Goymann V
Sankt Josef-Zentrum für Orthopädie und Rheumatologie, Wuppertal.
Orthopade. 1999 Jan;28(1):11-8. doi: 10.1007/s001320050316.
The removal of areas of chondromatous hyaline cartilage and the attempt to create new lod capacities for articular surfaces remain an encore in miscellaneous variations, pursued over decades in the last century. Recent research findings describe the biochemical interrelations and the three-dimensional structures of the collagenic matrix much more exactly. It was not until now a better insight into the metabolism and the dependent "state of aggregation" of the cartilage under changing mechanical exertion was made possible. From it prove, that the hyaline cartilage of the articulations represent a highly differentiated structure that is susceptible to mechanical and metabolic noxa and avails of remarkably minimal capability of regeneration. The results of repair are not within reach to approximate to functional ability of the original. This lights up that the amititious beginning to get to qualitative comparable regeneration by repair is not completed yet. Previous and furthermore differentiated and with restrictions of chondrocytes in compound with other protective and stimulating substances. Hitherto it seems advisable to refrain from steps being too active therapeutically. The unadulterated open abrasion of pathological articular cartilage has to be marked obsolete, today. Also the effect of abrasive arthroplasty, inductive character suggested, remains in the opinion of well-known authors in no proportion to expenditure of operation and rehabilitation and the expenses, because a sustaining success is not be expected in the long run, no matter whether drilling is done merely subcortical or subchondral, or use of spongiosa or microfracturing procedures. A more positive perspective in therapy appears with the holmium YAG-laser paving the way for gently treatment merely for degenerated cartilage: Regenerative beginnings to build hyaline cartilage have been reported. The abrasive arthroplasty probably will establish as a joint-conserving procedure in combination with the possibility of transplantation of chondrocyxtes to improve specific construction of the collagen matrix.
去除软骨瘤样透明软骨区域并尝试为关节表面创造新的容纳能力，在过去一个世纪里，数十年来一直以各种不同的方式不断尝试。最近的研究结果更精确地描述了胶原基质的生化相互关系和三维结构。直到现在，才有可能更好地了解在不断变化的机械应力下软骨的代谢及其相关的“聚集状态”。由此证明，关节的透明软骨是一种高度分化的结构，易受机械和代谢性有害物质的影响，且再生能力非常有限。修复结果无法达到接近原始功能能力的程度。这表明通过修复实现质量上可比的再生这一雄心勃勃的开端尚未完成。此前，软骨细胞与其他保护和刺激物质进一步分化并受到限制。迄今为止，似乎最好避免治疗步骤过于积极。如今，单纯对病理性关节软骨进行开放性磨削显然已过时。同样，尽管有人认为磨削关节成形术具有诱导性，但知名作者认为，无论只是进行皮质下还是软骨下钻孔，或者使用松质骨或微骨折手术，其效果与手术、康复费用以及开支都不成比例，因为从长远来看，无法期望取得持续的成功。随着钬激光为仅对退变软骨进行温和治疗开辟道路，治疗方面出现了更积极的前景：已有报道称开始有生成透明软骨的再生迹象。磨削关节成形术可能会作为一种保留关节的手术方法确立下来，并结合软骨细胞移植的可能性，以改善胶原基质的特定结构。
