Bruns J, Steinhagen J
Orthopädische Universitätsklinik Hamburg.
Orthopade. 1999 Jan;28(1):52-60. doi: 10.1007/s001320050321.
The problem in the treatment of deep hyalin cartilage defects is due to the minimal regeneration potential of this specific tissue. Several attempts were made to solve this difficulties experimentally and clinically. The proliferative potential of autogenous perichondrium/periost is well-known for decades. Perichondrium can be harvested from the lower ribs near to the sternum and periost from the adjacent bone (mostly proximal tibia). Experimentally and clinically, it has been shown that both types of tissue bear the potential to form hyalin-like cartilage under in vitro and in vivo conditions. Furthermore, regarding the biomechanical data (shear modulus) and the biochemical data (content of type II collagen) the newly grown tissue resembles normal hyalin cartilage. In addition, it has been shown that the transplant fixation with fibrin glue is sufficient in order to allow early postoperative treatment with continuous passive motion which is known to stimulate cartilaginuous regeneration. Despite the satisfying experimental and clinical results further examinations are needed in order to evaluate the optimal surgical technique and postoperative regimen regarding the CPM-criteria. In addition, application of growth-factor might further improve this biological kind of treatment which has to be analysed.
深层透明软骨缺损治疗中的问题源于这种特定组织的再生潜力极小。人们在实验和临床方面进行了多次尝试来解决这一难题。自体软骨膜/骨膜的增殖潜力数十年来已为人所知。软骨膜可取自靠近胸骨的下肋骨，骨膜则取自相邻骨骼（大多为胫骨近端）。实验和临床研究均表明，这两种组织在体外和体内条件下都有形成透明样软骨的潜力。此外，就生物力学数据（剪切模量）和生化数据（II型胶原蛋白含量）而言，新生成的组织类似于正常透明软骨。另外，已表明用纤维蛋白胶进行移植固定足以允许术后早期采用连续被动运动治疗，而连续被动运动已知可刺激软骨再生。尽管取得了令人满意的实验和临床结果，但仍需要进一步检查，以便根据连续被动运动标准评估最佳手术技术和术后方案。此外，生长因子的应用可能会进一步改善这种生物治疗方法，这还有待分析。
