自体软骨细胞团块植入修复兔陈旧性关节软骨缺损的实验研究

Repair of prefabricated defects of articular cartilage by transplanting cultured masses of autologous chondrocytes

目的 观察自体软骨细胞团块植入对兔关节软骨缺损的修复作用。方法 24只成年新西兰大白兔48侧膝关节，随机分为三组（n=16）并制备双膝关节股骨滑车软骨缺损模型。空白对照组无特殊处理，骨膜移植组将骨膜覆盖缺损并缝合于缺损两侧的股骨髁上，实验组将自体软骨细胞团块植入缺损中。术后3、6个月分别取材（n=8），进行大体和组织学观察，修复组织行Wakitani评分并进行比较。结果 实验组共成功取材11个缺损关节，9个为透明软骨修复，2个因植入细胞生长状态差未修复；骨膜移植组修复组织为纤维软骨或纤维组织，修复组织薄，基质异染弱；空白对照组仅有少量纤维组织填充缺损底部。修复组织Wakitani评分：实验组3．82分，骨膜移植组6．71分，空白对照组9．23分，差异有统计学意义（F=5．96，P=0．00）。结论 自体软骨细胞团块植入能较好修复关节软骨缺损，修复的质量与植入细胞的质量有关。

Objective To explore the feasibility of repairing defects of articular cartilage with cultured mass of autologous chondrocytes. Methods Forty-eight knees of 24 adult New Zealand rabbits were divided into blank control group, periosteum transplantation group and experiment group. A quadrate full-thickness cartilage defect was fabricated in each patellar grove of distal femur. In experiment group, cartilage was obtained from one of the shoulders in the same operation, and the chondrocytes were isolated from the cartilage tissue with type 11 collagenase digestion and cultured and amplified in flasks in vitro. In a second surgery, masses of the autologous chondrocytes were implanted into the defects after debridement of the prefabricated defects. Finally the defect was sealed with a piece of periosteum obtained from the upper anterior tibia. The defects in blank control group were left untreated and in periosteum transplanted group were sealed only with periosteum. The animals were sacrificed in the 3rd and 6th months after the second operation respectively. Efficiency of repair was evaluated according to Wakaniti scoring and statistically analyzed with One-Way ANOVA and Scheffe test. Results In experiment group, 9 of the 11 defects were well repaired with mature hyaline cartilage tissue. However, 2 of the 11 defects were not repaired due to languishment of the cells implanted. In periosteum transplantation group, most of the defects were repaired only with thin fibro- cartilage or fibrous tissue. In blank control group, most of the defects were just filled with little fibrous tissue. Wakauiti scoring showed 3.82 points for experiment group, 6.71 for periosteum transplantation group and 9.23 for blank control group, with a significant difference （ F = 5.96, P = 0.00）. Conclusions It is a promising way of repairing the articular cartilage to conduct mass transplantation of cultured autologous articular chondrocytes. The quality of repaired tissue is correlated with the activity of cells transplanted.