Microfracture technique and osteochondral transplantation in the treatment of articular cartilage defects

doi:10.3969/j.issn.2095-4344.2013.31.025

Abstract

Abstract:

BACKGROUND: Microfracture technique and osteochondral transplantation are one of the methods for the treatment of articular cartilage defects with broad application prospects.
OBJECTIVE: To investigate the effect of microfracture technique and autologous and allogeneic osteochondral transplantation in the treatment of knee osteoarthritis complicated with articular cartilage defects.
METHODS: The articular cartilage defects were treated with arthroscopic debridement combined with microfracture surgery in the cartilage defect region, and then the clinical effect, clinical symptoms and Tenger sport score were detected. The patients were followed-up for 3-24 months. The articular cartilage defects patients treated with autologous osteochondral transplantation were followed-up. The effect of autologous osteochondral transplantation was evaluated through assessing the range of motion after transplantation, improvement of clinical symptoms and joint imaging examination. The animal experiment of allogeneic osteochondral transplantation for the treatment of articular cartilage defects was conducted to evaluate the effect of allogeneic osteochondral transplantation through general observation of transplantation site, histological and immunohistochemical staining.
RESULTS AND CONCLUSION: For the patients treated with arthroscopic microfracture technique, the total efficiency of joint debridement combined with microfracture surgery in the cartilage defect region was 89.7%. For the articular cartilage defects patients treated with autologous osteochondral transplantation, the symptoms of joint pain and swelling were improved, and the range of motion was normal with rest pain and slight pain after movement occasionally. Radiographic examination showed the transplanted osteochondral was in good position with good healing. In the experiment animals with articular cartilage defects after treated with allogeneic osteochondral transplantation, the range of motion was normal, transplanted articular surface was finishing, the articular cartilage was covered with hyaline cartilage, and the cells were arranged in order; there was cartilage matrix secretion, and the collagen type II in the repaired articular cartilage was strongly positive with immunohistochemical staining.

Key words: organ transplantation, organ transplantation academic discussion, osteochondral transplantation, articular cartilage defects, microfracture, knee arthritis, hyaline cartilage, chondrocytes, femoral medial condyle, femoral condyle, subchondral bone, provincial grants-supported paper

CLC Number:

R318

Liu Li-bing, Wang Cheng-wei, Gao Jian, Shen Zhi-min. Microfracture technique and osteochondral transplantation in the treatment of articular cartilage defects[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2013.31.025.

Figures/Tables 3

2.2 与相关研究结果的比较 2.2.1 自体骨软骨移植治疗关节软骨缺损张继春等[14]对17例股骨关节面软骨缺损的患者进行自体骨软骨移植治疗研究，其中男12例，女5例，年龄18-45岁，平均29岁，左膝10例，右膝7例，膝关节功能评分65-105分，其中3例有半年以上风湿病史，14例有外伤史，均有膝关节疼痛，伴大腿肌肉萎缩，3例伴绞锁，2例伴弹响。关节镜下观察以及骨软骨移植治疗结果见表3。夏亚一等[11]对7例膝关节股骨髁负重部位软骨损伤的患者进行自体骨软骨移植治疗研究，其中男5例，女2例，年龄16-43岁，所有患者均有关节疼痛，且均出现假性绞锁，其中4例伴有关节肿胀。影像学检查X射线可见4例患者股骨髁表面骨软骨损伤，MRI检查见3例患者骨软骨损伤，关节镜检查结果及骨软骨移植治疗结果见表3。张永红等[15]、徐东潭等[12]也分别对骨软骨移植治疗关节软骨缺损进行了研究，张永红等[15]对15例膝关节股骨髁负重部位软骨损伤的患者进行自体骨软骨移植治疗研究，其中男9例，女6例，年龄16-50岁，均有明显外伤史，其中12例伴有膝关节疼痛，大腿肌肉萎缩以及“打软腿”现象，12例患者中6例伴有弹响，6例伴有绞锁，关节镜检查及骨软骨移植治疗结果见表3。徐东潭等[12]对16例膝关节软骨缺损的患者进行自体骨软骨移植治疗研究，其中男10例。女6例，年龄18-45岁，所有患者均有膝关节疼痛、大腿肌肉萎缩症状，10例伴有弹响。关节镜检查及骨软骨移植治疗结果见表3。文章研究显示关节软骨缺损应用骨软骨移植治疗多为膝关节等负重大关节，经过对患者的观察随访，能够看出自体骨软骨移植治疗关节软骨缺损能够获得满意的移植修复效果，患者关节活动度完全正常，偶有静息痛或活动后轻微疼痛，影像学检查可见移植骨软骨位置良好，愈合修复良好。 2.2.2 同种异体骨软骨移植治疗关节软骨缺损自体骨软骨移植治疗关节软骨缺损能够获得良好的移植效果，且已经被临床广泛应用。而同种异体骨软骨移植治疗关节软骨缺损尚未进入临床应用阶段，仍处于动物实验分析阶段，且此类研究较少，陈百成等[16]、王洪等[13]和文昌明等[10]分别对同种异体骨软骨移植治疗关节软骨缺损进行了动物动物实验研究，研究对象为新西兰大白兔，移植骨软骨均为供体兔下肢膝关节内、外侧股骨髁关节面，对受体兔进行同种异体骨软骨移植模拟实验研究，具体研究结果见表4。"

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