兔内侧半月板置换术后关节软骨的组织学变化
Histologic changes in articular cartilage after medial meniscus replacement in rabbits.
作者信息
Rijk Paul C, Tigchelaar-Gutter Wikky, Bernoski Franz-Peter, Van Noorden Cornelis J F
机构信息
Department of Orthopaedic Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
出版信息
Arthroscopy. 2004 Nov;20(9):911-7. doi: 10.1016/j.arthro.2004.06.036.
PURPOSE
Meniscal allografts show capsular ingrowth, but it remains to be established whether meniscal transplantation can prevent long-term degeneration of articular cartilage. This study examined whether immediate or delayed transplantation of the medial meniscus can protect the knee from degenerative changes.
TYPE OF STUDY
Experimental study.
METHODS
Thirty-five rabbits were divided into 5 groups. Three rabbits developed infective arthritis and were excluded from the study. Group A (6 animals) and group C (6 animals) had meniscectomy only; group B (7 animals) and group D (6 animals) underwent meniscal transplantation immediately after meniscectomy; group E (7 animals) had delayed transplantation 6 weeks after meniscectomy. Six nonoperated knees served as controls. Histologic changes of the articular cartilage were examined 6 weeks (groups A, B) and 1 year (groups C, D, E, controls) after surgery.
RESULTS
All operated groups showed more histologic changes than the control group (P < .00001 for both the medial tibial plateau and medial femoral condyle in all groups). At 6 weeks follow-up, no differences were found between the postmeniscectomy group and the transplanted group. At 1 year, immediately transplanted knees showed less degenerative changes than meniscectomized knees (P < .0001 for medial tibial plateau and P < .005 for medial femoral condyle). Delayed transplantation resulted in more degenerative changes than both meniscectomy only and immediate transplantation (for both comparisons, P < .00001 for both medial tibial plateau and medial femoral condyle).
CONCLUSIONS
Immediate meniscal transplantation in rabbits has a protecting effect on articular cartilage for the long-term whereas delayed transplantation leads to even more degenerative changes than meniscectomy only.
CLINICAL RELEVANCE
If these results are applicable to humans, they would support immediate, not delayed, transplantation after removal of a meniscus.
目的
半月板同种异体移植显示有滑膜内生，但半月板移植能否预防关节软骨的长期退变仍有待确定。本研究探讨内侧半月板即刻或延迟移植是否能保护膝关节免于退变。
研究类型
实验研究。
方法
35只兔子分为5组。3只兔子发生感染性关节炎，被排除在研究之外。A组（6只动物）和C组（6只动物）仅行半月板切除术；B组（7只动物）和D组（6只动物）在半月板切除术后即刻进行半月板移植；E组（7只动物）在半月板切除术后6周进行延迟移植。6个未手术的膝关节作为对照。术后6周（A组、B组）和1年（C组、D组、E组、对照组）检查关节软骨的组织学变化。
结果
所有手术组的组织学变化均比对照组多（所有组内侧胫骨平台和内侧股骨髁的P均<0.00001）。随访6周时，半月板切除术后组和移植组之间未发现差异。1年时，即刻移植的膝关节退变变化比半月板切除的膝关节少（内侧胫骨平台P<0.0001，内侧股骨髁P<0.005）。延迟移植导致的退变变化比单纯半月板切除术和即刻移植都多（两组比较，内侧胫骨平台和内侧股骨髁的P均<0.00001）。
结论
兔子的即刻半月板移植对关节软骨有长期保护作用，而延迟移植导致的退变变化比单纯半月板切除术更多。
临床意义
如果这些结果适用于人类，将支持半月板切除后即刻而非延迟移植。
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