微骨折孔内应用低能量冲击波修复兔关节软骨缺损的研究

背景：对新西兰大白兔全层关节软骨缺损模型应用微骨折术，并在微骨折孔内应用低能量冲击波治疗，观察分析修复效果。目的在于明确微骨折孔内应用低能量冲击波能否改善新西兰大白兔模型的软骨修复效果，探究一种新的改良微骨折术的方法。方法：将36只成年新西兰大白兔随机分为3组。建立新西兰大白兔股骨内髁全层软骨缺损模型。对实验A组应用微骨折术治疗，并应用DolorClast Master冲击波治疗仪微探头（直径0.8cm）对微骨折孔（直径1cm）内进行冲击波治疗（能流密度0.095mj/mm2，200次冲击）。对实验B组仅应用微骨折术治疗。而对照组作为软骨缺损组不予以治疗。术后4、8、12周对修复结果进行大体外观、组织学及免疫组织化学评估。结果：术后12周实验A组及B组的软骨缺损区逐渐被修复组织填充，对照组软骨缺损区无修复组织生成。术后4、8、12周组织学染色及免疫组织化学染色显示实验A组的修复组织比B组含有大量软骨细胞、蛋白多糖以及II型胶原，同时在微骨折孔底部血管增生明显。术后8周、12周实验B组缺损区修复组织内纤维组织生成。软骨缺损区及微骨折孔内修复组织Wakitani评分显示实验A组术后8周、12周修复效果优于实验B组（P<0.05）。结论：在对实验兔关节软骨全层缺损的修复中，在微骨折术的基础上，对微骨折孔内应用低能量冲击波治疗，比单纯应用微骨折术更能够促进透明软骨样修复组织增生。该方法是一种改善微骨折术并将冲击波应用于体内的新途径。但其长期修复效果有待进一步研究。

The effect of low-energy shock waves in microfracture holes in the repair of articular cartilage defects in a rabbit model

Background In this study, low-energy shock waves were applied in microfracture holes to repair full-thickness cartilage defects in rabbits, and the repair results were observed and analyzed. The aim was to investigate a novel method of enhancing microfracture by determining whether low-energy shock waves in microfracture holes would facilitate cartilage repair in a rabbit model.Methods Full-thickness cartilage defects were created at the medial femoral condyle of 36 mature New Zealand White rabbits without penetrating subchondral bone. The rabbits were randomly divided into three groups. In experimental group A, low-energy shock-wave therapy was performed in microfracture holes (diameter, 1 mm) at an energy flux density (EFD)of 0.095 mJ/mm2 and 200 impulses by DolorClast Master (Electro Medical Systems SA, Switzerland) microprobe (diameter, 0.8 mm). In experimental group B, microfracture was performed alone. The untreated rabbits served as a control group. At 4, 8, and 12 weeks after the operations, repair tissues at the defects were analyzed stereologically, histologically, and immunohistochemically.Results The defects were filled gradually with repair tissues in experimental groups A and B, and no repair tissues had formed in the control group at 12 weeks. Repair tissues in experimental group A contained more chondrocytes, proteoglycans, and collagen type II than those in experimental group B. In experimental group B, fibrous tissues had formed at the defects at 8 and 12 weeks. Histologic analysis of experimental group A showed a better Wakitani score (P < 0.05) than in experimental group B at 8 and 12 weeks after the operation.Conclusions In the repair of full-thickness articular cartilage defects in rabbits, low-energy shock waves in microfracture holes facilitated the production of hyaline-like cartilage repair tissues more than microfracture alone. This model demonstrates a new method of improving microfracture and applying shock waves in vivo. However, longer-term outcomes require further study.