带蒂骨膜瓣翻转移植修复兔关节软骨缺损

Experimental study on the repair of articular cartilage defect with reversed pedicle periosteal graft

目的 :设计建立一种以骨膜固有血管血供为主的带蒂骨膜瓣翻转移植修复关节软骨缺损的新方法。方法 :用墨汁混合液血管灌注观察大耳白兔股骨外髁部切取的“U”形骨膜瓣模型的血供。取大耳白兔 32只 ,在双膝股骨髌面外侧造成 5mm× 8mm的全层软骨缺损 ,分别行带蒂骨膜瓣 (实验组 )和游离骨膜移植 (对照组 ) ,术后 2周、4周、8周、12周取材行组织形态学观察。结果 :该骨膜瓣模型的血供主要来自骨膜固有血管 ,可维持骨膜瓣的存活。术后 4周 ,对照组和实验组新生组织的优势组织性质分别为纤维组织和幼稚软骨 ,术后 12周 ,实验组有75 %的优势组织性质为类透明软骨 ,对照组为 12 .5 % ,2组比较差异有统计学意义 (P <0 .0 5 )。结论 :带蒂骨膜瓣移植的成软骨能力优于自体游离骨膜移植 ,且取材简便、术式简单、操作容易。

Aim:To establish a new method to repair articular cartilage defect by reversed pedicle periosteal grafts in which blood supply is from intrinsic vessels of periosteum. Methods:The blood supply of U shaped periosteal grafts in external condyle of femur in rabbits was observed by the vascular perfusion of ink mixed fluid.Full thickness defects of 5 mm× 8 mm were made over the articular surface of both external condyles of femur in 32 rabbits. Free periosteum (control group) and pedicle periosteum (trial group) autografting were performed respectively over the defects.The newly formed tissues in defects were examined and compared under light microscopes after sacrificed postoperatively at 2,4,8,and 12 weeks. Results:The blood source of the U shaped periosteal grafts was chiefly from the intrinsic vessels of periosteum,which could maitain the periosteal grafts survival. The nature of predominant newly formed tissues in control group and trial group were fibrous tissue and immature cartilage respectively at the 4th week. At the 12th week,the formed hyaline like cartilage took in 75% in trial group, in comparison with 12.5% in control group,and the the difference was significant ( P < 0.05).Conclusion:The chondrogenic potential of the pedicle periosteal autografting is superior to that of the free periosteum autografting.The operation of pedicle periosteal autografting is simple, easy and the materials can be obtained easily.