Gotterbarm Tobias, Richter Wiltrud, Jung Martin, Berardi Vilei Simona, Mainil-Varlet Pierre, Yamashita Takeshi, Breusch Steffen J
Department of Orthopaedics, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
Biomaterials. 2006 Jun;27(18):3387-95. doi: 10.1016/j.biomaterials.2006.01.041. Epub 2006 Feb 20.
Focal osteochondral defects are still a challenging problem in joint surgery. We have developed a two-layered implant consisting of a basal porous beta-tricalcium phosphate (TCP) for bone reconstruction and a superficial fibrous collagen type I/III layer for cartilage regeneration. Fifty-four osteochondral defects in the trochlear groove of 27 Göttinger Minipigs were created and either left untreated, treated with the implant alone, or the implant augmented with an additional growth factor mixture, which was assumed to stimulate cell and tissue differentiation. Follow-up was 6, 12 and 52 weeks with n=6 for each group. The repair tissue was evaluated for its gross appearance and biomechanical properties. Histological sections were semi-quantitatively scored for their histomorphological structure. Treatment with the two-layered implant improved defect filling and subchondral bone repair at 6 and 12 weeks follow-up. The TCP was replaced by cancellous bone at 52 weeks. Cartilage repair tissue mainly consisted of fibrocartilage and showed a moderate cell density up to the joint surface. Growth factor treatment improved the mechanical and histomorphological properties of the cartilage repair tissue at 12, but not at 52 weeks postoperatively. In conclusion, the two-layered collagen-TCP implant augmented with chondroinductive growth factors seems a promising new option for the treatment of deep osteochondral defects in joint surgery.
局限性骨软骨缺损仍是关节外科领域一个具有挑战性的问题。我们研发了一种双层植入物，其底层为用于骨重建的多孔β-磷酸三钙（TCP），表层为用于软骨再生的I/III型纤维胶原蛋白层。在27只哥廷根小型猪的滑车沟制造了54处骨软骨缺损，缺损处要么不进行治疗，要么仅用植入物治疗，要么用植入物并添加一种额外的生长因子混合物进行治疗，该生长因子混合物被认为可刺激细胞和组织分化。每组n = 6，随访时间分别为6周、12周和52周。对修复组织的大体外观和生物力学特性进行了评估。对组织学切片的组织形态结构进行了半定量评分。在6周和12周随访时，双层植入物治疗改善了缺损填充和软骨下骨修复情况。52周时，TCP被松质骨替代。软骨修复组织主要由纤维软骨组成，直至关节表面细胞密度适中。生长因子治疗在术后12周改善了软骨修复组织的力学和组织形态学特性，但在52周时未改善。总之，添加软骨诱导生长因子的双层胶原蛋白-TCP植入物似乎是关节外科治疗深部骨软骨缺损的一种有前景的新选择。
