骨膜移植修补全层骨关节软骨缺损—rhTGF—β1体外培养与关节内注射之比较
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REPAIR OF WHOLE-LAYER ARTICULAR CARTILAGE DEFECTS WITH PERIOSTEAL GRAFT
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    摘要:

    游离骨膜已被用于全层骨软骨缺损的修补,但新生软骨之早期退化使此方法无法广泛应用于临床。本实验乃利用转换成长激素之软骨生成效用,比较短时与游离骨膜体外培养或直接行关节腔内注射两种方法,以评估其软骨生成及提高全层骨软骨缺损修补的作用。64只白兔分成5组:无骨膜移植缺损组、骨膜移植缺损组、激素短时培养骨膜移植缺损组、100ng激素关节腔内注射骨膜移植缺损组和200ng激素关节腔内注射骨膜移植缺损组。手术后2至12周取下标本,脱钙后行SafraninO染色。组织学观察结果,无骨膜移植缺损组未见软骨组织修补。骨膜移植缺损组,於术后4周达最大之透明软骨生成,但此透明软骨持续变薄。激素短时培养组,可加速软骨之生成,但亦加速新生软骨之退化。激素关节腔内注射组并未提高软骨修补品质,反而形成骨赘。

    Abstract:

    Periosteal grafts have been used to repair large osteochondral defects in rabbit articular cartilage but early degeneration of the new cartilage has hindered extensive clinical application of this procedure. The effect of TGF-βintroduced either by pre-incubation of the periosteum in vitro or by intraarticular injection in vivo was compared to determine the relative effects of these two methods on the generation of new cartilage.Sixty-four rabbits were divided into five groups: 1. non-grafted group; 2. grafted group; 3. 100ng/ml rhTGF-β1 pre-incubation group; 4. grafted and 100ng/100μl rhTGF-β1 injected group; 5. grafted and 200ng/100μl rhTGF-β1 injected group. The rabbits were sacificed at 2 to 12 weeks, and specimens taken for histological examination sections were stained with Safranin O and were scored basing on a new subjective scoring system. Results showed that the grafted group healed with hyaline cartilage-like material formed to its utmost at 4 weeks, but soon followed with progressive thinning; the rhTGF-β1 incubated group did accelerated chondrogenesis but also accelerated degeneration. The rhTGF-β1 injected groups did not enhance chondrogenesis but generated osteophytes instead. While the non-grafted group healed without any cartilaginous material. The rhTGF-β1 pre-incubation in vitro is preferred over intra-articular injection as the route of administering this polypeptide growth factor and is effective in accelerating chondrogenesis, but the problem of early degeneration of new cartilage necessitates further study.

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谢博钦,周有礼,张冠谅,王世宗,王国照.骨膜移植修补全层骨关节软骨缺损—rhTGF—β1体外培养与关节内注射之比较[J].医用生物力学,1995,10(3):189-201

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