摘要
目的:通过自体游离骨膜移植修复儿童髋关节软骨大面积缺损的实验研究和临床应用,观察关节软骨缺损修复的组织形态学变化和临床应用疗效。方法:①动物实验:实验于2002-03/10在南京医科大学附属南京儿童医院儿科研究所完成。选用新西兰幼兔24只,将幼兔股骨头全层关节软骨用利刀切除其表面积的20%以上,制造髋关节软骨大面积缺损模型。按随机数字表法分为2组,每组12只,自体游离骨膜移植组取同侧股骨全层游离骨膜,将骨膜生发层朝向关节腔移植于软骨缺损区;对照组仅同法切除股骨头关节软骨。分别于术后第4,8,12,24周取其股骨头制成标本,对关节软骨缺损修复情况进行大体及组织形态学观察,并用Wston-blot法检测修复组织中Ⅱ型胶原蛋白的表达情况。②临床实验:选择2000-01/2005-06在南京医科大学附属南京儿童医院骨科手术治疗髋关节脱位时,采用自体游离骨膜移植修复髋关节软骨大面积缺损的患儿39例(48髋),监护人均知情同意。术后定期随访检查。髋关节脱位术后疗效根据临床功能及X射线检查结果进行评定:积分16-20分为优,11-15分为良,6-10分为可,<5分为差。结果:①动物实验:自体游离骨膜移植组术后第4周幼兔股骨头软骨缺损被光滑、不透明的类软骨组织替代;12周后软骨缺损由透明的软骨样组织修复;24周后则完全被近似正常的透明软骨修复。对照组术后24周股骨头软骨缺损仍由纤维样组织覆盖。自体游离骨膜移植组术后第4周起软骨缺损修复组织中Ⅱ型胶原蛋白呈持续高表达。②临床实验:39例患儿48髋均获随访,随访18-36个月18例22髋,37-54个月14例16髋,55-72个月7例10髋,平均32个月。髋关节脱位术后疗效优19例25髋(52.1%);良12例10髋(25.0%);可7例8髋(16.7%);差3例3髋(6.2%),优良率达77.1%。结论:动物实验结果显示幼兔自体游离骨膜移植3个月后基本完成了游离骨膜向关节软骨的分化,可为临床应用提供客观依据。临床实验证实,在手术治疗儿童髋关节脱位时,移植自体游离骨膜修复关节软骨大面积缺损,能够提高手术疗效。
AIM： To explore a histomorphology and clinical application for children with large articular cartilage defect by experimental and clinical study in which large articular cartilage defect of hip is repaired with free autogenous periosteal graft.
METHODS： （1）Animal trial： The experiment was accomplished in the Institute of Pediatrics, Nanjing Children＇s Hospital of Nanjing Medical University between March and October in 2002. A total of 24 New Zealand rabbits were used to establish the experimental models of large articular cartilage defect by removing full-thickness cartilage of femoral head of immature rabbits, and then over 20% of surface area was excised. All the rabbits were randomized into transplantation group and control group of 12 in each. Free pieces of periosteam were grafted to defective area from identical femur, and the gerninative layer towards the articular cavity. While only articular cartilage of femoral head was excised in the control group. At 4, 8, 12 and 24 weeks respectively after operation, the appearance in defective area of articular cartilage was observed by gross specimens and sections of femoral head, and Type Ⅱ collagen in regenerative tissue was examined by Western-blot analysis. （2）Clinical trial： A total of 39 children with hip dislocation （48 hips） were treated between January 2000 and June 2005 in the Department of Orthopaedics, Nanjing Children＇s Hospital of Nanjing Medical University, by applying free autogenous periosteal graft to defective area of acetabular cartilage in the course of operation, with the informed consents of their relatives. All the patients were examined by regular follow-ups. The curative effect of surgery for dislocation of hip joint was assayed with clinical function and X-ray examination： 16-20 scores as excellent, 11-15 scores as good, 6-10 scores as fair, and less than 5 scores as poor.
RESULTS： （1）Animal trial： The smooth and non-transparent tissue, which was similar to cartilage, appeared in defective area of cartilage of immature rabbits＇ femoral head at 4 weeks after operation, became transparent cartilage-like tissue at 12 weeks and was completely replaced by approximately normal transparent cartilage at 24 weeks. However, the fibrous tissue eventually covered defective area in the control group. Type Ⅱ collagen in regenerative tissue had been increasingly expressed since postoperative 4 weeks. （2）Clinical trial： All 39 patients （48 hips） were followed up for an average 32 months after surgery, including 18 cases （22 hips） for 18-36 months, 14 cases （16 hips） for 37-54 months, 7 cases （10 hips） for 55-72 months. The outcome of the treatment was evaluated as excellent in 19 cases （25 hips, 52.1%）, good in 12 cases （10 hips, 25.0%）, fair in 7 cases （8 hips, 16.7%） and poor in 3 cases （3 hips, 6.2%）. And the rate of excellent and good effects reached 77.1%.
CONCLUSION： The animal trial displays that free periosteum differentiate to articular cartilage at three months after transplanting free autogenous periosteal graft, and provides the evidence for clinical application. Clinical trial confirms that free autogenous periosteal graft may be used to repair large articular cartilage defect, and the technique can improve operative effect when applied to the treatment of hip dislocation in children.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第16期3013-3017,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
江苏省南京市社会发展计划项目(991128)~~
