自体游离骨膜移植修复幼兔关节软骨大面积缺损的实验研究

Repair of large area of articular cartilage defects by free autogenous periosteal grafts in the rabbits

目的采用自体游离骨膜移植修复幼兔关节软骨大面积缺损,并对其组织形态学进行观察,探讨髋关节软骨大面积缺损的修复方法。方法40只新西兰幼兔用利刀切除股骨头全层关节软骨达关节软骨表面积的20%以上,制成关节软骨大面积缺损模型。实验组取股骨全层游离骨膜,移植修复股骨头关节软骨缺损;对照组关节软骨缺损不作任何处理。于术后4、8、12、24周取股骨头关节软骨进行大体、光镜观察,Weston-blot法检测关节软骨缺损的修复组织中Ⅱ型胶原蛋白。结果骨膜移植24周后,肉眼下实验组关节软骨缺损区被透明、光滑的软骨覆盖,与周围正常关节软骨组织已难以区分。而对照组软骨缺损区在24周后仍清晰可见基底部少量暗红色纤维结缔组织。光镜下,实验组移植4周后软骨缺损区被骨膜再生组织完全填充,为幼稚透明软骨;12周后新生软骨细胞明显增多,逐渐成熟,但排列紊乱;24周后新生软骨排列趋于规则,与周围正常透明关节软骨结构相似,甲苯胺蓝呈异染性。对照组24周后软骨缺损区仍由纤维样组织覆盖,与周围正常组织分界清晰,边缘可见少量幼稚软骨细胞,甲苯胺蓝异染性不明显。通过Weston-blot法检测证实自体骨膜移植后第四周起,关节软骨缺损的修复组织中Ⅱ型胶原蛋白呈持续高度表达。结论自体游离骨膜移植于幼兔受损髋关节软骨,在一定条件下能演化形成关节透明软骨,可用于修复关节软骨大面积缺损。

Objective To analyze the repair of large area of articular cartilage defects with free autogenous periosteum implants in rabbits. Methods Forty young New Zealand rabbits, weight between 1.05 to 1.50 kg, were used in this experiment. Full-thickness of articular cartilage defects in the femoral head were created. Spontaneous evolution occurred in 20 animals. the other 20 animals were treated with a free autogenous periosteal femoral implant fixed with Tissucol. Animals were sacrificed in all groups at 4, 8, 12 and 24 weeks. Macroscopic, histological and molecular biologic results were evaluated. Results The spontaneous evolution of the lesion did not lead to complete repair in any case. The periosteum-free implant provided complete repair of the lesion and got the statistically significant restoration of the articular surface compared with that of spontaneous repair. Western-blot test confirmed that type Ⅱ collagen was expressed in the tissues of periosteal chondrogenesis. Conclusions The free autogenous periosteal graft is beneficial to repair of large area of articular cartilage defects by its potential chondrogenesis.