±3.8)分,治疗后较治疗前平均提高39.8分;单独修复距腓前韧带组治疗前(50.0±6.4)分,治疗后(89.5±3.4)分,治疗后较治疗前平均提高39.5分。Good评级优 19例,良 6例,可 1例,优良率 96%。患者均无严重并发症。结果提示应用深低温冷冻保存同种异体肌腱解剖重建踝关节外侧韧带治疗踝关节慢性外侧不稳,增大了腱骨接触面积,增加了骨腱愈合的概率,增强了踝关节的稳定性,其远期疗效仍待进一步评估。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

非血管化髂骨移植同期修复下颌骨缺损的临床应用

目的：总结非血管化髂骨移植修复下颌骨肿瘤切除术后骨缺损的经验以及提高移植骨的成活率。方法：对52例下颌骨良恶性肿瘤患者切除肿瘤后采用自体非血管化髂骨同期移植修复下颌骨缺损。结果：术后3～6月随访，51例下颌骨缺损获得修复，外形及健侧咬合功能满意，其移植成活率为98．1％；1例感染失败(1．9％)。结论：采用自体非血管化髂骨同期植入修复下颌骨缺损是重建其功能和外形的较理想方法。     

以胫骨滋养动脉为蒂的复合骨膜皮瓣移植修复胫前皮肤缺损骨不连

目的：探讨以胫骨滋养动脉为蒂的复合骨膜皮瓣修复胫前皮肤缺损骨不连的方法及疗效。方法：采用以胫骨滋养动脉为蒂的复合骨膜皮瓣游离移植于胫前皮肤缺损处，修复治疗胫骨骨不连26例病例，进行回顾性研究，随访治疗效果。切取皮瓣大小6cm×4cm～18cm×9cm。结果：26例皮瓣全部成活。随访6～28个月，平均17个月，皮瓣外形满意，骨不连在术后3～6个月愈合。结论：以胫骨滋养动脉为蒂的复合骨膜皮瓣，是治疗胫前皮肤缺损骨不连的有效方法。     

全髋置换术中髋臼异常处理的临床研究

目的：探讨髋关节发育不良、髋臼骨折及全髋翻修等髋臼侧异常行人工全髋关节置换术时髋臼重建的方法和疗效。方法：根据影像解剖学的特点，将41例髋关节病例分为两组，A组（20例）为髋关节发育不良造成的髋臼移位或假臼形成，全髋置换术中利用颗粒植骨、股骨头结构植骨或真臼内移重建髋臼；B组（21例）为髋臼骨折、全髋翻修的髋臼侧严重骨缺损等形态异常的髋臼，利用股骨头结构植骨或颗粒打压植骨填补骨缺损并重建真臼。结果：术后全部获得随访，随访6～72个月，平均23．6个月，关节功能按Harris评分，术前平均32．5分，术后平均82．6分；植入骨均愈合，无假体松动和翻修病例。结论：髋臼植骨重建解决了全髋置换中恢复正常旋转中心及骨储备不足的技术难题，为髋臼假体创造了良好的植入环境，保证髋臼假体具有良好的位置和牢固性。     

头皮大面积缺损外科修复方法的选择

目的总结修复大面积头皮缺损的经验及教训，探讨外科修复大面积头皮缺损的方法及适应证。方法对头皮撕脱伤头皮保存完整者急症实施吻合血管的头皮再植，对保存不完整者尽可能寻找血管实行部分再植；对头皮缺损但帽状腱膜完整者根据污染情况实施急症植皮术或二期植皮修复；对伴有大面积颅骨外露者应用带蒂斜方肌皮瓣或游离皮瓣移植修复。结果再植头皮大部坏死1例，部分坏死2例；带蒂斜方肌皮瓣部分坏死1例，寄养游离股前外侧皮瓣完全坏死1例，其余皮瓣及植皮均全部成活，颅骨完全覆盖。结论对急性期头皮撕脱伤应尽力予以再植；对帽状腱膜完整者植皮修复简单易行，效果良好；带蒂斜方肌皮瓣血运可靠，适应于修复头顶枕部的缺损；游离股前外侧皮瓣修复颅骨大面积外露具有供皮量大、抗感染能力强的优点，适用于颅骨长期外露的患者。     

动力化髋关节外固定器研制及其临床试用

目的 研制动力化髋关节外固定器,并辅助带血管蒂的髂骨瓣移植治疗股骨头坏死,评价其治疗效果.方法 根据髋关节的解剖学和运动学特点,设计动力化髋关节外固定器;对4例中年股骨头坏死患者,采用动力化髋关节外固定器辅助带血管蒂的髂骨瓣移植治疗.术前、术后进行Harris评分和常规的X线检查,并进行对比.结果 经12～30个月的随访,Harris评分由术前的平均56分提高到术后平均81分,良3例,可1例.X线检查,移植的髂骨瓣愈合良好,关节间隙平均4mm.结论 通过本组病例观察,动力化髋关节外固定器可维持髋关节的间隙,带血管蒂的髂骨瓣可恢复股骨头的血运,两者技术的结合使用较好地解决在股骨头修复期早期功能锻炼的问题.     

微骨折技术与骨软骨移植治疗关节软骨缺损

背景：关节镜下微骨折治疗与骨软骨移植是关节软骨缺损主要的治疗方法之一,具有广阔的应用前景。 目的：探讨关节镜下微骨折治疗与自体和同种异体骨软骨移植治疗膝骨关节炎合并关节软骨缺损的效果。 方法：应用关节镜下微骨折治疗清理术结合软骨缺损区微骨折术治疗膝骨关节炎的临床疗效、临床症状及Tegner运动评级判定疗效并随访观察3-24个月。自体骨软骨移植治疗关节软骨缺损的患者进行观察随访,通过评价移植后关节活动度、临床症状的改善、关节影像学检查等评估自体骨软骨移植治疗的效果。并对同种异体骨软骨移植治疗关节软骨缺损进行动物实验研究,通过对移植部位的大体观察、组织学观察以及免疫组织化学染色观察,评估同种异体骨软骨移植治疗的效果。 结果与结论：关节软骨缺损应用关节镜下微骨折治疗后的患者,关节清理术结合软骨缺损区微骨折术总有效率89.7%。关节软骨缺损应用自体骨软骨移植治疗后的患者,关节疼痛、肿胀的症状改善,关节活动度正常,偶有关节静息痛或活动后轻微疼痛,影像学检查见移植骨软骨位置良好,修复愈合良好。关节软骨缺损应用同种异体骨软骨移植治疗后的实验动物,关节活动度正常,移植关节面光整,关节软骨被透明软骨覆盖,细胞有序排列,软骨基质分泌,修复软骨Ⅱ型胶原免疫组织化学染色强阳性。     

Repairing large porcine full-thickness defects of articular cartilage using autologous chondrocyte-engineered cartilage

Large full-thickness defects of articular cartilage remain a major challenge to orthopedic surgeons because of unsatisfactory results of current therapy. Many methods, such as chondrectomy, drilling, cartilage scraping, arthroplasty, transplantation of chondrocytes, periosteum, perichondrium, as well as cartilage and bone, have been tried to repair articular cartilage defects. However, the results are far from satisfactory. In this study, we applied a tissue-engineering approach to the repair of articular cartilage defects of knee joints in a porcine model. Using isolated autologous chondrocytes, polyglycolic acid (PGA), and Pluronic, we have successfully in vivo-engineered hyaline cartilage and repaired articular cartilage defects. The surface of the repaired defects appeared smooth at 24 weeks postrepair. Histological examination demonstrated a typical hyaline cartilage structure with ideal interface healing between the engineered cartilage and the adjacent normal cartilage and underlying cancellous bone. In addition, glycosaminoglycan (GAG) levels in the engineered cartilage reached 80% of that found in native cartilage at 24 weeks postrepair. Biomechanical analysis at 24 weeks demonstrated that the biomechanical properties of the tissue-engineered cartilage were improved compared with those at an earlier stage. Thus, the results of this study may provide insight into the clinical repair of articular cartilage defects.     

大块异体骨联合自体骨髓移植修复股骨上段肿瘤切除后缺损

背景：由于骨肿瘤切除造成的骨组织缺损是临床面临的难题之一,而如何修复缺损是骨科领域的热点问题。 目的：探讨采用大块异体骨联合自体骨髓移植治疗股骨上段肿瘤的临床应用及疗效。 方法：于2000-07/2005-06采用辐照冻存的大块异体骨联合自体骨髓移植治疗股骨上段良性肿瘤切除后遗留大块骨缺损12例,手术采用类似脊柱的“蛋壳”技术,掏空股骨头,保留股骨头圆韧带及头的皮质骨,尽量保留股骨头的1/3的血供,应用大块异体骨联合自体骨髓移植加内固定治疗。 结果与结论：患者术后随访6~11年。术后所有12例患者的大块异体骨联合自体骨髓在X射线中均显示整合血管化良好,骨小梁通过自体骨。MSTS93总体平均评分为26.33分,患者肢体功能总的优良率为83.3%。提示大块异体骨联合自体骨髓移植是修复股骨上段肿瘤切除后骨大块缺损的有效方法,并能充分整合成周围的自体骨。     

Repair of osteochondral defects in rabbits with ectopically produced cartilage

Cartilage has poor regenerative capacity. Donor site morbidity and interference with joint homeostasis should be considered when applying the autologous chondrocyte transplantation technique. The use of ectopically produced cartilage, derived from periosteum, might be a novel method to heal cartilage defects. Ectopic cartilage was produced by dissecting a piece of periosteum from the tibia of rabbits. After 14 days the reactive tissue at the dissection site was harvested and a graft was cored out and press-fit implanted in an osteochondral defect in the medial condyle of the femur with or without addition of hyaluronan. After 3 weeks and 3 months the repair reaction was evaluated by histology. Thionine- and collagen type II-stained sections were evaluated for graft viability, ingrowth of the graft, and joint surface repair. Empty defects remained empty 3 weeks after implantation, ectopic cartilage filled the defect to the level of the surrounding cartilage. Histologically, the grafts were viable, consisting mainly of cartilage, and showed a variable pattern of ingrowth. Three months after implantation empty defects with or without hyaluronan were filled primarily with fibrocartilaginous tissue. Defects treated with ectopic cartilage contained mixtures of fibrocartilaginous and hyaline cartilage. Sometimes a tidemark was observed in the new articular cartilage and the orientation of the cells resembled that of healthy articular cartilage. Subchondral bone repair was excellent. The modified O'Driscoll scores for empty defects without and with hyaluronan were 12.7 +/- 6.4 and 15.3 +/- 3.2; for treated defects scores were better (15.4 +/- 3.9 and 18.2 +/- 2.9). In this conceptual study the use of ectopic cartilage derived from periosteum appears to be a promising novel method for joint surface repair in rabbits.     

Repair of Extensive Articular Cartilage Defects in Horses by Autologous Chondrocyte Transplantation

Damaged adult articular cartilage has very limited capacity to heal. Autologous chondrocyte transplantation (ACT) has been used clinically and studied in experimental animals in an attempt to provide biologically based cartilage regeneration. This study evaluated cartilage repair following ACT in a large animal model over a period of 2 years. Articular cartilage defects (10 mm in diameter, full-thickness) were created in the minor load-bearing area on the lateral talus of tibiotarsal joints of eight adult horses. In each animal, the right joint was repaired using autologous chondrocytes injected beneath the periosteum, as in the original ACT procedure (Brittberg, M., A. Lindahl, A. Nilsson, C. Ohlsson, O. Isaksson, and L. Peterson N. Engl. J. Med. 331:889-895, 1994): the left joint remained untreated to serve as a control. Clinical and pathological evaluation was within the range of normal for all horses at both time points. Compared to untreated defects, ACT resulted in significantly improved defect filling with a well-integrated neocartilage and comparable expression of cartilage-specific markers. The histological score (Peterson, L., T. Minas, M. Brittberg, A. Nilsson, E. Sjogren-Jansson, and A. Lindahl Clin. Orthop. 374:212-234, 2000) (10.4 +/- 0.9 for ACT and 5.6 +/- 3.9 for controls, all animals, p = 0.016) indicated that ACT contributed to the reparative process. For the first time, the efficacy of ACT was demonstrated in a large animal model supporting the potential of ACT for cartilage regeneration in patients.     

Repair of articular cartilage defect by cell transplantation

Full-thickness articular cartilage defects are a major clinical problem; however, at present there is no treatment that is widely accepted to regeneratively repair these lesions. The current therapeutic approach is to drill or abrade the base of the defect to expose the bone marrow with its cells and growth factors. This usually results in a repaired tissue of fibrocartilage that functions poorly in the loaded joint environment. Recently, autologous cultured chondrocyte transplantation and mosaic plasty were explored. We can repair small articular cartilage defects using these methods, although their effectiveness is still controversial. We have reported that transplantation of allogeneic chondrocytes embedded in collagen gels or allogeneic chondrocytes cultured in collagen gels could repair articular cartilage defect in a rabbit model. We also reported that autologous culture-expanded bone marrow mesenchymal cell transplantation could repair articular cartilage defect in a rabbit model. This procedure offers expedient clinical use, given that autologous bone marrow cells are easily obtained and can be culture-expanded. We transplanted autologous culture-expanded bone marrow cells into the cartilage defect of the osteoarthritic knee joint on 11 patients at the time of high tibial osteotomy. As early as 6.8 weeks after transplantation, the defect was covered with white soft tissue, in which slight metachromasia was histologically observed. Thirty-three weeks after transplantation, the repaired tissue had hardened. Histologically, repaired tissues showed stronger metachromasia and a partial hyaline cartilage-like appearance. This procedure may prove a promising method by which to repair articular cartilage defects.     

膝关节自体软骨细胞移植修复软骨缺损：MR成像评价生物力学指标

背景：磁共振(MR)检查目前被认为是关节软骨的最佳无创性检查方法,通过MR检查可以发现软骨损伤及软骨下骨病变。 目的：磁共振成像观察膝关节软骨缺损自体软骨细胞移植修复后软骨生物力学指标变化。 方法：回顾性分析10例膝关节软骨损伤患者临床资料,均接受自体软骨细胞移植治疗。移植后随访12个月,分别于移植后3,6,12个月对患者进行膝关节损伤与骨关节炎评分(KOOS)和磁共振成像检查,了解软骨生物力学指标变化情况。 结果与结论：①膝关节损伤与骨关节炎评分：经比较,移植后3,6,12个月患者的疼痛、症状、日常活动、运动和娱乐、生活质量各项指标评分较移植前均出现显著提高(P < 0.05)。②患者软骨生物力学MR成像：移植后3个月,患者的软骨缺损部位均大的部分得到良好的填充;移植后6个月,移植软骨与周围软骨基本处于完全整合状态;移植后12个月复查,修复组织信号强度与周围组织呈现出良好的一致现象。随着时间的推移,移植区的T2值呈现出不断下降的情况。且移植后3,6,12个月的T2值均显著小于移植前(P < 0.05);移植后6,12个月的T2值均显著小于移植后3个月(P < 0.05);移植前与移植后3个月,移植区的T2值均显著大于正常区(P < 0.05)。结果表明,磁共振成像检查可以了解膝关节软骨缺损自体软骨细胞移植后不同时间软骨修复的生物力学情况,掌握治疗效果,是一种安全、无创的随访方式。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程      

髋关节冠状断层影像解剖学

目的：为髋关节疾患的影像学诊断提供冠状断层解剖学基础。方法：成年男性右髋部标本5例(新鲜3，常规固定2)．先以解剖骨性标志画线．1例先作髋部冠状位MR1扫描．所有标本冻硬后．切制髋部冠状断层标本．结果：观察每一断层标小髓关节的主要结构、殴骨头韧带，髂股韧带和其周围组织的形态．位置、毗邻的特征及在连续断层的变化规伴；测量结果如下：股骨头垂直径41．2mm，冠状径42．9mm．髋臼冠状径52．7mm．髋臼深度29．6mm．股骨头及髋臼节软骨厚各为3.3mm与2．5mm，股骨头韧带长25．1mm，厚2．6mm．髂股韧带厚7．7mm。结论：髋关节的冠状断层解剖各结构形态、位置及变化规律．为临床骨科、影像学及髋关节镜技术诊断与治疗髋关节疾患，提供了有价值的形态学依据。     

以羊膜为载体培养游离软骨细胞修复兔关节软骨缺损

目的：探讨膜结构为载体培养游离软骨细胞修复软骨缺损的可行性。方法：以兔羊膜为载体将体外培养的同种异体游离软骨细胞植于兔左侧股骨外踝软骨缺损区，分别于4、8、12周处死动物，整个膝关节被解剖，进行大体观察、组织学评价、电镜观察及SRY基因性别鉴定，并以兔体的右膝关节做为对照。结果：术后4、8、12周大体、组织学、电镜观察显示软骨缺损区新生了透明软骨，SRY基因性别鉴定证明新生的软骨来源于移植的同种异体软骨细胞；而对照组则仅见纤维组织样的修复组织。结论：以羊膜为载体进行同种异体软骨细胞移植能够修复关节软骨缺损。     

脱钙骨基质与骨髓间充质干细胞共培养关节腔内的成软骨活性

背景：将骨髓间充质干细胞附着到支架材料上再植入关节软骨缺损处,细胞不但不消失,而且可形成新的软骨。 目的：观察同种异体脱钙骨基质与骨髓间充质干细胞共培养在关节内的成软骨活性。 方法：在54只青紫蓝兔单侧膝关节制作关节软骨全层缺损模型,随机分组：实验组在缺损处植入自体骨髓间充质干细胞与同种异体脱钙骨基质复合物,对照组缺损处仅植入同种异体脱钙骨基质,空白对照组未植入任何物质。 结果与结论：植入后12周,实验组缺损处修复组织呈软骨样,表面光滑平坦,与周围软骨整合的软骨细胞更为成熟,修复组织与软骨下骨结合牢固;修复组织的细胞为透明软骨样细胞,柱状排列,Ⅱ型胶原染色阳性,与周围软骨及软骨下骨整合良好,且实验组组织学评分优于对照组和空白对照组 (P < 0.01)。对照组缺损处修复组织呈纤维样,与周围软骨未结合,空白对照组缺损区无修复组织,两组均无Ⅱ型胶原染色阳性表达。表明同种异体脱钙骨基质与骨髓间充质干细胞共培养后植入膝关节可形成软骨样组织,有效修复关节软骨缺损。