颞下颌关节面骨软骨缺损自然修复过程的实验观察

目的 分析猕猴颞下颌关节功能面骨软骨全层缺损后的自然修复能力以及修复组织的性质。方法 12只猕猴24侧关节，于关节镜下在关键结节后斜面和／或髁突前斜面进行钻孔，造成直径3mm、深度5mm，同时穿透关节软骨全层和软骨下皮质骨，并深入骨髓腔的圆柱形缺损。术后4周、8周、12周和24周对修复组织进行大体形态学、组织学、免疫组织化学检查。结果 4周即出现损伤区纤维组织部分修复；随时间推移，损伤区仍为纤维组织修复；12周后缺损区基本与正常周围组织平齐，局部出现钙化组织。免疫组化染色Ⅱ型胶原染色不明显，I型胶原有不同程度的染色。理论 单纯软骨下骨钻孔术能修复关节面骨软骨的全层缺损，只是修复组织为大量的纤维组织和少量纤维软骨样组织的混合体，与正常关节骨有差别。

A Experimental Study on Arthroscopic Subchondral Drilling for Repair of Osteochondral Defect of Temporomandibular Joint

Objective To investigate the resurfacing ability of TMJ cartilage of rhesus monkeys with osteochondral defect.Methods 3 millimeter diameter, 5 millimeter depth, cylindrical full thickness drilled osteochondral defect of articular cartilage on the functional slope of TMJ were made on 12 rhesus monkeys(24 joints) by arthroscope. Every 3 monkeys were sacrificed at 4, 8, 12 and 24 weeks postoperatively and the repaired tissue were studied by gross observation, histology and immunohistochemical staining(IHC). Results The repaired tissues after subchondral drilling were dominated with fibrous tissues and IHC showed that Type II collagen stain was negative and Type I collagen stain was positive.Conclusion The osteochondral defect in TMJ can be repaired by arthroscopic subchondral drilling. The nature of repaired tissue is fibrous connective tissue, something different from normal cartilage. Subchondral drilling can be regarded as one of the treatments for articular cartilage defect.