術后早期活動對同種異體關節移植后關節軟骨保護作用的實驗研究_《中國修復重建外科雜志》

作者：

李翔 , 張友樂 , 鄧玖征

北京積水潭醫院北京大學第四臨床醫學院手外科（北京，100035）;

關鍵詞：

同種異體關節移植關節軟骨早期活動兔

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【摘要】目的采用同種異體關節移植動物模型，于術后采用不同處理方法進行對照實驗，探討同種異體關節移植后早期活動對關節軟骨的保護作用。方法選用生長條件相同的6月齡新西蘭大耳白兔10只（雌雄不限，體重2.5～3.0 kg）作為供體，取其一側半膝關節，經深低溫凍存處理后移植于取下股骨側半膝關節的6月齡青紫藍兔（雌雄不限，體重2.5～3.0 kg）膝關節處，術后分別給予早期活動（術后2周，早期活動組，n=5）或持續石膏固定6周（持續固定組，n=5）；并取供體對側半膝關節設立空白對照組（未經任何處理，n=5）和凍存對照組（經深低溫處理2周，n=5）。術后分別行大體、X線片及組織學觀測，觀察同種異體關節軟骨的變化情況。結果大體觀察示，早期活動組實驗兔關節活動良好；持續固定組實驗兔關節活動受限明顯。X線片示，術后當天、術后2周同種異體關節供體骨端與受體骨端對合整齊、對位對線良好；術后6周，早期活動組3只實驗兔受體和供體骨端略有成角畸形，持續固定組對位及對線仍良好。HE染色示，早期活動組同種異體半膝關節標本軟骨細胞數量和形態基本正常，偶見核碎裂及核溶解；持續固定組同種異體半膝關節標本中軟骨細胞大量減少，大部分細胞核溶解消失，軟骨基質中大量纖維組織增生。細胞存活率檢測示，早期活動組細胞存活率（49.66% ± 2.15%）顯著高于持續固定組（20.68% ± 1.24%），比較差異有統計學意義（P lt; 0.05）。掃描電鏡觀察示，早期活動組同種異體半膝關節標本可見軟骨細胞細胞核核膜尚完整，染色質凝聚、邊集，線粒體及粗面內質網腫脹；持續固定組同種異體半膝關節標本可見軟骨細胞細胞膜消失，軟骨細胞與周圍基質界限不清，核膜破裂，染色質及細胞質內細胞器消失。結論同種異體關節移植術后進行早期功能活動對兔關節軟骨有保護作用，但不能完全阻止軟骨退變。

引用本文： 李翔,張友樂,鄧玖征. 術后早期活動對同種異體關節移植后關節軟骨保護作用的實驗研究. 中國修復重建外科雜志, 2012, 26(1): 26-30. doi: 復制

1.	allografts: long-term survival, but frequent complications. Clin Orthop Relat Res, 2010, 468(11): 2914-2923.
2.	in porcine articular chondrocytes. Cryobiology, 2010, 61(3): 297-302.
3.	of osteochondral allograft viability. Am J Sports Med, 2011, 39(7): 1494-1499.
4.	transplantation of human femoral iaphysis and total knee joints—first clinical experiences. Transplant Proc, 1998, 30(6): 2754-2761.
5.	joints. The first 18 years of basic research and its clinical application.
6.	Clin Orthop Relat Res, 1989, (242): 12-25.
7.	Orthop Clin North Am, 1987, 18(2): 275-289.
8.	lesions of the talar shoulder treated with fresh osteochondral allograft transplantation. J Bone Joint Surg (Am), 2011, 93(7): 648-654.
9.	defect of the lateral femoral condyle. Knee Surg Sports Traumatol.
10.	Arthrosc, 2011, 19(4): 556-558.
11.	of the acetabulum with osteochondral allograft transplantation. Orthopedics, 2011, 34(7): e307-311.
12.	Transplant Proc, 2011, 43(2): 652-654.
13.	文雪, 張朝躍. 同種異體半關節移植治療下肢關節端骨腫瘤. 現代生物醫學進展, 2010, 10(13): 2476-2478.
14.	劉躍輝, 屠重棋, 張開偉, 等. 同種異體骨關節移植并鋼板置入內固定治療橈骨遠端骨巨細胞瘤9例. 中國組織工程研究與臨床康復, 2009, 13(43): 8573-8577.
15.	Toy PC, White JR, Scarborough MT, et al. Distal femoral osteoarticular.
16.	Ogilvie CM, Crawford EA, Hosalkar HS, et al. Long-term results for limb salvage with osteoarticular allograft reconstruction. Clin Orthop Relat Res, 2009, 467(10): 2685-2690.
17.	Song YC, An YH, Kang QK, et al. Vitreous preservation of articular cartilage grafts. J Invest Surg, 2004, 17(2): 65-70.
18.	Jomha NM, Weiss AD, Fraser Forbes J, et al. Cryoprotectant agent toxicity.
19.	Ohlendorf C, Tomford WW, Mankin HJ. Chondrocyte survival in cryopreserved osteochondral articular cartilage. J Orthop Res, 1996, 14(3): 413-416.
20.	Linn MS, Chase DC, Healey RM, et al. Etanercept enhances preservation.
21.	Hofmann GO, Kirschner MH, Wagner FD, et al. Allogeneic vascularized.
22.	Diefenbeck M, Wagner F, Kirschner MH, et al. Outcome of allogeneic vascularized knee transplants. Transpl Int, 2007, 20(5): 410-418.
23.	Diefenbeck M, Nerlich A, Schneeberger S, et al. Allograft vasculopathy after allogeneic vascularized knee transplantation. Transpl Int, 2011, 24(1): e1-5.
24.	李也白, 葉忠, 歷智, 等. 采用大塊同種異體骨和復合手術治療骨缺損(附46例異體骨和半關節移植). 中華骨科雜志, 1995, 15(1): 3-9.
25.	Salter RB. The biologic concept of continuous passive motion of synovial.
26.	楊貴勇, 盧世璧. 關節軟骨損傷修復基礎研究進展. 中國矯形外科雜志, 1996, 3(1): 54-55.
27.	Mankin HJ, Gebhardt MC, Tomford WW. The use of frozen cadaveric allografts in the management of patients with bone tumors of the extremities.
28.	Adams SB Jr, Viens NA, Easley ME, et al. Midterm results of osteochondral.
29.	Lee JH, Wang SI, Choi HR, et al. Unicondylar osteoarticular allograft reconstruction of the distal femur in a patient with a traumatic osteoaticular.
30.	鄭小飛, 黃華揚, 丁煥文, 等. 大塊同種異體骨移植重建骨腫瘤巨大骨缺損78例. 中國組織工程研究與臨床康復, 2009, 13(15): 2978-2983.
31.	Krych AJ, Lorich DG, Kelly BT. Treatment of focal osteochondral defects.
32.	Hossein EM, Ashraf H, Peivandi L. Total allograft transplantation of the elbow joint after wide resection of synovial cell sarcoma: a case series.

1. allografts: long-term survival, but frequent complications. Clin Orthop Relat Res, 2010, 468(11): 2914-2923.
2. in porcine articular chondrocytes. Cryobiology, 2010, 61(3): 297-302.
3. of osteochondral allograft viability. Am J Sports Med, 2011, 39(7): 1494-1499.
4. transplantation of human femoral iaphysis and total knee joints—first clinical experiences. Transplant Proc, 1998, 30(6): 2754-2761.
5. joints. The first 18 years of basic research and its clinical application.
6. Clin Orthop Relat Res, 1989, (242): 12-25.
7. Orthop Clin North Am, 1987, 18(2): 275-289.
8. lesions of the talar shoulder treated with fresh osteochondral allograft transplantation. J Bone Joint Surg (Am), 2011, 93(7): 648-654.
9. defect of the lateral femoral condyle. Knee Surg Sports Traumatol.
10. Arthrosc, 2011, 19(4): 556-558.
11. of the acetabulum with osteochondral allograft transplantation. Orthopedics, 2011, 34(7): e307-311.
12. Transplant Proc, 2011, 43(2): 652-654.
13. 文雪, 張朝躍. 同種異體半關節移植治療下肢關節端骨腫瘤. 現代生物醫學進展, 2010, 10(13): 2476-2478.
14. 劉躍輝, 屠重棋, 張開偉, 等. 同種異體骨關節移植并鋼板置入內固定治療橈骨遠端骨巨細胞瘤9例. 中國組織工程研究與臨床康復, 2009, 13(43): 8573-8577.
15. Toy PC, White JR, Scarborough MT, et al. Distal femoral osteoarticular.
16. Ogilvie CM, Crawford EA, Hosalkar HS, et al. Long-term results for limb salvage with osteoarticular allograft reconstruction. Clin Orthop Relat Res, 2009, 467(10): 2685-2690.
17. Song YC, An YH, Kang QK, et al. Vitreous preservation of articular cartilage grafts. J Invest Surg, 2004, 17(2): 65-70.
18. Jomha NM, Weiss AD, Fraser Forbes J, et al. Cryoprotectant agent toxicity.
19. Ohlendorf C, Tomford WW, Mankin HJ. Chondrocyte survival in cryopreserved osteochondral articular cartilage. J Orthop Res, 1996, 14(3): 413-416.
20. Linn MS, Chase DC, Healey RM, et al. Etanercept enhances preservation.
21. Hofmann GO, Kirschner MH, Wagner FD, et al. Allogeneic vascularized.
22. Diefenbeck M, Wagner F, Kirschner MH, et al. Outcome of allogeneic vascularized knee transplants. Transpl Int, 2007, 20(5): 410-418.
23. Diefenbeck M, Nerlich A, Schneeberger S, et al. Allograft vasculopathy after allogeneic vascularized knee transplantation. Transpl Int, 2011, 24(1): e1-5.
24. 李也白, 葉忠, 歷智, 等. 采用大塊同種異體骨和復合手術治療骨缺損(附46例異體骨和半關節移植). 中華骨科雜志, 1995, 15(1): 3-9.
25. Salter RB. The biologic concept of continuous passive motion of synovial.
26. 楊貴勇, 盧世璧. 關節軟骨損傷修復基礎研究進展. 中國矯形外科雜志, 1996, 3(1): 54-55.
27. Mankin HJ, Gebhardt MC, Tomford WW. The use of frozen cadaveric allografts in the management of patients with bone tumors of the extremities.
28. Adams SB Jr, Viens NA, Easley ME, et al. Midterm results of osteochondral.
29. Lee JH, Wang SI, Choi HR, et al. Unicondylar osteoarticular allograft reconstruction of the distal femur in a patient with a traumatic osteoaticular.
30. 鄭小飛, 黃華揚, 丁煥文, 等. 大塊同種異體骨移植重建骨腫瘤巨大骨缺損78例. 中國組織工程研究與臨床康復, 2009, 13(15): 2978-2983.
31. Krych AJ, Lorich DG, Kelly BT. Treatment of focal osteochondral defects.
32. Hossein EM, Ashraf H, Peivandi L. Total allograft transplantation of the elbow joint after wide resection of synovial cell sarcoma: a case series.

《中國修復重建外科雜志》

術后早期活動對同種異體關節移植后關節軟骨保護作用的實驗研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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《中國修復重建外科雜志》

術后早期活動對同種異體關節移植后關節軟骨保護作用的實驗研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料