治疗关节软骨缺损手术方法的比较

Comparison of surgical methods for repair of articular cartilage defect

目的对比研究骨膜移植术、软骨细胞移植术和骨软骨钻孔术对关节软骨损伤的修复。方法纯种青紫蓝兔４４只，随机分为Ａ、Ｂ、Ｃ、Ｄ４组，在膝关节作全层软骨缺损模型，Ａ、Ｂ、Ｃ组分别选择行上述一种操作，Ｄ组不作处理。术后４、８、１２周取材作大体、光镜和电镜观察。结果各组缺损均有不同程度修复，但修复优势组织性质有所差别。结论自体游离骨膜移植术和钻孔术修复关节节软骨缺损效果明显优于未处理组，其中以钻孔术为简便实用。细胞移植所产生的修复组织接近正常软骨组织，明显优于其他两种术式。

Objective To study periosteum grafting,subchondral bone drilling and chondrocyte grafting for repair of articular cartilage defect. Methods A fullthickness defect in the articular cartilage and subchondral bone was made in both femoral condyles in 44 rabbits. Free periosteum autografting, subchondral bone drilling and chondrodytes transplanting embedded in collagen gel were performed respectively over the defects, except the control ones. The rabbits were killed at the 4th,8th,and 12th week, and the speciments were observed under eyes, light and electron microscope. Results The defects of all groups were repaired to different degrees, but the quality and origin of repair tissues were different. Conclusion The effects of both free periosteum grafting and subchondral bone drilling are significantly superior to the control group, the subchondral bone drilling is simpler and easier to be available. The tissues repaired by cell transplantation are similar to normal hyline cartilage. The chondrocyte grafting is dramatically superior to other two methods.