重组骨形态发生蛋白-2结合软骨下钻孔治疗犬关节软骨全层缺损的实验研究

Experimental study on the treatment of canine full-thickness articular cartilage defects by rhBMP-2 in combination with subchondral bone drilling

目的 研究重组骨形态发生蛋白 2 (rhBMP 2 )结合软骨下骨钻孔治疗犬关节软骨全层缺损的可行性 ,为临床应用提供实验依据。方法 依照软骨缺损处理方法的不同将 6 4侧股骨髁随机均分为 4组 :①结合组 :软骨下骨钻孔 +胶原海绵吸附rhBMP 2充填软骨缺损 ;②BMP组 :胶原海绵吸附rhBMP 2充填软骨缺损 ;③钻孔组 :单纯软骨下骨钻孔 ;④对照组 :不作处理或单纯用胶原海绵填塞。术后 2、4、8、12周取材观察其大体、光镜、透射电镜、免疫组织化学情况。结果 除对照组仅有纤维组织修复外 ,其余 3组均有不同程度的软骨修复 ,但结合组的修复在组织细胞形态、超微结构、Ⅱ型胶原含量等方面均明显优于其他两组。结论 rhBMP 2结合软骨下骨钻孔能有效修复犬膝关节软骨的全层缺损 ,该技术可行 ,有望在临床应用。

Objective To study the feasibility of the treatment of canine full thickness articular cartilage defects by rhBMP 2 in combination with subchondral bone drilling,so as to provide evidence for its clinical application. Methods Experimental full thickness articular cartilage defects were created in the medial and lateral condyles of the bilateral femurs of 16 dogs. The 64 defects were randomly divided into 4 groups: ① the defects were treated with rhBMP 2 only; ② subchondral bone drilling alone; ③ rhBMP 2 in combination with subchondral bone drilling; ④ just left alone as controls. The specimens were taken 2, 4, 8, 12 weeks after operation for macroscopical observation, light and electromicroscopic examination and immunohistochemical analysis. Results Except for the control group in which the defects were repaired with only fibrous tissues, all defects of the other three groups were repaired by cartilage to some extents. The group of rhBMP 2 in combination with subchondral bone drilling gave better results than the others in the aspects of cell morphology, type Ⅱ collagen content and ultrastructure. Conclusion Combination of rhBMP 2 and subchondral bone drilling can well repair the full thickness of articular cartilage defects in dogs practically predicting the foreseen feasible clinical application.