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。     

自体骨膜游离移植一期修复髌骨骨折及软骨缺损

目的　探讨自体骨膜游离移植一期修复严重粉碎性髌骨骨折软骨缺损的临床疗效。方法　 1992年 1月～ 1998年 8月 ,用自体骨膜游离移植一期修复严重粉碎性髌骨骨折软骨缺损 17例 ,其中全髌骨粉碎骨折 9例 ,髌骨中上极骨折 3例 ,髌骨中下极骨折 5例。采用膝内侧 S形切口经膝关节腔入路。骨折复位后钢丝内固定 ,清除骨折区残存软骨 ,露出松质骨 ,修理平整 ;胫骨上端前内侧切取骨膜 3cm× 4cm～ 5 cm× 6 cm,游离移植到软骨缺损区并固定 ,术后 1周开始关节被动活动。结果　 17例全部获得随访 ,时间为 8个月～ 6年 2个月 ,平均为 2 .8年。优 12例 ,膝关节功能正常 ;良 4例 ,膝关节功能基本正常 ;可 1例 ,膝关节活动受限 ,但屈曲大于 90°。结论　自体骨膜游离移植一期修复髌骨骨折软骨缺损 ,取材容易 ,操作简便 ,疗效满意 ,有临床应用价值。     

自体骨膜游离移植修复髋膝关节软骨大面积缺损的远期观察

目的观察自体骨膜游离移植修复髋、膝关节软骨大面积缺损的远期临床效果. 方法在动物实验基础上,于1987年2月～1996年8月,采用自体骨膜游离移植修复52例关节软骨大面积缺损的患者,其中有完整随访资料的37例中,先天性髋关节脱位16例,创伤性髋关节炎6例,股骨头低毒性感染1例,强直性脊柱炎2例,膝关节内骨折6例,骨性关节炎4例,创伤感染后膝关节僵直2例.术前有髋关节脱位者行松解牵引术,术中切除病变的软骨组织达出血骨组织;从胫骨前内侧切取大于软骨缺损10%～15%的骨膜,生发层朝向关节腔,缝合固定在软骨缺损表面;双侧移植骨膜的关节间放置硅胶膜;术后进行CPM练习,逐渐增加活动范围,活动时间为4～6周;出院后6个月内避免负重,可主动练习关节活动. 结果术后37例获7～15年随访,平均10.5年.功能评价标准按有无关节疼痛、关节活动角度、日常生活能力和X线片测量关节间隙宽度进行评价,结果:优11例,良18例,差8例. 结论游离骨膜移植修复关节软骨缺损,经远期随访应用于临床是可行的.     

胫骨高位截骨合并骨膜移植治疗膝关节骨性关节炎

膝关节骨性关节炎十分常见，治疗较为困难。为了提高膝关节骨性关节炎的治疗效果，于１９８８年７月～１９９２年１０月，采用胫骨高位外翻截骨植骨矫正膝关节骨性关节炎膝内翻畸形的同时，用自体骨膜移植治疗髌骨软骨软化症。手术治疗３２例（５１个膝）。经平均５．１年随访，优良率为９０．２％，明显优于各式单纯胫骨高位截骨术。认为，该手术是治疗膝关节骨性关节炎膝内翻畸形伴髌骨软骨软化症的有效方法之一     

自体软骨-软骨膜移植重建手指关节面11例

目的:自行设计应用自体软骨-软骨膜复合物进行移植,修复手指关节的软骨缺损,达到重建关节面的目的。方法:2005年10月至2009年10月治疗11例手外伤患者,其中男7例,女4例;年龄17～50岁,平均29岁;均伴有严重手指关节毁损。进行自体软骨-软骨膜移植术,术后指导其进行适当的功能锻炼。术后按手部关节的综合评分法进行评分。结果:全部患者获得随访,时间1～4年,平均24个月。手术全部成功,无感染出现。术后2年随访,手部关节综合评分平均(41.0±0.63)分;其中优(38分)8例,良(35～38分)2例,差(30分)1例。结论:自体软骨-软骨膜复合物移植术,对关节软骨毁损的修复重建功能效果好,减少了手部外伤的伤残率。     

自体腓骨移植治疗胫骨骨纤维结构不良及其相关疾病之探讨

【】目的：探讨病灶边缘切除+自体腓骨移植重建胫骨+内固定的手术方式治疗胫骨骨纤维结构不良的疗效。方法：对10例胫骨骨纤维结构不良儿童行胫骨病灶骨膜下边缘切除,保留胫骨后壁,所遗骨缺损以自体健侧腓骨移植加钢板内固定重建。移植腓骨长6cm～20cm ,平均12. 2cm。术后随访4年～12年,平均6.6年。结果：移植的自体腓骨术后平均4.5个月(3～8个月)达到骨性愈合,双下肢等长,功能接近正常。结论：1.骨纤维结构不良因易与釉质细胞瘤容易混淆,且有发生病理性骨折和有恶变的可能性,建议以手术治疗取代保守治疗;2.骨纤维结构不良病灶行骨膜下病灶切除术并未发生术后复发;3.自体腓骨移植重建胫骨骨纤维结构不良病灶切除后骨缺损,游离腓骨骨移植加钢板固定术与带血管腓骨移植效果相当,但方法简单,操作难度小,可最大限度地恢复患肢功能,是行之有效的方法。     

自体镶嵌式骨软骨移植治疗伴局灶性软骨缺损的膝骨性关节炎

目的探讨自体镶嵌式骨软骨移植修复膝骨性关节炎负重区局灶性软骨缺损的可行性和疗效。方法2004年1月～2006年11月,对19例伴局灶性软骨缺损的膝骨性关节炎采用自体镶嵌式骨软骨移植技术治疗,在关节镜下行非负重区自体骨软骨移植修复软骨缺损,术后给予中药口服、玻璃酸钠关节腔注射,6周下地部分负重。定期随访,根据改良Lysholm评分标准、关节液蛋白多糖(PG)、膝关节MRI评价疗效。结果术后获随访12～34(平均24个月)个月,患者疼痛基本消失,功能良好。术前改良Lysholm评分15～63(39.7±4.6)分,术后54～100(93.1±5.9)分,有显著性差异(P<0.01)。术前关节液蛋白多糖215.5～897.3(508.8±203.6)μg/L,术后80.4～571.6(263.5±141.2)μg/L,治疗前后相比,差异有统计学意义(P<0.05)。术后复查MRI示原缺损区软骨表面光滑,移植的软骨下骨愈合良好,总有效率94.8。结论关节镜下自体骨软骨移植创伤小,结合中药口服、玻璃酸钠关节腔注射是治疗伴软骨缺损的膝骨性关节炎的有效方法。     

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.     

自体带骨膜髂骨板移植修复桡骨远端骨折并软骨缺损

目的 探讨采用自体带骨膜髂骨板移植修复桡骨远端骨折并软骨缺损的疗效.方法 应用自体带骨膜髂骨板移植修复桡骨远端骨折并软骨缺损33例.结果 患者获随访0.5～4年,腕关节功能评定结果:优23例,良5例,可3例,差2例,优良率84.8％.结论 应用自体带骨膜髂骨板移植修复桡骨远端骨折并软骨缺损可取得满意疗效,值得推广应用.     

自体游离骨膜再造膝关节半月板的实验研究

目的：对于严重损伤的半月板全切除术后行自体游离骨膜重建半月板，以维持膝关节结构、生理及功能特性。方法：使用１７只成年犬，５只幼犬。外侧半月板全切除以后，胫骨内侧近端的骨膜游离并移植到外侧半月板部位。于２、４、８、１２、２４、４８周取下重建半月板及不同部位的关节面软骨进行大体、光镜及电镜观察。结果：术后２个月，重建半月板的大体形态、组织结构与正常半月板近似。外侧股骨软骨面及没有被覆盖的胫骨软骨面表现退行性改变，被移植物覆盖的软骨面退变较轻。幼犬的退变更早、更严重。结论：本研究说明了自体游离骨膜在滑液环境及受到合适的应力刺激会向纤维软骨演化，在半月板全切除后，应用游离骨膜重建半月板是可行的     

冷冻保存胎兔颅骨骨膜修复关节软骨缺损的实验研究

为探讨关节软骨缺损的修复方法，采用家兔３０只，平均分成两组。在每个动物的双侧髌股关节股骨关节面作４ｍｍ×７ｍｍ全层软骨缺损。将经二步冷冻法保存的胎兔颅骨骨膜移植于一组动物一侧后肢作为实验组，另一侧用自体骨膜移植作为自体对照组。在另一组动物的一侧后肢用新鲜胎兔颅骨骨膜移植作为新鲜对照组，另一侧关节软骨缺损不修复作为空白对照组。术后肢体不作外固定。１６周后取材，经大体观察、组织学观察及氨基酸成分分析。结果发现，经冷冻保存的胎兔颅骨骨膜移植后能形成透明样软骨，与自体对照组无显著性差异（Ｐ＞０．０５），与新鲜对照组及空白对照组主要指标有显著性差异（Ｐ＜０．０５）。氨基酸分析示实验组新生物接近纤维软骨（Ｐ＞０．０５）。认为，冷冻胎兔颅骨骨膜移植为关节软骨缺损的修复提供了实验依据。     

骨膜移植重建关节面治疗肘关节强直畸形

目的　探讨骨膜移植重建关节面治疗肘关节强直畸形的临床效果。方法　 1985年 5月～ 1999年 11月手术治疗 2 3例 ,有完整随访资料 18例。男 13例 ,女 5例。陈旧性肘关节骨折、脱位致关节僵直 13例 ,晚期类风湿性关节炎 3例 ,陈旧性全关节结核 2例。其中肘关节骨性强直 6例 ,纤维性强直 12例 ;16例关节活动度 0°～ 10°,2例 2 0°～30°。肱骨下端截骨切除一个较大的弧形骨块 ,保留肱骨内、外髁、冠状突及尺骨鹰嘴全部关节面并重建肱骨后方鹰嘴窝。取自体胫骨上段大块骨膜行肱骨下段截骨后关节面重建 ,结合术后持续鹰嘴骨牵引下被动和主动锻炼肘关节至术后 4周。结果　术后随访时间 1～ 9年 ,平均 5 .2年。11例肘关节屈伸正常 ,4例屈伸于 10 0°～ 0°,3例因屈伸肌严重萎缩不能进行有效主动屈伸锻炼 ,肘关节屈伸范围仅 6 0°。结论　保留尺骨关节面 ,移植骨膜重建肱骨下段关节面并在鹰嘴骨牵引下行主动和被动活动 ,既保留正常活动度 ,又促进移植骨膜生长 ,形成新关节面 ,术后功能恢复满意。     

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.     

Rabbit articular cartilage defects treated by allogenic chondrocyte transplantation

Articular cartilage defects have a poor capacity for repair. Most of the current treatment options result in the formation of fibro-cartilage, which is functionally inferior to normal hyaline articular cartilage. We studied the effectiveness of allogenic chondrocyte transplantation for focal articular cartilage defects in rabbits. Chondrocytes were cultured in vitro from cartilage harvested from the knee joints of a New Zealand White rabbit. A 3 mm defect was created in the articular cartilage of both knees in other rabbits. The cultured allogenic chondrocytes were transplanted into the defect in the right knees and closed with a periosteal flap, while the defects in the left knees served as controls and were closed with a periosteal flap alone, without chondrocytes. Healing of the defects was assessed at 12 weeks by histological studies. Allogenic chondrocyte transplantation significantly increased the amount of newly formed repair tissue (P=0.04) compared with that found in the control knees. The histological quality score of the repair tissue was significantly better (P=0.05), with more hyaline characteristics in the knees treated with allogenic chondrocytes than in the control knees. Articular cartilage defects treated with allogenic chondrocyte transplantation result in better repair tissue formation with hyaline characteristics than those in control knees.     

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。     

综合手术治疗膝关节骨性关节炎合并膝内翻

目的 为使膝关节骨性关节炎合并膝内翻的年轻患者延缓行全膝关节置换,探讨股骨内髁马赛克植骨、髌骨成形并胫骨高位截骨综合手术治疗膝关节骨性关节炎合并膝内翻的临床疗效.方法 2004年6月-2006 年2月,对8例10膝骨性关节炎合并膝内翻患者行综合手术治疗.其中男2例3膝,女6例7膝;年龄42～56岁.左膝3例,右膝3例,双膝2例.患者均表现为行走或站久后疼痛.X 线片示股胫关节及髌骨边缘骨质增生,以内侧为重,髌股关节间隙变窄或消失,膝关节内侧间隙明显变窄.股胫角185～200°,平均 190°;HSS 膝关节评分为55～75分,平均60分.膝痛1～12年,平均5年. 结果 术后切口均Ⅰ期愈合,无早期并发症发生.患者均获随访7～24个月,平均15个月.患者截骨部位均于8～11 周达临床愈合,平均9周.股胫角矫正15～30°,平均 20°,基本恢复正常负重力线,膝关节外翻角 10°.术后关节活动度为 100～120°,较术前增加 5～20°,平均增加 10°.X 线片示膝关节内翻畸形基本纠正,截骨处无移位,内固定无松动、断裂.术后6个月HSS膝关节评分75～88分,平均80分. 结论 股骨内髁马赛克植骨使关节软骨得到一定程度的修复重建,髌骨成形有效解决膝前区疼痛,胫骨高位截骨矫正异常负重力线,三者结合,疗效肯定.     

Treatment of chondral lesions in advanced osteochondritis dissecans: a comparative study of the efficacy of chondrocytes, mesenchymal stem cells, periosteal graft, and mosaicplasty (osteochondral autograft) in animal models

Management of chondral lesions in osteochondritis dissecans remains a challenge. This study investigated the efficacy of periosteal graft, osteochondroidal autograft, autologous chondrocyte and mesenchymal stem cell transplants in the treatment of chondral lesions in animal models. Full-thickness articular cartilage defects were created in the weight-bearing surface of the medial femoral condyle in 20-week-old NZW rabbits. A total of 56 knees were randomly divided into four groups as follows: group 1, transfer of cultured chondrocytes; group 2, transfer of cultured mesenchymal stem cells; group 3, repair by periosteal graft; and group 4, mosaicplasty. All of the contralateral knees served as control. Gross, histologic, and biomechanical examinations at 36 weeks after the operation showed that the cultured chondrocytes and mesenchymal stem cells had comparable enhancing effects on the repair of chondral defects in advanced osteochondritis dissecans, whereas mosaicplasty did well initially and periosteal graft did less favorably.     

Value of autologous chondrocyte transplantation in the reconstruction of experimental cartilage defects. Part I. Extent of defect, macroscopic appearance of reconstructed articular surface and microscopic analysis of predominant tissue]

Articular cartilage defect is one of the main reasons of osteoarthritis. Currently, tissue engineering techniques are the methods concerning better cartilage reconstruction. The aim of this part of the study was macroscopic evaluation of degree of defect feeling, macroscopic appearance of repair tissue and microscopic analysis of predominant tissue after autologous chondrocytes transplantation. Repair of partial thickness cartilage defect on distal part of femur was evaluated (25 adolescent rabbits). Procedures were performed in II groups: I--autologous chondrocytes transplantation under periosteal flap, II--periosteal graft. Chondrocytes were isolated from the cartilage specimens by enzymatic digestion and cultured in vitro. The regenerates were inspected 4, 8 and 12 weeks after the operation. Macroscopic analysis in group I, in most cases revealed filling of the defect with tissue resembling surrounding cartilage. In group II the defect was partially filled, and there was many fissures and cracks in all regenerates. In microscopic analysis in group I, after 4 and 8 weeks following the transplantation the tissue similar to juvenile hyaline cartilage predominated. After 12 weeks it resembled mature hyaline cartilage. In group II, in all cases fibrous cartilage was observed after 4, 8, 12 weeks. Obtained results indicate, that macroscopic and microscopic characteristics of repair tissue after autologous chondrocytes transplantation more closely resembled hyaline cartilage, than in periosteal graft group. 12 weeks after autologous chondrocytes transplantation the repair tissue reached maturity, and demonstrated microscopic characteristics of hyaline-like cartilage. The method of autologous chondrocytes transplantation provides potential for clinical application.