软骨移植与软骨下骨钻孔修复全层关节软骨缺损的比较实验研究

Comparative Experimental Research on Repairing of Full-thick Articular Cartilage Defects with Cartilage Transplant and Subchondral Bone Drilling

目的 :评价软骨移植、软骨下骨钻孔修复关节软骨缺损的生物特性和效果差异。方法 :采用重复拉丁方设计 ,将 36只雄性新西兰大白兔按三个因素三个水平进行随机区组 ,对左右后肢按设计好的创面大小制造全层软骨缺损。软骨移植组将不同家兔关节软骨交换嵌入移植。钻孔组依创面大小制造孔直径、间距、深度相同的骨孔 ,深达松质骨。对照组缺损不作任何修复。术后 4、8、1 2周处死取材 ,分别进行大体观察、光镜观察、电镜观察 ,对观察指标进行量化统计学分析。结果 :(1 )两实验组在第 1 2周时均能以类透明软骨组织修复缺损 ,而对照组为纤维肉芽组织 ,统计学分析表明各组间有显著性差异 (P <0 .0 1 )。 (2 )光镜观察表明两种手术方法均能以软骨的方式修复缺损 ,软骨移植组无明显免疫排斥迹象 ,软骨细胞有活性 ,各组间有显著性差异 (P <0 .0 1 )。 (3)形态学分析表明 ,随时间延长 ,光密度与修复高度渐增 ,其中软骨移植组优于其他各组 (P <0 .0 1 )。 (4)随时间延长修复效果逐渐改善。小创面修复效果与中等创面间无明显差异。 (5)电镜观察表明 ,两种手术方法均有软骨细胞生成 ,细胞器发达。对照组符合纤维肉芽组织特征。结论 :(1 )软骨移植、钻孔均能以类透明软骨的结局修复关节软骨缺损 。

Objective: To compare and evaluate the differences of potentialities biological characteristics and between cartilage transplant and subchondral bone drilling in repairing defects of articular cartilage.Method:By using the Repeated Measure Design of Latin Square,36 adult male rabbits were divided into groups randomly based on three factors,and three levels.A free allogenic cartilage was grafted to a size-matched,full-thickness articular cartilage defect.Subchondral bone drilling were also used to repair the cartilaginous defects.The reconstructed cartilage were observed in gross and by optical and electron microscopes and morphological analysis at 4,8,12 weeks respectively.Results:All of these methods could repair the lesions completely at 12 weeks,while the control groups were filled with fibrous tissue.The height of the repair tissue and the light density data indicated that the cartilage transplant group was better than other groups.No evidence of immune rejection was observed.The lesion size was not a significantly important factor of the repairing.Conclusion:1.Allogenic cartilage transplant and subchondral bone drilling are feasible for repairing of the articular cartilage defects.2.Cartilage transplant is better than other methods without any acute immune rejection short termly.3.The results are advancing with time and the size of lesion is not the utmost important factor of cartilage healing.