全层关节软骨缺损三种修复方法的比较实验研究

目的评价骨膜移植、软骨移植、软骨下骨钻孔三种方法修复全层关节软骨缺损的生物学特性和修复效果,为临床应用提供实验依据。方法采用重复拉丁方设计的实验分组及统计学分析方法,按手术方式、观察时间、创面大小三个因素分四个水平进行随机分组,将32只雄性新西兰大白兔的左右后肢制成全层软骨缺损模型,分别进行骨膜移植、软骨移植和软骨下骨钻孔修复,对照组不作任何修复。术后第2、4、8、12周处死动物取材,分别进行大体观察、光镜观察与电镜观察,并对观察指标进行量化,数据行统计学分析。结果大体观察及电镜观察显示三个实验组在第12周时均能以类透明软骨组织修复缺损,而对照组为纤维肉芽组织。形态学分析表明,三种方法均能以类透明软骨组织覆盖缺损,软骨移植组无明显免疫排斥现象。随着时间延长,修复高度逐渐增加。软骨移植组效果最优,而骨膜移植组优于钻孔组(P<0.01)。甲苯胺蓝染色的光密度分析表明,随着时间延长,软骨基质分泌逐渐增加;三种方法与对照组间比较差异均有显著性(P<0.01),软骨移植组优于其它各组(P<0.01),但骨膜移植组与钻孔组间差异无显著性。结论软骨移植、骨膜移植与软骨下骨钻孔三种方法均能以类透明软骨组织修复全层关节软骨缺损,软骨移植的近期效果最佳。软骨下骨钻孔法修复组织的

Comparative experimental research in repairing of full-thickness articular cartilage defects with different methods

Objective To compare and evaluate the differences of potentialities, biological characteristics and results between periosteum transplant, cartilage transplant and subchondral bone drilling in repairing full-thickness defects of articular cartilage in weight-bearing joints, for the purpose of proposing the experimental basis for clinical application. Methods By using the repeated measure design of Latin Square, 32 adult male rabbits were divided into groups randomly based on three factors and four levels. Autologous periosteum transplant, allogenic cartilage transplant and subchondral bone drilling were applied for repairing of size-matched, full-thickness articular cartilage defects on the femoral condyle of the knees. The reconstructed tissues were observed by gross, optical and electronic microscopic view and analysed morphologically at 2, 4, 8, 12 weeks respectively. Results All of these three methods could repair the lesions by hyaline-like cartilage at 12 weeks, while the control groups were filled with fibrous tissue. The height of the repairing tissue compared with the normal cartilage and the light density data indicated that the cartilage transplant groups were better than others; periosteum transplant and bone drilling groups were better than the control groups as well. No evidence of immune rejection was observed. Based on the statistical analysis, the lesion size was not a significantly important factor for the repair. While the time was in a contrary way. Conclusion Autologous periosteum transplant, allogenic cartilage transplant and subchondral bone drilling are feasible for repairing of the full-thickness articular cartilage defects. These methods are beneficial options for clinical application, among which cartilage transplant is the best. The reconstructed tissue of subchondral bone drilling is insufficient for bigger defects.