自体游离骨膜—骨块复合组织移植修复关节骨软骨缺损

用三种类型的自体游离骨膜－骨块复合组织移植修复家兔膝关节的骨软骨缺损。实验结果显示，一个月后三组实验动物的膝关节骨软骨缺损区均被骨块和骨膜再生的新生软骨组织完全充填；不剥离翻转骨膜的骨膜－骨块复合组织移植具有操作简便、不影响骨膜再生软骨之优点；关节滑液能为骨膜再生软骨提供充足的营养。     

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。     

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。     

筋膜蒂骨膜移植修复关节软骨缺损的实验研究

目的：应用筋膜蒂骨膜移植修复关节软骨缺损，观察骨膜在关节腔内再生关节软骨的情况，探讨骨膜再生软骨的机制。方法：用成年家兔２２只，在右侧膝关节造成胫骨关节面软骨缺损，行筋膜蒂骨膜移植；在左侧膝关节行游离骨膜移植，作为对照。观察方法包括形态学观察、Ｘ线和组织学检查。结果：实验组再生关节软骨的质与量均优于对照组。结论：筋膜蒂骨膜移植，由于有血液供应，能够再生关节软骨，修复关节软骨缺损。     

游离骨-骨膜修复关节软骨缺损的研究

目的 观察自体游离骨－骨膜复合组织移植修复关节软骨缺损的组织形态学演变过程及其分期，探讨骨膜演化为软骨的影响因素，新生软骨退变的主要影响因素。方法 将健康家兔30只随机分为6组，每组5只。随机选择一侧足部跗骨切取骨－骨膜复合组织2块，在双膝股骨髁间人为形成软骨及软骨下骨缺损，植入骨－骨膜块。结果 骨膜组织可演化为透明软骨组织，60个关节中48个形成透明软骨，演变过程可分为3期。结论 手术操作不得当对新生软骨的形态有不良影响，导致新生软骨早期退变的主要因素是未能注意修复的“完整性原则”，及骨膜生发层朝向关节腔。     

同种异体骨软骨移植修复关节软骨缺损的研究进展

同种异体骨软骨移植修复膝关节软骨和骨软骨缺损适用于大面积骨软骨缺损的修复,且不受缺损形状和面积的限制,在临床上已取得令人鼓舞的结果。现对国内外同种异体骨软骨移植修复关节软骨缺损的研究进展作一综述。     

骨软骨镶嵌成形术修复骨软骨复合缺损的比较研究

目的观察采用骨软骨镶嵌成形术（Mosaicplasty）修复膝关节中等和大面积骨软骨复合缺损的效果,为临床应用提供理论依据。方法24只成年山羊随机分成3组（n=8）。中等面积缺损组在股骨内髁制造直径6mm缺损,植入直径2mm骨软骨柱修复;大面积缺损组于股骨内髁制造9mm直径缺损,以直径3mm骨软骨柱修复;对照组于股骨内髁制造直径6mm缺损后不修复。自股骨髁间窝和滑车沟两侧非负重区用自制Mosaicplasty器械钻取骨软骨柱,推出器嵌入缺损处镶嵌填满。术后4、8、16及24周处死动物,取修复骨软骨组织行大体观察、HE及甲苯胺蓝染色。术后24周,取大面积缺损组和对照组膝关节摄X线片,观察骨软骨缺损修复情况,并分别取修复组织及正常软骨组织行蛋白聚糖（glycosaminogly cans,GAG）含量测定。结果中等面积缺损组术后4周,移植的骨软骨柱与基底部骨床结合牢固;8-24周软骨层之间以及与正常软骨间界限仍清晰。大面积缺损组术后4周,移植的骨软骨柱与基底骨床结合牢固,部分骨软骨柱被压入骨床内;8-24周压陷程度加重,与股骨髁相对关节面的部分软骨被磨损。对照组24周缺损仍无明显修复迹象,与股骨髁相对关节面的软骨磨损剥脱。组织学观察结果类似大体观察,术后24周中等及大面积缺损组软骨柱间均有缝隙存在,大面积缺损组毗邻软骨细胞稀疏肥大。术后24周,X线片可见大面积缺损组软骨下骨愈合良好,而对照组仍可见骨质缺损,与股骨髁相对关节面的软骨局部骨质硬化;软骨GAG含量测定显示正常软骨和大面积缺损组修复组织间差异无统计学意义（P〉0.05）;前两者与对照组修复组织比较,差异均有统计学差异（P〈0.05）。结论Mosaicplasty可修复中等面积骨软骨复合缺损,但无法有效修复大面积缺损,效果有待改进。     

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。     

胶原/羟基磷灰石支架负载软骨细胞修复兔膝关节骨软骨缺损

目的 探讨胶原复合梯度羟基磷灰石(Col/HA)双相支架负载软骨细胞修复兔膝关节骨软骨缺损的可行性及疗效.方法 构建Col/HA双相支架,将软骨细胞种植于支架培养1周,再将软骨细胞-支架复合体移植修复兔膝关节股骨髁的骨软骨缺损,并对骨软骨缺损的修复进行检测.结果 光镜及扫描电镜观察显示软骨细胞在Col/HA支架中贴附良好,表型维持稳定,分泌胞外基质.大体观察和组织学检测显示,植入体内16周后实验组软骨层呈透明软骨样修复,软骨下骨缺损有新骨构建;对照组骨软骨缺损修复不良,组织学检测以纤维性组织或纤维软骨组织形成.Wakitani评分显示实验组修复组织优于对照组,差异有统计学意义(P＜0.05).结论 双相Col/HA复合支架可作为骨软骨组织工程支架,负载软骨细胞可修复兔膝关节骨软骨缺损,重建关节软骨的结构和功能.     

培养细胞移植修复骨和软骨缺损

本文介绍软骨细胞培养的最新进展和用于关节软骨缺损修复的情况，对骨膜和骨髓中具有骨软骨发生潜能的间充质细胞的分离，培养和体内外成骨研究也作了介绍。     

Autoarthroplasty of knee cartilage defects by osteoperiosteal grafts

Five fresh osteochondral fractures of the knee, which could not be fixed because of extensive fragmentation, were treated by excision of the fragments and reconstruction of the joint surface defect by an autogenous osteoperiosteal graft. The procedure was also used for joint surface reconstruction in sclerotic osteochondritis of the femoral condyle (nine knees) and grave patellofemoral chondromalacia (three knees). Plaster cast immobilization for 3 weeks was used in the two early cases. In all other cases, we employed a passive motion apparatus for 2 days postoperatively, followed by active mobilization in a knee brace with extension-flexion 30 to 90 degrees (femoral condyle reconstruction) or 0 to 45 degrees (patellar reconstruction). Gradual free movements were started 3 weeks postoperatively. The results after 1.5 to 6.5 years were satisfactory in all but one case. One arthroscopic removal of the loose graft was performed, as were two arthroscopic graft margin shavings. Three other reoperations were unrelated to the osteoperiosteal reconstruction. It appears that periosteal reconstruction should be considered in local osteochondral lesions, where excision of the injured cartilage is mandatory. The results were best in fresh trauma cases and younger people.     

自体骨软骨移植治疗股骨髁关节软骨缺损

目的探讨关节镜下自体骨软骨移植治疗关节软骨缺损的可行性。方法16例膝关节软骨缺损患者,关节镜下在其非负重区的软骨面上用专用器械凿取圆柱状骨软骨,移植至软骨缺损部位以修复缺损。术后行系统功能锻炼和MRI检查。结果随访7～20个月,患者关节症状消失,关节活动度正常,MRI显示原关节软骨缺损区表面平整,移植骨软骨位置良好。Brittberg-Peterson评分：13例0分,2例2分,1例1分。结论关节镜下自体镶嵌式骨软骨移植术创伤小,操作简单,能保持关节面曲度,可用于修复关节软骨缺损。     

Osteochondral autografts transfer for post-traumatic osteochondral defect of the knee-2 to 5 years follow-up

The treatment of post-traumatic osteochondral defects of the weight-bearing surface of the knee in young active patients remains a significant challenge. We report the results of an osteochondral autograft transfer (OAT) in 18 patients (mean age 29 years) with post-traumatic focal osteochondral defects of the knee. Sixteen lesions were over the femoral condyle and two were over the tibial plateau. The average size of the lesion was 4.1 cm² (from 2.25 to 6 cm²), and the subchondral bone involved no more than 1 cm in depth. Osteochondral grafts were harvested from the non-weight-bearing area of the femoral condyle. Ten patients also had concomitant surgical procedures. The average follow-up was 42 months (from 24 to 64 months). All patients were evaluated by Lysholm and Tegner activity scores and plain radiographs. Nine patients had MRI, eight patients had second-look arthroscopy and two had a biopsy. Sixteen patients (89%) had good to excellent results, while two patients with lesion over the tibial surface had fair results. The biopsy revealed survival of hyaline cartilage. For small to medium osteochondral lesion over the femoral condyle of the knee in selected patients, osteochondral autografting yielded promising short to mid-term results.     

Donor-site morbidity after osteochondral autograft transfer procedures

We report on 2 patients who had donor-site morbidity after an autogenous osteochondral grafting was performed. Both patients had fibrocartilage hypertrophy at the donor sites that contributed to knee pain and occasional locking; the second patient also had a lack of fibrocartilaginous regrowth with symptomatic residual osteocartilaginous defects. Additional arthroscopic surgery was required in both cases to trim the fibrocartilage. In addition, for the second case, a fresh osteoarticular allograft was used to transfer osteocartilaginous plugs back into the original knee donor sites due to continued knee pain. When performing an osteochondral autograft transfer, the benefits provided at the recipient site must be weighed against the possible donor-site morbidity that may result.     

Hepatocyte growth factor facilitates cartilage repair: Full thickness articular cartilage defect studied in rabbit knees

Hepatocyte growth factor (HGF) is a multifunctional factor which promotes proliferation, motility and morphogenesis in epithelial cells. In addition, it has been found to play an important role in cartilage metabolism. To investigate articular cartilage repair using HGF in vivo, we injected HGF into rabbit knee joints, where 4 mm diameter osteochondral defects had been made, and observed the animals for 6 months.

We found that HGF effectively repaired osteochondral defects. The repair process of the articular cartilage defects using HGF was shown to be much better than saline injection on all macroscopic and histologic examinations. Although the observation period in our study was short, HGF is one of the most promising candidates for repairing articular cartilage defects clinically.     

Case Report: Fresh-Stored Osteochondral Allograft for Treatment of Osteochondritis Dissecans the Femoral Head

Osteochondral defects of the femoral head are exceedingly rare, with limited treatment options. Restoration procedures for similar defects involving the knee and ankle have been well described. In this report, we present a young patient who had a symptomatic osteochondral defect of the femoral head develop secondary to trauma and underwent subsequent treatment using a fresh-stored osteochondral allograft via a trochanteric osteotomy. At the 1-year followup, the patient was symptom free with near-complete incorporation of the graft radiographically. Our observations in this case suggest osteoarticular implantation may be an appropriate alternative to consider when treating osteochondral defects of the femoral head.     

Autologous osteochondral grafting in the knee: indication,results, and reflections

The use of multiple autologous osteochondral plugs (mosaicplasty) for repair of articular cartilage defects is a well-accepted technique. Since 1995, the authors have used mosaicplasty to treat more than 110 patients with cartilage defects of the knee, hip, and ankle. The first 52 consecutive patients who had mosaicplasty of the knee and have an average followup of 37 months (range, 24-56 months) were examined. Indications for surgical treatment were osteochondritis dissecans, acute trauma, and posttraumatic lesions of the femorotibial joint, femoropatellar maltracking with recurrent episodes of patella dislocations, and distinct femoropatellar arthrosis. Preoperatively, cartilage defects were classified as International Cartilage Repair Society Grade III lesions in 23 patients and Grade IV lesions in 29 patients. Two years after surgery, an increased level of knee function was found in 86% of the patients. At the latest followup, improved knee function was observed in 92% of the patients. In four patients, reoperation was necessary because of graft failure. Complications and reoperation rate were related to large surface lesions. Autologous osteochondral transplantation is a valid option for the treatment of full-thickness osteochondral defects. However, the method is limited by the defect size and the number of plugs to be taken at the donor site.     

The repair of major osteochondral defects in joint surfaces by neochondrogenesis with autogenous osteoperiosteal grafts stimulated by continuous passive motion. An experimental investigation in the rabbit

The purpose of this investigation was to determine the effects of continuous passive motion (CPM) on the chondrogenic potential of autogenous osteoperiosteal grafts to repair major osteochondral defects. A 3.5-mm-wide circular full-thickness defect was drilled in one medial femoral condyle of 55 adolescent New Zealand rabbits. A graft of periosteum from the proximal tibia was wrapped around a disc of bone from the same area (cambium layer of the periosteum facing outward), then press-fitted into the defect. The rabbits were treated by either immobilization (Imm) or intermittent active motion (IAM) for five weeks, or by continuous passive motion (CPM) for two weeks followed by IAM for three weeks. A control group (no osteoperiosteal graft in the defect) was also treated by CPM for two weeks and IAM for three weeks. At five weeks, hyaline cartilage was the predominant tissue in only 10% of the defects in the Imm, IAM, and control groups, compared with 70% in the CPM group (p less than .025). Bonding of the newly formed tissue to the adjacent cartilage was significantly better in the CPM group.     

Treatment of cartilage defects of the talus by autologous osteochondral grafts

We reviewed retrospectively 11 patients who had been treated surgically by open autologous osteochondral grafting for symptomatic chondral or osteochondral defects of the dome of the talus between 1996 and 1999. The mean ages of the eight men and three women were 34.2 and 25.9 years, respectively, with a mean time to follow-up of 24 months. The results of functional outcome were prospectively obtained using the MODEMS AAOS foot and ankle follow-up questionnaire, the AOFAS ankle-hindfoot scale and the Hannover scores for the ankle. The grafts were harvested from the ipsilateral knee. Good to excellent results were obtained for the ankle without adverse effects on the knee. We believe that autologous osteochondral grafting should be considered for the patient with a symptomatic osteochondral defect of the talus.     

动物源性骨软骨支架修复兔膝关节复合缺损

目的探讨软骨细胞-动物源性骨软骨支架复合体修复兔膝关节骨软骨复合缺损的可行性和影响因素。方法将改良贴壁离心法获取的骨髓间充质干细胞（bone marrowm esenchymal stem cells,BMSCs）/诱导分化的软骨细胞共培养后与经深低温冷冻、脱脂、脱钙、真空冷冻干燥和辐照消毒的动物源性骨软骨支架复合,构建共培养细胞＋软骨-骨一体化复合支架。27只新西兰大白兔随机分为实验组（A组）、对照组（B组）和空白组（C组）,每组9只。于兔股骨髁间窝处钻一深6mm的骨软骨复合缺损,A组植入共培养细胞＋骨软骨复合支架,B组植入骨软骨复合支架,C组不植入任何支架材料和细胞,分别于术后4周、8周和12周取材,行大体观察、苏木精—伊红染色和甲苯胺蓝染色,并对各标本的软骨切片进行组织学评分。结果随着时间的延长,A组大体观察见复合缺损区已完全修复,局部无凹陷,新生组织和周围组织融合;B组新生组织仍不能完全填充缺损;C组缺损区仍明显。苏木精—伊红染色和甲苯胺蓝染色见A组软骨缺损区由新生的透明软骨样组织修复,细胞呈柱状排列,极性好,软骨陷窝明显,骨缺损区由骨样组织修复,新生软骨和软骨下骨以及宿主骨界面耦合良好;B组新生软骨细胞无软骨陷窝,排列混乱,各界面藕合欠理想;C组可见陈旧性肉芽组织生长并突出于缺损区表面。甲苯胺蓝染色阳性率和组织学评分结果表明,A组与B、C两组之间的差异具有统计学意义（P〈0.05）。结论 BMSCs/诱导分化的软骨细胞共培养细胞复合动物源性骨软骨支架对兔膝关节软骨和软骨下骨的复合缺损具有修复作用。