自体软骨膜、骨膜游离移植修复软骨缺损治疗骨性关节炎

目的：评价自体软骨膜或骨膜游离移植术修复膝关节大面积软骨缺损，治疗膝关节骨性关节炎的疗效。方法：将髌骨及股骨髁，胫骨平台病损软骨清除，游离移植软骨或骨膜修复软骨缺损，治疗骨性关节炎124例，术后不需外固定，4天后持续被动关节活动器作持续动活动。2周后下床活动，结果：术后平均随访6年，治疗效果满意。结论：采用自体软骨膜，骨膜游离移植修复大面积软骨缺损，治疗骨性关节炎，可取得满意效果。     

骨膜移植和钻孔术修复关节软骨缺损的实验比较

用中国白兔２４只，在股骨关书面造成６ｍｍ×８ｍｍ全层软骨缺损，分别进行游离骨膜自体移植和钻孔术。术后４、８周取材做组织学及电镜观察并进行比较。结果表明：（１）钻孔、移植骨膜和对照组的优势修复组织分别为类透明软骨、幼稚软骨和纤维组织。（２）修复组织平均数量，移植骨膜明显优于钻孔和对照组。（３）骨膜移植、钻孔和对照组修复组织来源分别为骨膜本身、髓腔和软骨下骨及与缺损毗连的软骨。初步结论：移植骨膜和软骨下骨钻孔均能修复关节软骨缺员，单纯刮除后修复能力最差。     

活动对自体骨膜游离移植修复关节软骨缺损的影响实验研究

为了探索活动对骨膜游离移植修复关节软骨缺损的影响，选用成年健康家兔６０只，随机分三组：笼外活动组，笼内活动组及制动组。手术造成双后肢骨宾股关节股骨关节面０．５ｃｍ×１ｃｍ全层软骨缺损各一处，将自体胫骨骨膜游离移植于左侧软骨缺损处，右侧作为对照。分别于术后第４，８和１２周处死动物，取关节软骨标本。通过大体组织学、组织化学及电镜观察软骨再生情况，并比较活动量的多少对骨膜化生软骨的影响。结果表明，游离骨膜产生类透明软骨能有效地修复全层关节软骨缺损；统计学分析，笼外活动组与笼内活动组差异显著（Ｐ＜０．０５），笼内活动组与制动组差异显著（Ｐ＜０．０５），笼外活动组与制动组差异高度显著（Ｐ＜０．０１）。证明，活动量的大小对骨膜化生软骨有着重要的影响     

骨膜移植修复骨缺损的实验研究及临床应用

为探寻大块骨缺损修复方法的新途径，进行了自体骨膜游离移植修复骨缺损的实验及临床研究。实验用４２只兔，于双侧胫骨作人工骨缺损模型（６ｍｍ×１８ｍｍ×５ｍｍ）。一侧随机植入自体游离骨膜片，另一侧不植入，作为对照。以组织学、Ｘ线和放射性同位素为观察指标，研究成骨过程。结果表明，骨膜植入侧骨缺损的愈合比对照侧缺损的愈合快一倍。原因可能是骨膜提供了大量成骨细胞并直接呈膜内成骨而非软骨内化骨。在此基础上，为２１例骨缺损患者应用自体胫骨骨膜片植入治疗骨缺损，面积最大１０．５ｃｍ×４ｃｍ×４ｃｍ，最小２ｃｍ×２ｃｍ×２ｃｍ；其中１７例为良性骨肿瘤，４例为骨慢性感染。骨缺损均得到修复，关节功能恢复满意。为腔洞性骨缺损的修复提供了一种新方法。     

新鲜胎儿颅骨骨膜移植治疗成人严重股骨头缺血坏死

近年来，应用自体骨膜移植修复软骨面缺损已有报道。然而，异体骨膜移植仍未见叙述。我们在动物实验基础上，应用于临床１０５例病人，疗效良好。现介绍如下。动物实验成熟中国山羊８只，体重１８ｋｇ～３０ｋｇ，于右后腿股骨髁间髌股关节面上造成１．５×１．０ｃｍ２全层软骨缺损创面，植入同样大小足月胎羊颅骨骨膜，用１号丝线固定。术后患肢自由活动，术后第１，２，４个月分别手术取标本，观察异生软骨性状和组织超微结构。结果：（一）肉眼观察：术后１个月，新生软骨填满缺损面，但低于正常软骨面，表面平呈浅蓝色。术后２个月，新…     

在连续被动活动作用下自体骨膜游离移植修复髋、膝关节软骨大面积缺损的临床应用

关节软骨损伤修复是临床骨科难题之一。在动物实验研究基础上，从１９８７年１月起，采用自体游离骨膜移植修复４３例关节软骨大面积缺损的病人，在连续被动活动作用下，促进修复后的关节功能恢复。并对３５例病人进行随诊观察，包括先天性髋关节脱位１８例、创伤性髋关节炎７例、股骨头低毒性感染１例、类风湿性髋关节炎１例、膝关节内骨折６例和创伤感染后膝关节僵直２例。术中，切除病变的软骨组织达出血的骨组织，从胫骨前内侧切取稍大于软骨缺损的骨膜缝合固定在缺损表面，移植骨膜和关节间放置硅膜。术后立即进行ＣＰＭ练习，逐渐增加活动范围，活动时间为４～６周，术后６个月取出硅膜。随访的３５例病人中男１６例，女１９例，年龄１２～２９岁，平均随访时间为３５个月（６～６０个月）。评价结果：髋和膝关节功能优良率分别为７６．９％和８８．９％。     

游离骨膜移植修复关节软骨缺损的多因素实验研究

作者就影响游离骨膜移植修复关节软骨缺损的五个因素分十二水平，使用生长期家兔，正交设计安排实验。术后４周处死取材，进行多指标观察，方差分析。结果表明下列因素均影响游离骨膜修复关节软骨缺损，即创面面积以小于２者为好；生发层朝向关节腔优于朝向创面者；骨膜旋转９０°更有利于关节面的修复；骨膜与创面面积比值应为１．３～１．６：１；合适的ＣＰＭ可以促进移植物早期构型，诱导移植物向类透明软骨转化。     

骨形态形成蛋白修复大面积关节软骨缺损的实验研究

将骨形态形成骨蛋白用于大面积关节软骨缺损的修复，探讨应用方法，观察修复效果。在５１只成年兔股骨的髌髁关节面上制造５ｍｍ×１０ｍｍ的骨软骨缺损，深３－５ｍｍ。缺损内分别填充骨形态形成蛋白和纤维蛋白粘合剂复合物，ＢＭＰ，ＦＳ，植入物均用自体游离骨膜覆盖，并设单独骨膜覆盖缺损组和空白对照组。     

关节负重区不同负重部位对骨膜再生软骨的影响

关节负重区不同负重部位对骨膜再生软骨的影响王建设陆裕朴＊李稔生近年来，骨膜再生软骨的能力逐渐被认识，一系列实验研究均证实自体骨膜游离移植可以修复关节软骨缺损〔１、２〕。以往有关的实验，多为造成兔股骨髌骨沟部位全厚软骨缺损加以修复，该部位为低负重区〔...     

股深血管及穿血管股骨膜（骨）瓣转位的应用解剖

目的：为股骨骨折、骨不连提供带血管蒂骨膜（骨）瓣转位修复的解剖学基础。方法：在４０侧成人下肢标本上，解剖观察了股深血管穿支的起始、走行、分支、吻合及骨膜支。结果：股深血管主干经大收肌和短收肌之间，贴股骨后内侧下降直达大收肌止端深面，沿途分出３～４支穿动脉，起始点距小转子尖下依次为４．５±１．３ｃｍ、９．３±２．６ｃｍ、１４．３±３．１ｃｍ和１６．０±１．５ｃｍ，外径分别为２．８±０．７ｍｍ、２．４±０．６ｍｍ、２．２±０．５ｍｍ和１．３±０．２ｍｍ。各穿支分出１～３支外径１．０ｍｍ左右的肌骨膜支，分布股骨体粗线及粗线两侧骨膜，形成骨膜动脉网。结论：以股深血管及其穿支为蒂可设计３种骨膜（骨）瓣修复股骨各段骨折骨不连。     

Transplantation of free tibial periosteal grafts for the repair of articular cartilage defect: An experimental study

Background:

Articular chondrocytes have got a long lifespan but rarely divides after maturity. Thus, an articular cartilage has a limited capacity for repair. Periosteal grafts have chondrogenic potential and have been used to repair defects in the articular cartilage. The purpose of the present study is to investigate the differentiation of free periosteal grafts in the patellofemoral joint where the cambium layer faces the subchondral bone and to investigate the applicability of periosteal grafts in the reconstruction of articular surfaces.

Materials and Methods:

The study was carried out over a period of 1 year on 25 adult, male Indian rabbits after obtaining permission from the institutional animal ethical committee. A full-thickness osteochondral defect was created by shaving off the whole articular cartilage of the patella of the left knee. The defect thus created was grafted with free periosteal graft. The patella of the right knee was taken as a control where no grafting was done after shaving off the articular cartilage. The first animal was used to study the normal histology of the patellar articular cartilage and periosteum obtained from the medial surface of tibial condyle. Rest 24 animals were subjected to patellectomy, 4 each at serial intervals of 2, 4, 8, 16, 32 and 48 weeks and the patellar articular surfaces were examined macroscopically and histologically.

Results:

The grafts got adherent to the underlying patellar articular surface at the end of 4 weeks. Microscopically, graft incorporation could be appreciated at 4 weeks. Mesenchymal cells of the cambium layer were seen differentiating into chondrocytes by the end of 4 weeks in four grafts (100%) and they were arranged in a haphazard manner. Till the end of 8 weeks, the cellular arrangement was mostly wooly. At 16 weeks, one graft (25%) had wooly arrangement of chondrocytes and three grafts (75%) had columnar formation of cells. Same percentage was maintained at 32 weeks. Four grafts (100%) at 48 weeks showed columnar orientation. The control side showed no changes over the shaved off articular surface in all the rabbits. One rabbit at 4 weeks had a dislocation of the patella on the control side. None of the rabbits developed any infection or wound dehiscence.

Conclusion:

Autologous periosteal graft transplantation can be a promising substitute for articular cartilaginous defects.     

自体骨膜延迟游离移植修复成年后关节软骨缺损的实验研究

目的：研究年龄对自体骨膜游离移植修复关节软骨缺损的影响,探讨延迟游离移植能否提高成年后骨膜修复软骨能力。方法：选中国白兔,成年兔20只,幼兔10只,分3组。A组：成年兔左膝骨膜直接游离移植组;B组：成年兔右膝骨膜延迟游离移植组;C组：幼兔骨膜直接游离移植组,取骨膜或骨膜新生组织、行光镜、电镜组织学观察比较。结果：移植前B、C组骨膜厚度、细胞计数及细胞活跃程度均优于A组（均为P＜0．01）,移植后12周3组关节软骨缺损获得不同程度修复,C组优于A组（P＜0．01）及B组（P＜0．05）,B组优于A组（P＜0．01）。结论：自体骨膜局部剥离、原位激活,体内培养、延迟游离移植可提高成年骨膜成软骨能力,更好地修复成年后关节软骨缺损。     

Reconstruction of patellar cartilage defects with free periosteal grafts. An experimental study

The osteo-chondrogenic potential of free periosteal grafts was investigated within the knee joint in 26 rabbits aged four to six weeks. A total of 36 knee joints were operated on. The grafts were stripped from the medial side of the right tibia and sutured on the articular surface of the patella, from which the cartilage had been totally excised to the subchondral bone. In 16 knees the graft was sutured with the cambium layer towards the subchondral bone and in eight knees the fibrous layer faced the bone. In the control group of twelve knees the patellar articular cartilages were excised and no periosteal transplant was grafted to the patellar articular surface. In the transplantation group cartilage formation could be seen already one week after the operation. There were no marked differences between the series with the cambium layer facing the subchondral bone or the group with the fibrous layer facing the bone. At 20 weeks the hypertrophied cartilage had thinned and resembled normal joint cartilage. In the control group the histological picture resembled osteoarthritis.     

髌骨和髂骨移植修复膝部骨巨细胞瘤致大块骨缺损

目的 探讨髌骨和髂骨移植对股骨下端和胫骨上端大块骨缺损修复的治疗效果.方法 股骨下端和胫骨上端骨巨细胞瘤患者14例,男8例,女6例;年龄20～42岁,平均33.9岁;病史2～12个月,平均5.6个月;股骨下端6例,胫骨上端8例.按Ennecking外科分期,2期11例,3期3例.游离髌骨移植8例,带肌蒂髌骨移植2例,髂骨移植4例.股骨和胫骨肿瘤侵犯一侧髁软骨面时用游离或带肌蒂髌骨移植,胫骨肿瘤同时侵犯髁间部时用髂骨移植,修复和重建膝关节部骨缺损.结果 随访时间3个月～11年,平均4.5年.根据国际保肢学会功能评分标准,优3例,良8例,可2例,差1例.游离髌骨移植者关节功能较好.术后主要并发症为关节活动范围减小(活动范围,40°～120°,平均82°),关节不适,肌力下降,疼痛.带肌蒂髌骨移植者术后伸膝肌力有不同程度地下降,但随着时间的延长有一定的恢复.游离髌骨移植者术后伸膝肌力下降不明显.髂骨移植患者术后关节退行性改变明显.结论 膝关节周围骨巨细胞瘤侵犯关节软骨时,行包括肿瘤在内的股骨或胫骨一侧髁切除后,可以用髌骨和髂骨移植修复和重建骨缺损.     

Chondromalacia patellae. Results of operative treatment

The series consisted of 26 patients operated on in 1972-1978 for chondromalacia patellae. The patients were followed up an average of 4.6 years after the operation. The operation involved one knee in 21 patients, both knees in 5. The primary operation was carried out for lesions of the articular cartilage of the patella alone in 18 cases (in 6 of these a second operation was necessary) and for a biomechanical disturbance of the patellofemoral joint in 13 cases. Degenerative changes of the patellar cartilage were observed at anatomo-pathological examination in 29 of 31 knees. On average, the patients' symptoms were alleviated after the operation, but comparison of different types of operation showed a statistically significant improvement only after operations that modified the biomechanics. The results confirm the view that symptoms originating in the patellofemoral joint often are due to biomechanical disturbances of this joint and the extensor system of the knee, and that the removal of injured cartilage alone is not sufficient.     

Gross pathological changes in the knee joint of the aged individual: a study of 300 cases

The incidence of chondromalacia of the pattella and degenerative arthritis of the knee is based on conjectural rather than objective autopsy observations. The notion that chondromalacia is a disabling, troublesome and almost universal disease affecting most older individuals is chiefly derived from clinical impressions of physicians who treat arthritis plus a few reports of European authors published some 50 years ago. The present investigation of 300 cadaver knees, whose average age was 70 years, demonstrates a much lower incidence of degenerative lesions of the articular cartilage than might be expected. There was minimal or no damage to the patella in 62% of the cases and an even lower incidence of 23% in the weight-bearing areas of the joint. Eighty-two per cent of the menisci were essentially normal, as were 96% of the cruciates. In patients in the U.S.A., articular cartilage of the knee resists the wear and tear of a normal lifespan remarkably well and infrequently undergoes progressive degradation.     

经骨缝合手术治疗急性髌骨脱位合并髌骨软骨Peeloff损伤早期疗效观察

目的评价经骨缝合手术治疗急性髌骨脱位合并髌骨软骨骨折(Peeloff损伤)的早期临床疗效。方法回顾性分析自2019-05—2020-03诊治的15例急性髌骨脱位合并髌骨软骨Peeloff损伤,膝关节镜检查并确诊髌骨软骨缺损,关节腔内找到与缺损区域吻合的游离软骨片,关节镜下或内侧小切口取出游离软骨片;再作髌内侧切口,将游离软骨片复位并在其边缘选取4个合适进针点,用带孔克氏针在髌骨主体上从内向外垂直钻孔,每两孔之间导入可吸收缝线,经孔道将克氏针抽出时带出缝线并打结。结果 15例均获得随访,随访时间平均8(3~13)个月。术后3个月MRI显示所有患者髌骨关节面软骨骨折均愈合。2例出现早期髌股关节疼痛(1例VAS评分为4分,1例VAS评分为5分),经康复治疗后好转,其余13例疼痛VAS评分平均1.8(1~3)分。末次随访时Tegner运动评级:3级5例,4级9例,5级1例。末次随访时膝关节功能Lysholm评分80~96(88.9±4.7)分,其中优6例,良7例。结论关节镜下探查可确诊急性髌骨脱位合并的髌骨软骨Peeloff损伤,采用可吸收缝线经骨缝合固定髌骨关节面软骨片无需特殊内固定器械及二次手术取出,既能实现软骨稳定固定、正常愈合,又能保证膝关节功能良好恢复。     

The influence of subchondral vascularisation on chondromalacia patellae

An experiment was carried out on 40 rabbits in which the blood supply to the patella was interrupted for periods from 2 weeks to 6 months. With prolonged ischaemia, there were clear changes in the articular cartilage which were comparable with those seen in chondromalacia patellae.     

Reconstruction of Articular Cartilage Defects with Free Periosteal Grafts: An Experimental Study

The chondrogenic potential of free autogenous periosteal grafts was studied histologically in 6-month-old rabbits. The grafts were taken from the tibia and transplanted to 7 × 14 mm large artificial defects of the femoral articular cartilage. The results revealed that the defects were repaired and filled after 4 weeks with a hyaline-like cartilage which was histologically similar to the cartilage adjacent to the transplant. The tissue maintained this morphology after 1 year of observation. In control animals where no periosteum was transplanted to the defect, no real cartilage was found. The tissue which partially filled the defect was a variable mixture of fibrous tissue and fibrocartilage.