新鲜自体与异体骨软骨移植修复兔关节软骨缺损的比较

Comparison of repairing cartilage defects with autograft and allograft osteochondral implantation in rabbits

背景:骨软骨移植是修复关节软骨损伤的主要方法之一,但新鲜自体骨软骨移植与新鲜异体骨软骨移植相比效果尚无定论。目的:探讨新鲜自体骨软骨移植与异体骨软骨移植修复兔关节软骨缺损的方法及疗效。设计、时间及单位:动物实验观察,于2007-01/2008-05在解放军第四军医大学唐都医院骨科完成。材料:新西兰大白兔9只,随机分为3组,3只/组,分别实施自体骨软骨移植、异体骨软骨移植、单纯软骨缺损3种手术。方法:自体移植组:在股骨内侧髁负重关节面取直径3mm骨软骨缺损,于非负重关节面取4块直径1mm骨软骨柱移植;异体移植组:在股骨内侧髁负重关节面直径3mm骨软骨缺损处植入相同直径的异体骨软骨柱;对照组:于股骨内侧髁负重关节面取直径3mm全层软骨缺损,不做处理。主要观察指标:术后12周取材,进行大体观察,组织学检查和半定量的改良Wakitani score评分。结果:大体观察异体移植组修复面较自体移植组稍平整,光镜可见自体和异体移植软骨均已覆盖缺损,与正常软骨高度相当。绝大部分修复面为透明软骨,增殖活跃。软骨下骨、松质骨小梁均与骨床完全骨性愈合。自体移植组软骨浅表区细胞数目及排布更接近正常透明软骨,过渡区及辐射区细胞密度、厚度也明显优于异体移植组,基质染色丰富。结论:自体与异体骨软骨移植的方法均可完成关节软骨缺损的透明软骨修复,自体骨软骨移植更优。

BACKGROUND： Osteochondral implantation is one of the main methods for repairing articular cartilage defect; however, the comparison of repairing cartilage defects with fresh autograft and allograft osteochondral implantation has not been reported. OBJECTIVE： To evaluate the methods and curative effect of fresh autograft and allograft osteochondral implantation in repairing cartilage defects. DESIGN, TIME AND SETTING： Animal experimental observation was performed at the Department of Orthopaedic Surgery, Tangdu Hospital, the Fourth Military Medical University between January 2007 and May 2008. MATERIALS： Nine New Zealand rabbits were randomly and equally divided into 3 groups, which receiving autograft osteochondral implantation, allograft osteochondral implantation and cartilage defects, respectively. METHODS： Rabbits in the autograft osteochondral implantation group were prepared diameter 3 mm cartilage defect in the weight-bearing regions of the femur condyle. Four osteochondral grafts were harvested from the unweight-bearing articular facet, and then were inlaid implanted to the defect. In the allograft osteochondral implantation group, animals were prepared diameter 3 mm cartilage defect in the weight-bearing regions of the femur condyle and implanted with the same diameter osteochondral grafts. There was no other treatment except prepared diameter 3 mm cartilage defect in the weight-bearing regions of the femur condyle in the control group. MAIN OUTCOME MEASURES： Gross observation, histological examination and revised Wakitani score was performed at 12 weeks after operation. RESULTS： Gross observation showed that the repaired surface of the allograft osteochondral implantation group was more burnish than autograft osteochondral implantation group; under light microscope, the articular defects could be found covered by grafts, which had the same height as surrounding cartilage. Articular chondrocytes were proliferating activity and arrayed orderly with vast of secreting cartilage maxtrix, distributed with groups. The bone under the cartilage and the bone trabecula were healed with the hosting bone. However, the articular chondrocytes of the autograft osteochondral implantation group were more densify than allograft group, the alignment the distribution of the chondrocytes were more likely similar to normal articular cartilage. CONCLUSION： Both autograft and allograft osteochondral implantation can repair articular cartilage defect, especially more superior with autograft osteochondral implantation.