同种异体软骨移植免疫排斥反应的研究进展

关节炎、颞颌关节疾病及关节机械损伤以及颌面部美容整形的发展，都使得软骨治疗成为倍受关注的对象，由于软骨组织中无血管、神经及淋巴等供应，而软骨细胞又为终末分化细胞，软骨缺损很难自身修复，故治疗以软骨移植为主。软骨移植包括自体、同种异体、异种移植，其中自体软骨移植来源有限、给患者带来二次创伤并增加患者疼痛而致应用受限，异种移植由于强烈的免疫排斥等问题研究还处在基础实验阶段，而同种异体软骨移植来源广泛，生物学性能良好，可望成为较理想的软骨移植物，但其存在的免疫排斥反应影响移植物在体内的长期存活，是目前研究不容忽视的问题。     

软骨膜移植的研究及应用

用软骨移植物来重建修复软骨缺损对整形外科医生来说一直是个挑战。修复软骨缺损时 ,最好用自体软骨 ,以避免移植性疾病和预防免疫排斥反应[1] 。最常用的是肋软骨和耳廓软骨。然而 ,供区继发病变 ,进行性供区结构异常 ,移植物早期吸收 ,有限的可供使用的软骨块体积及移植软骨与受区结合能力差等 ,是自体软骨移植术中主要的缺点。软骨膜生发层细胞具有分化、增殖形成新软骨的特性[2 ] ,几十年来人们实验证明了软骨膜具有生成软骨的潜在能力[3 ,4] ,并有人先后试应用于临床[5,6] 。然而 ,单纯软骨膜移植形成软骨的量有限[7] ,且不均一。有人…     

自体软骨在鼻整形中的应用及研究进展

亚洲人采用的鼻整形材料一直以固体硅胶、膨体聚四氟乙烯、自体软骨等为主。近年来,人工材料所带来的问题使得鼻整形移植物的选择显现出由单纯人工假体转向人工假体与自体软骨联合使用的趋势,自体软骨在安全性和长期稳定性方面的优势逐渐被关注。随着技术的发展,自体软骨移植带来的供区并发症、术后瘢痕、远期变形问题得到明显改善,自体软骨移植在鼻整形中的优越性更加明显,组织工程学和3D生物打印技术的发展,更为其增添了新的活力。     

距骨骨软骨损伤的治疗研究进展

距骨骨软骨损伤是运动医学中具有挑战性的疾病之一。临床治疗策略包括保守治疗和手术治疗,保守治疗在儿童患者中效果最佳,对于成人患者常常选择进行手术治疗。目前常见的外科手术治疗方案包括关节镜下骨髓刺激、自体软骨细胞植入、自体骨软骨移植、同种异体骨软骨移植或同种异体青少年软骨微粒移植等。关节镜下骨髓刺激技术(特别是微骨折)适用于较小的病灶,是常见的一线治疗方案,中短期临床疗效令人满意,但长期疗效有待进一步观察。自体骨软骨移植常用于伴有较大囊性病变的距骨骨软骨损伤患者,有着较好的中短期临床疗效,然而术后存在囊肿复发和供区并发症的发生。近年来有大量文献报道其他生物治疗措施,如骨软骨损伤区域注射富含血小板血浆、或者浓缩骨髓细胞等,均有一定的临床疗效。本文对这些技术的应用细节和疗效进行综述,目的是为临床医生能够更好地治疗距骨骨软骨损伤提供依据。     

同种异体骨软骨移植修复软骨损伤的研究进展

关节软骨损伤的治疗是骨科领域一个难题,同种异体骨软骨移植是修复全层软骨损伤的有效方法.文中综述了同种异体骨软骨移植修复软骨损伤的研究进展,包括该方法的适应证和禁忌证,目前在临床的应用情况及治疗效果,并进一步探讨了同种异体骨软骨移植中的3个热点话题,如疾病传播、免疫排斥和移植物的保存.这些文献综述显示同种异体骨软骨移植修复关节软骨损伤具有特定优势,但进一步推广该方法仍有一些需要解决的问题.     

人工骨及其应用

骨移植对于提供支持，填充空腔，加速骨缺损的愈合是一种必要的治疗方式。自体骨移植是骨移植的“金标准”，但自体骨移植受到许多限制，如供区损伤、植骨量不足等，不能制备特殊的形状，这些限制促进了骨移植替代材料的研究。同种异体骨已被广泛应用，同种异体移植物可以是松质骨、皮质骨或两者一起使用。     

软骨组织工程支架材料研究进展

软骨损伤和缺失后 ,软骨组织的自身修复能力极其有限 ,因此缺损往往不能自行修复 ,其修复和功能重建是修复重建外科十分重要的研究课题之一。现代外科的发展已使人类修复缺损软骨成为可能 ,目前临床上的修复方法主要包括植入自体生物移植物和植入软骨代用品。植入自体生物移植物 ,如骨膜、软骨膜、韧带、软骨等 ,不仅来源非常有限 ,而且会造成供区的畸形和瘢痕 ;软骨代用品 ,如冻干的同种异体软骨、人工合成材料等。植入后易引起排斥反应和感染 ,无法取得良好的术后疗效。 80年代末以来 ,国外学者研究用组织工程的方法修复软骨缺损 ,取得了…     

新鲜和深低温冷冻同种异体骨软骨移植长期转归实验研究

[目的]观察和比较新鲜和深低温冷冻同种异体骨软骨移植后的长期转归情况,为同种异体骨软骨移植治疗关节软骨缺损进一步提供理论基础。[方法]建立兔膝关节软骨缺损模型,行新鲜和深低温冷冻同种异体骨软骨移植。在术后12个月和18个月,骨软骨移植物取材进行关节软骨蛋白多糖、软骨细胞活性检测和软骨细胞超微结构观察。[结果]新鲜和冷冻骨软骨移植物中蛋白多糖阿尔新蓝染色强度和存活软骨细胞比率术后均下降,且在各时间点新鲜移植组的结果优于冷冻移植组,有统计学差异(P0.05)。超微结构显示软骨细胞退行性改变。[结论]新鲜和深低温冷冻同种异体骨软骨在移植术后较长时间均出现严重退变,冷冻骨软骨移植物退变较严重,其作为关节软骨缺损治疗方法目前是不可行的。     

慢速梯度降温冷冻保存同种异体骨软骨移植治疗膝关节全层软骨缺损(附三例报告)

目的总结冷冻保存同种异体骨软骨移植物治疗3例膝关节全层骨软骨缺损的手术方法及疗效。方法应用梯度降温冷冻保存的6枚同种异体骨软骨移植物治疗3例膝关节全层骨软骨缺损,2例在关节镜下同种异体骨软骨移植,1例行关节切开移植。膝关节股骨髁关节软骨全层缺损平均面积2.16 cm2。所有患者在手术后第1个月、第3个月时进行膝关节MRI检查,了解移植物与周围骨软骨组织的愈合情况。并于门诊复查时进行Brittberg-Peterson膝关节功能评分,了解功能恢复情况。结果随访4～6个月,平均4.7个月。所有患者术后疼痛消失;无排异反应发生。术后3个月时,MRI检查示术后移植物与宿主软骨下骨整合良好,移植软骨组织结构与内部信号良好。Brittberg-Peterson评分术后6个月比手术前明显降低。结论经梯度降温冷冻保存的同种异体骨软骨移植治疗膝关节软骨缺损早期效果满意。     

自体髌骨外侧软骨移植治疗膝关节软骨缺损的实验研究

自体髌骨外侧软骨移植治疗膝关节软骨缺损的实验研究杨述华李进杜靖远罗怀灿夏志道汪岚关节软骨缺损的修复是至今未能解决的问题，软骨移植治疗软骨缺损仍处于实验阶段，且多数采用同种异体软骨移植，因取材困难以及排异反应仍不能用于临床。作者设计自体髌骨外侧软骨移植...     

Comparison of AlloDerm, fat, fascia, cartilage, and dermal grafts in rabbits

OBJECTIVE: To compare various graft materials in the rabbit model, including autologous cartilage, dermal tissue, fat, and AlloDerm (a cadaver-derived material). METHODS: Twenty-five New Zealand white rabbits were used. Equally sized autogenous (fat, fascia, cartilage, and dermal) grafts and AlloDerm were implanted into subcutaneous dorsal pockets on the rabbits. Animals were killed 1, 2, 3, and 4 months after surgery. The grafts were examined microscopically for thickness, resorption, fibrosis, neovascularization, inflammation, eosinophilia, and the presence of multinucleated giant cells or microcysts. RESULTS: The cartilage grafts revealed excellent viability with no resorption. The fascial grafts showed negligible volume loss. The dermal grafts developed epidermoid cysts. The AlloDerm grafts demonstrated graft thickening at 1 month and total resorption at 3 and 4 months. The fat grafts demonstrated 30% to 60% partial resorption. CONCLUSIONS: The major disadvantage of using an autogenous fat graft was partial resorption, whereas cyst formation was observed with dermal grafts. AlloDerm caused tissue reaction and resorption. The best graft material was cartilage, with a low absorption rate, good biocompatibility, and minimal tissue reaction or fibrosis, followed by fascia, with a minimal shrinkage capacity and tissue reaction.     

The protective effects of meniscal transplantation on cartilage. An experimental study in sheep

BACKGROUND: Meniscal loss may result in arthritis. The aim of this study was to establish a simple operative method for meniscal transplantation in a large-animal model and to determine whether meniscal transplantation provides protection of the articular surfaces, whether meniscal allografts have the same protective effect as meniscal autogenous grafts, and whether there is any rejection phenomenon associated with meniscal allografts. METHODS: Twenty-eight sheep were divided into four study groups, which were treated with (1) a sham operation (four sheep), (2) a meniscectomy (eight sheep), (3) a meniscal autogenous graft (eight sheep), or (4) a meniscal allograft (eight sheep). The meniscal transplant was secured with three suture anchors to the tibia. At four months after the operation, macroscopic and microscopic evaluations of the articular cartilage and the menisci of the sheep knees were performed in a blinded fashion. RESULTS: The group treated with the sham operation had no cartilage damage and had normal meniscal tissue. The meniscectomies resulted in significant macroscopic and microscopic damage to the articular cartilage in the medial compartment. The mean score (and standard error of the mean) for macroscopic damage to the cartilage in the group treated with the meniscectomy was 6.5+/-0.8 points compared with 3.9+/-0.7 points in the group treated with the autogenous graft and 4.3+/-0.6 points in the group treated with the allograft (p<0.05). The size of the area of damaged articular cartilage was reduced by approximately 50 percent in both groups treated with a meniscal transplant compared with the group treated with the meniscectomy (p<0.05). There were no significant differences between the group treated with the autogenous graft and that treated with the allograft. The histological appearance of the meniscal autogenous grafts was within normal limits. Interestingly, all of the allografts had evidence of fibrinoid degeneration with areas of hypocellularity and cloning of chondroid cells. CONCLUSIONS: These results suggest that meniscal transplantation provides noticeable although not complete protection against damage to the articular cartilage after a meniscectomy. The meniscal allografts were just as effective in providing this protection as were the meniscal autogenous grafts.     

Allogenous Cartilage Graft Versus Autogenous Cartilage Graft in Augmentation Rhinoplasty: A Decade of Clinical Experience

Cartilage grafts have great value in augmentation rhinoplasty. For most surgeons, an autogenous cartilage graft is the first choice in rhinoplasty because of its resistance to infection and resorption. On the other hand, an allogenous cartilage graft might be preferred over an autogenous graft to avoid additional morbidity and lengthened operating time. Allogenous cartilage grafts not only have the advantage of averting donor site morbidity but also are resistant to infection, resembling autogenous cartilage grafts. The authors present their experience with 41 patients who underwent augmentation rhinoplasty using 22 autogenous and 19 allogenous cartilage grafts between June 1994 and August 2004. For evaluation of adequate augmentation rates, photographic analyses were performed on preoperative, early postoperative, and late postoperative photographs from all the patients. To assess patient satisfaction, the Facial Appearance Sorting Test (FAST) was applied preoperatively and late postoperatively in both groups. These results were compared, and it was concluded that in terms of resorption, there was no difference in the early and late postoperative follow-up data between allogenous and autogenous cartilage grafts. Evaluation of the preoperative and early postoperative photographic outcomes showed statistically significant differences with respect to adequate augmentation rates between the two groups. The FAST scores showed statistically significant differences between preoperative and late postoperative outcomes. There were no infections in the two groups of patients. Commentary to DOI: .     

The survival of costal cartilage graft in laryngotracheal reconstruction

Acquired subglottic stenosis in children is a difficult problem. One of the successful procedures used to correct this condition is an autogenous costal cartilage graft to the subglottis and upper trachea. The fate of the cartilage graft is not known, despite the good results of the procedure. Prompted by recovery of viable cartilage graft from two patients previously operated upon by this procedure, we performed autogenous costal cartilage grafting to the subglottic area of fifty young New Zealand rabbits, with inspection of these grafts at 2- and 4-month postoperative intervals. The purpose of this study is to prove the survival of autogenous costal cartilage grafts in the subglottic area. Gross and histologic examination 2 and 4 months postoperatively showed viable cartilage as well as lining of the graft with respiratory epithelium in the majority of cases.     

Growth difference of multilayer onlay cartilage grafts in rabbit ears

Successful survival and growth of autogenous cartilage graft has been well proved in the experimental studies of Dupertuis and Peer. However, it is still unknown whether multilayer cartilage graft has the same survival and growth as a single-layer graft. The authors studied any difference of survival and growth rate between single and multilayer cartilage grafts in rabbits. Single, double, and triple layers of autogenous cartilage grafts were inserted into three separate pockets in a single rabbit ear. The three grafts were left in place for 6 months. They performed this procedures in 10 rabbit ears. Proliferating activity of chondrocytes was measured with a method of proliferating cell nuclear antigen immunolabeling. The authors found that there were more proliferating cell nuclear antigen-positive cartilage cells in the graft than in the host bed, but no difference in weight and thickness of the graft among the three groups.     

The versatile autogenous costal cartilage graft in septorhinoplasty

Secondary septorhinoplasty often requires a large amount of tissue, and autogenous costal cartilage is one type of grafting material that can be used in these cases. In this study, 20 patients with severe nasal deformity received autogenous costal cartilage grafts. Nineteen of the 20 cases were revisions. Costal cartilage grafts were used for structural and nonstructural purposes in these patients. Follow-up ranged from 8 to 32 months. The complications included 1 patient with early wound infection and 3 with minor warping. There were no problems with graft resorption or extrusion. Other than temporary pain, there were also no complications at the donor sites. We conclude that the autogenous costal cartilage graft is an outstanding material for volume filling and structural support when large amounts of tissue are needed in septorhinoplasty.     

Management and Aesthetic Results of Support Grafts in Saddle Nose Surgery

To define the surgical management and long-term aesthetic results of patients undergoing rhinoplasty with support graft for saddle nose, 147 patients have been included in this retrospective study. One hundred forty-four autogenous grafts (bone or cartilage) and three processed irradiated bovine cartilage grafts have been used during the period 1980–1997. Two approaches have been employed: open rhinoplasty and endonasal approach. Most of cases have been treated with bony grafts (116 bone graft versus 26 cartilage grafts). Global follow-up after surgery for long-term aesthetic study was 8.5 years. Among the different autogenous that have been used in our series, the calvarial bone had the most interesting results in terms of resorption. In patients with important saddle nose deformity, we recommend calvarial bone as a material of choice for dorsonasal reconstruction. It provides excellent and natural long-term feel to the nasal complex.     

Secondary rhinoplasty: management of the overresected dorsum

Any discussion of grafting the dorsum in secondary rhinoplasty must take into account the different indications (aesthetic, augmentation, and structure) as well as recent changes in materials and techniques (fascia, diced cartilage). We have placed solid dorsal grafts with diced cartilage grafts either as an isolated diced cartilage graft in fascia graft or as the aesthetic dorsal contour layer of a composite reconstruction. The rational for this profound change in selection and indication of dorsal grafts for revising the overresected dorsum will become clear as the various alternative materials and techniques are analyzed. Currently, we only employ autogenous tissues.     

Viability of crushed and diced cartilage grafts: a study in rabbits

OBJECTIVE: To investigate the effects of dicing and different degrees of crushing on cartilage graft viability and outcome in rhinoplasty. METHODS: Cartilage was harvested from both ears of 29 rabbits. For each animal, 6 cartilage pieces were prepared as follows and inserted into the paraspinal subcutaneous tissue: (1) left intact, (2) diced to approximately 1 x 1-mm pieces and then wrapped in oxidized regenerated cellulose, (3) slightly crushed, (4) moderately crushed, (5) significantly crushed, and (6) severely crushed. Animals were killed at 2, 5, and 10 months, and graft specimens were microscopically examined. RESULTS: As crushing intensity rose, cartilage viability decreased and more cartilage tissue was transformed to connective tissue. The intact and slightly crushed grafts showed significant chondrocyte proliferation. This decreased as crushing intensity increased, and the severely crushed and diced cellulose-wrapped grafts exhibited almost no peripheral chondrocyte proliferation. CONCLUSIONS: Slight crushing of a cartilage graft can produce outstanding graft material that forms softer nasal contours and fills defects well. However, severe crushing of cartilage grafts results in extensive necrosis and eventual reduction in graft volume. The use of oxidized regenerated cellulose to wrap diced cartilage grafts also tends to reduce clinical predictability owing to negative effects on cartilage viability and regeneration.     

Study of rabbit septal cartilage grafts placed on the nasal dorsum

OBJECTIVE: To compare the reabsorption characteristics of fresh septal cartilage autografts, preserved homografts, and preserved autografts in the nasal dorsum of rabbits. METHODS: Rabbit nasal dorsum cartilage grafts were placed in 3 groups. The first group used fresh autologous cartilage; the second group, alcohol-preserved homologous cartilage; and the third group, alcohol-preserved autologous cartilage. Each rabbit received 2 grafts, one crushed and another noncrushed. After 16 weeks, the grafts were removed for analysis. RESULTS: No graft calcification occurred in any group. Chondrogenesis was observed in all groups. The fresh autograft group had the best results in the evaluation of the area of graft recovered and chondrocyte viability. The preserved autologous and homologous grafts did not differ in relation to any of the variables analyzed. Crushed grafts had inferior results in the area of graft recovered and chondrocyte viability compared with the noncrushed forms. No significant difference among the 3 groups was noted in the thickness of the fibrous capsule that developed around the graft. CONCLUSIONS: The fresh cartilage autograft was superior to the crushed and uncrushed preserved homografts and autografts; both types of preserved grafts had equivalent histological results. The uncrushed forms were superior to the crushed forms.