CAJ | 학술논문

　　背景：关节镜下微骨折治疗与骨软骨移植是关节软骨缺损主要的治疗方法之一，具有广阔的应用前景。目的：探讨关节镜下微骨折治疗与自体和同种异体骨软骨移植治疗膝骨关节炎合并关节软骨缺损的效果。方法：应用关节镜下微骨折治疗清理术结合软骨缺损区微骨折术治疗膝骨关节炎的临床疗效、临床症状及Tegner 运动评级判定疗效并随访观察3-24个月。自体骨软骨移植治疗关节软骨缺损的患者进行观察随访，通过评价移植后关节活动度、临床症状的改善、关节影像学检查等评估自体骨软骨移植治疗的效果。并对同种异体骨软骨移植治疗关节软骨缺损进行动物实验研究，通过对移植部位的大体观察、组织学观察以及免疫组织化学染色观察，评估同种异体骨软骨移植治疗的效果。结果与结论：关节软骨缺损应用关节镜下微骨折治疗后的患者，关节清理术结合软骨缺损区微骨折术总有效率89.7%。关节软骨缺损应用自体骨软骨移植治疗后的患者，关节疼痛、肿胀的症状改善，关节活动度正常，偶有关节静息痛或活动后轻微疼痛，影像学检查见移植骨软骨位置良好，修复愈合良好。关节软骨缺损应用同种异体骨软骨移植治疗后的实验动物，关节活动度正常，移植关节面光整，关节软骨被透明软骨覆盖，细胞有序排列，软骨基质分泌，修复软骨Ⅱ型胶原免疫组织化学染色强阳性。
　　배경：관절경하미골절치료여골연골이식시관절연골결손주요적치료방법지일，구유엄활적응용전경。목적：탐토관절경하미골절치료여자체화동충이체골연골이식치료슬골관절염합병관절연골결손적효과。방법：응용관절경하미골절치료청리술결합연골결손구미골절술치료슬골관절염적림상료효、림상증상급Tegner 운동평급판정료효병수방관찰3-24개월。자체골연골이식치료관절연골결손적환자진행관찰수방，통과평개이식후관절활동도、림상증상적개선、관절영상학검사등평고자체골연골이식치료적효과。병대동충이체골연골이식치료관절연골결손진행동물실험연구，통과대이식부위적대체관찰、조직학관찰이급면역조직화학염색관찰，평고동충이체골연골이식치료적효과。결과여결론：관절연골결손응용관절경하미골절치료후적환자，관절청리술결합연골결손구미골절술총유효솔89.7%。관절연골결손응용자체골연골이식치료후적환자，관절동통、종창적증상개선，관절활동도정상，우유관절정식통혹활동후경미동통，영상학검사견이식골연골위치량호，수복유합량호。관절연골결손응용동충이체골연골이식치료후적실험동물，관절활동도정상，이식관절면광정，관절연골피투명연골복개，세포유서배렬，연골기질분비，수복연골Ⅱ형효원면역조직화학염색강양성。
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 al ogeneic 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 fol owed-up for 3-24 months. The articular cartilage defects patients treated with autologous osteochondral transplantation were fol owed-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 al ogeneic osteochondral transplantation for the treatment of articular cartilage defects was conducted to evaluate the effect of al ogeneic 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 swel ing were improved, and the range of motion was normal with rest pain and slight pain after movement occasional y. Radiographic examination showed the transplanted osteochondral was in good position with good healing. In the experiment animals with articular cartilage defects after treated with al ogeneic 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 col agen type II in the repaired articular cartilage was strongly positive with immunohistochemical staining.