软骨下骨厚度及固定对兔膝关节软骨下骨移植后软骨的影响  

Changes of Articular Cartilage After Subchondral Replacement With Autogenous Bone Near Rabbits' Knee Joint by the Reserved Thickness of Subchondral Bone and Fixation on Cartilage

作　　者：李建军[1] 吕刚[1] 金成壁[1] 韩壮[1] 黄东辉[1] 李栋 

机构地区：[1]中国医科大学第一临床学院骨科,辽宁沈阳110001 [2]黑龙江省建筑一公司职工医院内科

出　　处：《中国医科大学学报》2002年第3期180-183,共4页Journal of China Medical University

摘　　要：目的 :研究兔膝关节软骨下自体骨移植后软骨下骨厚度及固定对软骨的影响。方法 :健康大耳白兔74只。其中 10只分为I、II两组 ,每组 5只 ,分别建立保留不同软骨下骨厚度的膝关节软骨下大块骨缺损的动物模型 ,术后 1周测量软骨下骨残留厚度。另 6 4只建立动物模型后 ,采用立柱式自体髂骨移植。按保留软骨下骨厚度及术后是否固定随机分为A、B、C、D 4组。A、B组采用I组模型 ,C、D采用II组模型 ,A、C组术后膝关节屈曲角度6 0°位固定 ,4周解除固定 ,B、D组未固定。于术后 12周取材 ,采用光镜、透射电镜 ,对关节软骨进行形态学观察。结果 :I组平均残留软骨下骨的厚度为 1.42mm ,1周时软骨下骨未发生坏死。II组软骨下骨平均残留厚度为 0 .86mm ,1周时全部软骨下骨发生坏死。A、B组 12周时软骨面无 1例塌陷 ,A组 6 .2 5 %的软骨发生退变 ,B组 12 .5 %的软骨发生退变。C、D组 12周时仅 1例关节软骨面塌陷 ,C组 18.7%的软骨发生退变。D组 43.7%的软骨发生退变。经 χ2 检验 ,B组与D组相比 ,有显著性差异 (P<0 .0 5 ) ,C组与D组相比无显著性差异 (P >0 .0 5 )。结论 :关节软骨下骨移植时过多刮除软骨下骨将引起软骨下骨缺血坏死 ,增加软骨退变的发生率。术后固定对关节软骨退变无显著性影响。Objective: Our aim was to explore the reserved thickness of subchondral bone and fixation effecting on cartilage after subchondral replacement with autogenous bone, in defects in medial tibial condyles of rabbits. Methods: Ten of 74 rabbits were divided into two groups, five in each one. The model was made according to the reserved thickness of subchondral bone. After one week, we measured reserved thickness of subchondral bone. Other rabbits were divided into four groups randomly. Subchondral defects in animal models were replacement with columnar bone. The rabbits in A and C groups underwent fixation(60°), and the fixation was displaced in four weeks. The rabbits in B and D groups didnt undergo fixation. The cartilage changes were observed 12 weeks after operation. Results: In group I, the thickness of reserved subchondral bone was 1.42 mm. No necrosis occurred at the 1st week. In group II, the thickness of reserved subchondral bone was 0.86 mm. All of subchondral bone necrosesed at the 1st week. None collapsed in cartilage at the 12 th week in A and B groups and only one collapsed in C and D groups. In group A,6.25% of articular cartilage degenerated. In group B, 12.5% of articular cartilage degenerated. In group C, 18.7% of cartilage degenerated. In group D, 43.7% of cartilage degenerated. Conclusions: Curetting subchondral bone extensively will carry a high risk of postoperative cartilage degeneration. Fixation can not reduce the risk of postoperative cartilage degenerating.

关 键 词：软骨下骨厚度 固定 膝关节软骨下骨移植 关节软骨骨缺损 

分 类 号：R681.3[医药卫生—骨科学] R683[医药卫生—外科学]