骨膜移植和钻孔术修复关节软骨缺损的实验研究

AN EXPERIMENTAL STUDY ON REPAIRING ARTICULAR CARTILAGE DEFECTS BY PERIOSTEUM AUTOGRAFTING AND SUBCHONDRAL BONE DRILLING

用中国白兔24只,在股骨关节面造成6mm×8mm 全层软骨缺损,分别进行游离骨膜自体移植和钻孔术。术后4、8周取材,做组织学及电镜观察并进行比较。结果表明:钻孔、移植骨膜和对照组的优势修复组织分别为类透明软骨、幼稚软骨和纤维组织。修复组织平均数量,移植骨膜明显优于钻孔和对照组,骨膜移植、钻孔和对照组修复组织来源分别为骨膜本身、髓腔和软骨下骨及与缺损毗连的软骨。初步结论:移植骨膜和软骨下骨钻孔均能修复关节软骨缺损。术后8周钻孔组可得到较成熟的透明样软骨,但修复组织厚度不及骨膜移植组,单纯刮除后修复能力最差。

Inorder toobserve the p(?)ocess of repairing articular cartilagedefects,full thickness defects of 6mm X 8mm were created over the articularsurfaces of both the femoral condyles in 24 rabbits.Free periosteum autograft-ing and subchondral bone drilling were performed respectively over the defectswith the exception of those of the control ones.All the animals were allowednormal activity immediately after surgery.They Were sacrificed postoperatively at the end of 4and 8 weeks.The newly formed tissues in the defects wereexamined histologically and ultrastructurally.The thickness of repair tissues(RT)were de(?)ermined by stage micrometer.The quantity and quality of the RTin different groups were compared.The results Were as follows:Matured hya-lin-like cartilage was formed in the drilled cartilage defects,immature cartilageWasaidentified in the periosteum grafted ones,and fibrous tissue was found inthe controls.The thickness and quality of RT of the periosteum grafted defectsexceeded that of the subchondral drill(?)d and control ones RT in the drilled de-fects Seeried to have aris(?)n from bone marrow,that in the grafted defects fromthe periosteum itself,and that of controls from the subchondral bone.It is pr-eliminarily concluded that both free periosteum autografting and subchondralbone drilling are feasible for rePairing full-thiekness arti(?)ular cartilage defe-ets.Wicn the defects are left alone,the tissue regeneration is much less andthe repair insufficient.