微骨折技术与骨软骨移植治疗关节软骨缺损

背景：关节镜下微骨折治疗与骨软骨移植是关节软骨缺损主要的治疗方法之一,具有广阔的应用前景。 目的：探讨关节镜下微骨折治疗与自体和同种异体骨软骨移植治疗膝骨关节炎合并关节软骨缺损的效果。 方法：应用关节镜下微骨折治疗清理术结合软骨缺损区微骨折术治疗膝骨关节炎的临床疗效、临床症状及Tegner运动评级判定疗效并随访观察3-24个月。自体骨软骨移植治疗关节软骨缺损的患者进行观察随访,通过评价移植后关节活动度、临床症状的改善、关节影像学检查等评估自体骨软骨移植治疗的效果。并对同种异体骨软骨移植治疗关节软骨缺损进行动物实验研究,通过对移植部位的大体观察、组织学观察以及免疫组织化学染色观察,评估同种异体骨软骨移植治疗的效果。 结果与结论：关节软骨缺损应用关节镜下微骨折治疗后的患者,关节清理术结合软骨缺损区微骨折术总有效率89.7%。关节软骨缺损应用自体骨软骨移植治疗后的患者,关节疼痛、肿胀的症状改善,关节活动度正常,偶有关节静息痛或活动后轻微疼痛,影像学检查见移植骨软骨位置良好,修复愈合良好。关节软骨缺损应用同种异体骨软骨移植治疗后的实验动物,关节活动度正常,移植关节面光整,关节软骨被透明软骨覆盖,细胞有序排列,软骨基质分泌,修复软骨Ⅱ型胶原免疫组织化学染色强阳性。

Microfracture technique and osteochondral transplantation in the treatment of articular cartilage defects

BACKGROUND:Microfracture technique and osteochondral transplantation are one of the methods for the treatment of articular cartilage defects with broad application prospects. OBJECTIVE: To investigate the effect of microfracture technique and autologous and allogeneic osteochondral transplantation in the treatment of knee osteoarthritis complicated with articular cartilage defects. METHODS: The articular cartilage defects were treated with arthroscopic debridement combined with microfracture surgery in the cartilage defect region, and then the clinical effect, clinical symptoms and Tenger sport score were detected. The patients were followed-up for 3-24 months. The articular cartilage defects patients treated with autologous osteochondral transplantation were followed-up. The effect of autologous osteochondral transplantation was evaluated through assessing the range of motion after transplantation, improvement of clinical symptoms and joint imaging examination. The animal experiment of allogeneic osteochondral transplantation for the treatment of articular cartilage defects was conducted to evaluate the effect of allogeneic osteochondral transplantation through general observation of transplantation site, histological and immunohistochemical staining. RESULTS AND CONCLUSION: For the patients treated with arthroscopic microfracture technique, the total efficiency of joint debridement combined with microfracture surgery in the cartilage defect region was 89.7%. For the articular cartilage defects patients treated with autologous osteochondral transplantation, the symptoms of joint pain and swelling were improved, and the range of motion was normal with rest pain and slight pain after movement occasionally. Radiographic examination showed the transplanted osteochondral was in good position with good healing. In the experiment animals with articular cartilage defects after treated with allogeneic osteochondral transplantation, the range of motion was normal, transplanted articular surface was finishing, the articular cartilage was covered with hyaline cartilage, and the cells were arranged in order; there was cartilage matrix secretion, and the collagen type II in the repaired articular cartilage was strongly positive with immunohistochemical staining.