膝关节软骨下立柱式自体骨移植后软骨的变化

Changes of Articular Cartilage after Subchondral Replacement with Autogenous Bone in Rabbits'Knee Joint

目的 通过观察兔膝关节软骨下立柱式自体骨移植后软骨的变化,探讨移植后关节软骨塌陷及软骨退变的原因。方法 42只大耳白兔为实验对象,随机分为A、B两组。分别建立保留不同厚度的关节软骨下大块骨缺损的动物模型,采用立柱式自体髂骨移植。分别于术后第1、12周处死10只、32只动物,切取标本。应用光镜、透射电镜,对实验动物的软骨进行形态学观察。结果 A组平均残留软骨下骨的厚度为1.42mm,1周时软骨下骨未发生坏死;12周时软骨面无一例塌陷,12.5％的软骨发生退变。B组软骨下骨平均残留厚度为0.86mm,1周时大部分软骨下骨发生坏死;12周时仅一例关节软骨面塌陷,43.7％的软骨发生退变。结论 关节软骨下骨移植时过多刮除软骨下骨将引起软骨下骨缺血坏死,增加软骨退变的发生率;立柱式自体骨移植可较好的修复关节软骨下的大块骨缺损。

Objective To explore the reason of cartilage collapsing and degenerate after subchondral replacement with autogenous bone, in defects in medial tibial condyles of rabbits. Methods 42 rabbits were divided into two groups, according to the reserved thickness of subchondral bone. Subchondral defects in animal models were replacement with columnar bone. Results Group A: the thickness of reserved Subchondral bone was 1.42mm. No necrosis came out at 1 week, no collapse in cartilage at 12 weeks. 12.5% articular cartilage degenerated. Group B: the thickness was 0.86mm. 43.7% cartilage degenerated. Conclusions Curetting of subchondral bone extensively will carry a high risk of postoperative cartilage degeneration. Columnar replacement with autogenous bone will recover bone defect under articular cartilage quiet well.