自体游离骨膜移植与软骨下骨钻孔术对关节软骨缺损远期修复效果的实验比较

Experimental Comparison of Long-term Effects in Repair of Articular Cartilage Defect with Free Autoperiostuem Transplantation and Subchondrol Bone Drilling

目的比较和评价自体游离骨膜移植和软骨下骨钻孔术修复关节软骨缺损的远期效果。方法用中国白兔40只,在股骨关节面制造6mm×8mm全层软骨缺损,分别进行自体游离骨膜移植和软骨下骨钻孔。术后13个月取材做组织学及电镜观察并进行比较。结果(1)骨膜移植和钻孔组软骨缺损完全被修复组织填充,修复组织稍高出毗邻软骨,关节表面光滑、平坦,已与毗邻软骨交融;对照组软骨缺损内无正常软骨形态,表面不平,仍为缺损状。(2)骨膜移植和钻孔优势修复组织均为透明软骨,对照组为纤维组织。(3)修复组织厚度:骨膜移植和钻孔组均稍高出毗邻软骨,但与毗邻软骨之间的厚度均无显著性差异。(4)修复组织覆盖缺损的面积:钻孔组与移植骨膜组无显著性差异,但二者均明显大于对照组。结论自体游离骨膜移植和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,二者的远期效果无明显差异,简单的钻孔术能够替代复杂的骨膜移植。

Objective To compare the effects of articular cartilage defect repairing with free auto periosteum transplantation and subchondral bone drilling. Methods Full thickness defects （6mm × 8mm） were created in the articular surfaces of the bilateral femoral condyles of 40 Chinese white rabbits. The defects were treated with free autoperiosteum transplantation and subchondral bone drilling respectively. The newly formed tissues in the defects were observed under light microscopes and electron microscopes after 13 months. Results （1） The articular cartilage defects in the autoperiosteum transplantation froup and the subchondral bone drilling group were compeletly repaired,although the new formed tissues were a little higher than the thickness of adjacent articular cartilage. At the same time, the articular surface is smoothly. While in the control group, the defects were not repaired by cartilage and its suface remained rough and defective. （2）The main repairing tissues of the experimental groups were hyaline cartilage, while that of the control group was still fibrous tissues. （3）The thickness of repair tissues had no significant difference between the periosteum transplantation group and the bone drilling group,and were a bit higher than the thickness of adjacent articular cartilage. （4）The covered areas of repair tissues was no significant difference between the periosteum transplantation group and the bone drilling group, but the two groups were significantly larger than the control group. Conclusion The long - term effects of periosteum transplantation and subchondral bone drilling for repairing full - thickness articular cartilage defects were satisfactory, and the repair tissues had a long - term adaptation to joint raovement and weight loading. There was no significant difference between periosteum transplantation and subchondral bone drilling in the long-term effects. Simple bone drilling can replace the complex periosteum transplantation.