微骨折技术结合自体骨软骨碎屑样移植修复兔膝关节软骨缺损的实验研究  

Microfracture plus autologous osteochondral paste transplantation to treat knee cartilage defects in rabbits

作　　者：邢麟子[1] 桂鉴超[1] 徐燕[1] 蒋逸秋[1] 高峰[1] 陆一鸣[1] 徐杨[1] 尹昭伟[1] 

机构地区：[1]南京医科大学附属南京医院（南京第一医院）关节外科,210006

出　　处：《中华创伤骨科杂志》2012年第5期424-428,共5页Chinese Journal of Orthopaedic Trauma

基　　金：江苏省“科教兴卫”工程资助项目（YZK07119）

摘　　要：目的评价应用微骨折技术结合自体骨软骨碎屑样团块移植修复兔膝关节软骨缺损的效果、方法取健康成年新西兰大白兔46例，随机分为3组：对照组10只，微骨折组18只，实验组18只。制作膝关节软骨缺损模型，对照组不做其他任何处理；微骨折组利用做骨折技术制作网格状做孔；实验组在制作网格状徽孔后在缺损表面填盖上碎屑样软骨团块。术后4、8、12周行大体观察、组织学观察及Wakitani组织学评分、糖胺聚糖（GAG）含量测定。结果术后12周实验组缺损由透明软骨样组织填充，软骨及软骨下骨组织基本恢复，修复的软骨组织在大体观察、组织形态学方面均优于做骨折组和对照组。术后4、8、12周实验组Wakitani组织学评分平均分别为（5．0±1．0）、（6．7±1．5）、（13．0±1．0）分，微骨折组平均分别为（2．3±0．6）、（5．0±1．0）、（7．7±1．2）分，对照组平均分别为（0．0±0．0）、（1．3±0．6）、（1．7±0．6）分，实验组不同时间点评分均高于微骨折组和对照组，差异有统计学意义（P〈0．05）。术后4、8、12周实验组GAG含量平均分别为（6．25±0．31）、（13．11±0．21）、（16．23±0．66）μg／mg，微骨折组平均分别为（3．04±0．21）、（5．75±0．24）、（7．03±0．21）μg／mg，两组比较差异均有统计学意义（P〈0．05）。结论微骨折技术结合自体骨软骨碎悄样移植是一种治疗软骨缺损的新选择，其能够有效提高软骨修复的效果。Objective To evaluate the effectiveness of mierofracture plus autologous osteoehondral paste transplantation in treatment of knee cartilage defects in rabhits. Methods Models of articular cartilage defects were established in 46 healthy adult male New Zealand rabbits which were divided into 3 groups： control group （ n = 10）, microfracture group （ n = 18） and experiment group （ n = 18）. In the control group, the cartilage defects were left untreated. In the microfracture group, muhiple grid-like mini-holes were made using the microfracture technique. In the experiment group, the defects were covered with autologous osteochondral paste after the grid-like mini-holes were made. At 4, 8 and 12 weeks post-treatment, the knees were assessed grossly, histologically, and by glycosaminoglycan （GAG） content measurement and Wakitani scoring . Results After 12 weeks, the detects in the experiment group were filled with hyaline-like cartilage tissue, and both the cartilage and the subchondral bone were basically repaired. The repaired cartilage was superior to those in the other groups in terms of gross appearance and histomorphology. The Wakitani histological scores at 4, 8 and 12 weeks post-treatment were respectively 5.0 ±1. 0, 6. 7 ± 1.5 and 13.0 ±1. 0 in the experiment group, 2.3 ±0.6, 5.0 ±1.0 and 7.7± 1.2 in the microfracture group, and 0.0 ±0.0, 1. 3 ±0.6 and 1. 7 ± 0. 6 in the control group. The experiment group was significantly better then the other 2 groups in all the above indexes （ P 〈 0.05）. The GAG contents at 4, 8 and 12 weeks post-treatment were respectively 6.25 ±0. 31 μg/mg, 13. 11 ±0.21 μg/mg and 16.23 ±0. 66 μg/mg in the experiment group, and 3.04 ±0.21 μg/mg, 5.75 ±0.24 μg/mg and 7.03 ±0.21 μg/mg in the microfracture group, with significant differences between the 2 groups （ P 〈 0. 05） . Conclusion Microfracture plus autologous osteochondral paste transplantation may be a promising treatment option for cartilage defects because it is much more effective

关 键 词：膝关节 关节镜检查 软骨 关节 移植 自体 创伤和损伤 

分 类 号：R687.3[医药卫生—骨科学]