关节镜下应用微骨折方法修复关节软骨缺损的实验研究及临床初步应用

目的探讨应用微骨折技术对全层关节软骨缺损修复的效果。方法20只大白兔随机分为两组，在其右股骨内髁先建立全层软骨缺损模型，实验组进行微骨折处理，对照组则不予特殊处理。分别在4周和8周各处死10只实验兔，作大体观察、病理学检查和修复组织厚度测量。临床上对68例全层关节软骨缺损进行随机分组：实验组35例，关节清理后应用微骨折技术进行处理；对照组33例，仅作关节清理术。结果对照组只有肉芽组织和瘢痕组织生长，仅边缘有少量软骨组织生长，实验组在4周时大部分为软骨组织生长，8周已全部被软骨组织修复。术后平均随访8．6个月，Lysholm评分实验组明显优于对照组。结论微骨折技术是一种有效的修复全层关节软骨缺损方法。

Experimental Study and Preliminary Application of Microfracture Techniques for Treatment of Cartilage Defect under Arthroscopy

Objective To investigate the methods of the repair of cartilage defect with microfracture technique. Methods The cartilage defects were created over the articular surface of medial condyles of femur in 20 rabbits.The 20 model rabbits were divided into 2 groups in random,with one group receiving the defect in the surface of articular cartilage as control,and the other group receiving the microfracture in the cancellous bone.Rabbits were sacrificed postoperatively at the end of 4 week and 8 week respectively.The newly formed tissue in the defects was examined by general observation,pathology and examination of the thickness of repair tissues.The 68 patients with complete cartilage defect were divided into 2 groups,with one group (35 patients) receiving the treatment with microfracture technique after the debridement,and the other group (33 patients) receiving the debridement as control. Results In the control group,granulation tissue and scar tissue were formed in the cartilage defects.Conversely,in the model group, cartilage tissue was found in the cartilage defects.Moreover,All of the cartilage defects were replaced by cartilage-like tissue at 8 week.A follow-up was carried out at 8.6 months on average.According to Lyshoml knees score evaluation system,the score of the examination group was significantly higher than that of control group. Conclusion Microfracture is an advisable option for the treatment of full thickness chondral defects.