Ⅱ型胶原海绵填充材料修复兔关节软骨缺损

背景修复关节软骨缺损一直是骨科医师致力解决的难题,以前采用自体软骨膜、骨膜或异体骨软骨片移植,但存在供体来源有限、固定困难,以及出现软骨内骨化、软骨下骨与修复性软骨的分层现象等.Ⅱ型胶原是软骨基质的主要成分,对关节软骨缺损的修复应有一定的作用.目的探讨Ⅱ型胶原海绵对修复关节软骨缺损的效果.设计随机对照的实验研究.地点和材料实验地点为广州市创伤外科研究所.材料普通级成年雄性纯种新西兰兔24只48膝,体质量(2.29±0.25)kg,标准饲料分笼喂养.干预在股骨滑车面钻孔为直径5 mm、深3 mm的全层关节软骨缺损,按随机数分为填充组(左膝关节缺损部位植入Ⅱ型胶原海绵)和对照组(右膝关节缺损部位作为空白对照).主要观察指标术后12周内,每双数周对缺损修复情况行大体形态和组织学观察.结果10～12周,对照组缺损区由白色、质软、按压无阻抗的组织修复,修复组织仍低于周围关节面,边界仍清晰可辨,组织学以类似炎症反应的机制修复缺损,最终以透明变性的纤维组织的增生来填补缺损部位;填充组缺损区由半透明状、质韧光滑有光泽,按压有阻抗并有弹性的组织修复,修复组织与周围软骨外形上已基本相似,不易区分,组织学未见有炎症反应的过程,内骨组织和软骨组织增生活跃,并可见大量类骨组织和骨小梁形成,新生软骨和周围软骨组织融合,并与周围组织连接.Ⅱ型胶原对关节软骨缺损的修复有明显的促进作用,修复结果接近正常软骨.结论自行研制的高纯度Ⅱ型胶原海绵,对关节软骨缺损具有良好的促进修复作用,且组织相容性好,无明显的毒副作用.

Repair of articular cartilage defect in rabbit with type Ⅱ collagen sponge filling material

BACKGROUND: The repair of articular cartilage defect is always a problem that is dedicatedly solved by doctors of orthopaedics. Autologous perichondrium, periosteum or allografting of cartilage have been used previously; however, the source of the donor is limited, the fixation is difficult as well as the occurrence of endochondrial ossification and delamination between the inferior cartilage and reparative cartilage, etc. Type Ⅱ collagen, the main component of cartilage matrix, has certain effects in the repair of articular cartilage defect.OBJECTIVE: To investigate the effects of type Ⅱ collagen sponge filling on the repair of articular cartilage defect.DESIGN: A randomized controlled trial.SETTING and MATERIALS: The study was conducted in the Guangzhou Institute of Traumatic Surgery. Materials were 24 adult male purebred New Zealand Rabbits(48 knees), ordinary grade, with a body mass of (2.29 ±0. 25) kg. Animals were fed with standard feeding in separate cage.INTERVENTIONS: A full-thickness defect in articular cartilage was made on the femoral trochlear surface by a drill of 5 mm in diameter and 3 mm in depth. Rabbits were allocated into filling group(type Ⅱ collagen sponge was grafted into left keen joint defect) and control group(right knee joint defect site was set as control) according to random number table.MAIN OUTCOME MEASURES: Gross morphological and histological observation of the defect repair in each dual week within 12 weeks after operation.RESULTS: During 10 - 12 weeks, in cuntrol group: The defect area was repaired by white and soft tissue that had no resistance to press. The repaired tissue was still lower than the surrounding articular surface with clear boundary. By histological observation, it was found that the defect was repaired by the mechanism similar to inflammatory reaction and the defect is ultimately filled by the hyperplasia of hyaline degenerative fibrous tissues. In filling group: the defect was repaired by semi-transparent, smooth, textured tissues with polish that had resistance to press as well as elasticity. The repaired tissue was almost similar to the shape of the surrounding cartilage,difficult to be distinguished. After histological observation, it was found that there was no inflammatory reaction, but active hyperplasia of inner bonetissue and cartilage tissues; a lot of osteoid tissues and trabeculation were found. Newlborn cartilage was fused with surrounding cartilage tissue and connected with surrounding tissues. Type Ⅱ collagen had significantly promoting effects in the repair of articular cartilage defect, and the repaired cartilage was close to normal cartilage. CONCLUSION: The self-made high purity type Ⅱ collagen sponge has favorable promoting effects in the repair of articular cartilage defect with good histocompatibility but without obvious toxic side effect.