微粒骨膜-三维支架修复大面积关节软骨缺损

Microperioteum-scaffolded repair of large, full-thickness defect of articular cartilage

目的探讨微粒骨膜-三维支架修复大面积关节软骨缺损的有效性和可行性。方法于兔股骨滑车关节面制作直径4．5mm深达软骨下骨板的全层软骨缺损模型，缺损处随机行自体微粒骨膜-纤维蛋白混凝物、单纯纤维蛋白“浇铸”移植。分别于术后3h、4d及1、2、4、8、12、24周取材，行大体观察、苏木素-伊红（HE）、Masson及藏红花（safranin-O）染色组织学检查，并进行组织学评分半定量分析。结果微粒骨膜．三维支架制备简便。微粒骨膜被均匀种植于纤维蛋白三维支架中，可随意“浇铸”充填骨软骨缺损，移植物不易脱落，手术1次完成。术后微粒骨膜在缺损空间内全方位迅速增殖、分化、分泌基质完成缺损骨软骨修复。新生软骨具有与周围正常软骨基本一致的厚度、细胞形态及排列、基质胶原及蛋白多糖染色，且与周边软骨及软骨下骨结合良好。术后4、8、12及24周，两组组织学评分差异有统计学意义（P〈0．05）。结论该方法能简单高效地构建工程化组织复合体，随意浇铸充填软骨缺损，完成较大面积关节软骨缺损的生物性修复。

Objective To explore the effectiveness and the feasibility of microperiosteum-scaffolded repair of larger defect of articular cartilage. Methods A larger （4.5 mm-in diameter） , full-thickness defect of articular cartilage were made in the femoral groove of New Zealand White rabbits. Microperiosteum was prepared and dispersed in fibering glue, then transplanted into defects by means of tapecasting. The contralateral knee served as a control：only fibering glue was transplanted into defects in the same way. The distal parts of the femur were harvested at the end of 3 h ,4 clays and 1 ,2,4,8,12,24 weeks postoperatively, and were examined grossly and histologically. The tissues were stained with HE, Masson （for collagen of articurlar cartilage） and safranin-O （for GAG）. Results The microperiosteum- fibering glue could be prepared simply, and could be transplanted freely into defects by the means of tapecasting. This approach could be accomplished easily by no more than one operation. Throughout the defects were repaired as MSCs of the microperiosteum proliferated tremendously and secreted special cartilage matrix ; The new cartilage was the same as the surrounding normal cartilage in its thickness, cellular histology, special staining for collage and GAG, and was excellently integrated with surrounding cartilage and subcartilage bone as well. There were significant differences （ P 〈 0.01 ） in histologic scores between control group and microperiosteum-seaffolded graft group at the end of 4,8,12,24 weeks postoperatively. Conclusion The approach can construct tissue complex,and mieroperiosteum- fibering glue can transplanted freely by the means of tapeeasting and repair the defects of artieurlar cartilage; It may be a useful alternative in the repair of large,full-thickness defect of joint surfaces.