软骨下骨钻孔术对兔软骨缺损修复的远期效果观察

LONG-TERM EFFECTS OF SUBCHONDRAL DRILLING WITH IN REPAIR OF ARTICULAR CARTILAGE DEFECT IN RABBITS

目的 观察软骨缺损的修复过程 ,比较不同数目钻孔术对软骨缺损修复的远期效果。方法 用中国白兔 4 0只 ,在股骨髁关节面造成 6mm× 8mm全层软骨缺损 ,分别施行 10孔及 5孔钻孔术 ,孔径1mm ,于术后 12周及 13个月取材 ,做组织学及电镜观察 ,并进行评估。结果 (1) 12周时 10孔、5孔和对照组的修复组织中类透明软骨分别占 70 %、5 0 %、0 % ;13个月时 10孔、5孔和对照组的修复组织中类透明软骨分别占 90 %、10 0 %、0 %。 (2 )修复组织厚度 :12周时 10孔及 5孔组均明显高出毗邻软骨 ,且 10孔明显高于 5孔 ;13个月时 10孔与 5孔无显著性差异 ,且已接近毗邻软骨厚度。 (3)修复组织覆盖缺损的面积 :12周时 10孔 >5孔 >对照组 ;13个月时 10孔与 5孔无显著性差异 ,但二者均明显大于对照组。结论 软骨下骨钻孔对关节软骨缺损修复的远期效果良好 ,能长期适应关节的生理运动和功能负重 ,10孔与 5孔的远期修复效果无显著性差异。

Objective To observe the process of articular cartilage defect repairing and compare the long-term effects after subchondral drilling with different number of holes.Methods Full-thickness defects (6mm×8mm) were created in the articular surface of both the femoral condyles in 40 Chinese white rabbits. 10 or 5 holes (diameter, 1mm) were drilled respectively over the defects with the exception of the control group. They were sacrificed postoperatively at 12 weeks and 13 months. The newly formed tissues in the defects were examined under light and electron microscopes. The long-term effects of defect repair in different groups were compared and evaluated.Results Results (1)The proportions of hyalin-like cartilage in the repair tissues were 70%, 50% and 0% respectively in the 10 holes, 5 holes and control groups by the end of 12 weeks and those were 90%, 100% and 0% respectively by the end of 13 months. (2) By the end of 12 weeks, the thickness of repair tissues in 10-hole and 5-hole groups were dramatically thicker than the adjacent articular cartilage, and that of 10 holes group was significantly thicker than the 5 holes group; by the end of 13 months, the thickness of repair tissues had no significant difference between the 10 holes and 5 holes groups and were near to the thickness of adjacent articular cartilage. (3)The covered areas of repair tissues of the 10 holes group exceeded those of 5 holes and control ones at 12 weeks; at 13 months, there was no significant difference between the 10 holes and 5 holes groups, but the two groups were significantly larger than the control ones.Conclusion The long-term effects of subchondral bone drilling for repairing full-thickness articular cartilage defects were satisfactory, and the repair tissues had a long-term adaptation to joint movement and weight loading. There was no significant difference between 10 holes group and 5 holes group in the long-term effects.