摘要
目的 研究分析软骨的营养和生长特点,探讨外伤性软骨缺损后软骨移植的可能性及提高手术疗效的处理对策。方法 对健康狗的掌指关节行全关节及半关节的肌肉内植及原位植入,大体及光镜下观察软骨的生长和变性情况;对18例手掌指关节及近侧指间关节外伤性软骨缺损行第二跖趾关节软骨及全关节移植,并对部分手术细节予以改进,随访分析。结果 动物实验中植入肌肉组较原位植入组软骨变性明显,后者在弹性软骨细胞数量及基质分泌虽较正常对照组减少,但均在4周左右建立循环,其中半关节组优于全关节组。18例患者经6月至8年随访,关节活动度平均较术前增加43.5度,5例出现疼痛,6例出现关节间隙狭窄,余关节形态及结构正常。结论 早期的规律的关节活动与关节的营养供应对软骨的存活同等重要,而匹配良好的关节软骨面,可靠的内固定,韧带重建,供区尽量薄的软骨面和少的骨量及适宜的生化,力学环境是提高手术疗效的关键。
Objective To research and analyse the cartilage feature about nutrition and growing, and
explore the probability of cartilage transfer after cartilage defect by trauma and how to improve the operative effects. Methods The metacrpophalangeal joint coming from healthy dogs were treated with transfer in muscle and original site. The gross and histological changes about growing and variation of cartilage were observed in different period. 18 joints with traumatic metacarpophalangeal joint or proximal interphalangeal joints cartilage defect treated with metatarsophalengeal joints transfer were followed, some operative details were improved. Results The result of the animal experiment revealed that hyalinization of joint cartilage in muscle group showed more distinct than in original site, and although the latter were smaller than the control group in quantity of cartilage cell and stromal secretion, blood supply of cartilage were established about four weeks, the group of half joint transer was better than of whole. All 18 patients were followed up for 6 months to 8 years, the range of the joints motion increased 43. 5 degrees on average, 5 cases are painful and 6 cases joint degeneration turn up, the others well present. Conclusion Both primeval frequently joint exercise and nutrition provision are the same important to the living of cartilage. Several issuse may be the key toimproving operative effects, i. e, anatomic structural coincidence between the joints of the finger and the toe, dependable fixation, reconstruction of ligement, thin cartilage and small bone of the donor, proper physiochemical and biomechenical surroundings as well.
