Kim H K, Moran M E, Salter R B
Division of Orthopaedic Surgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.
J Bone Joint Surg Am. 1991 Oct;73(9):1301-15.
Animal models for chondral shaving and subchondral abrasion were created to resolve the controversy about the nature of the repair tissue after these procedures and to determine the effect of continuous passive motion on the quality of the repair tissue. Chondral shaving was performed on the patella in forty adolescent rabbits, and subchondral abrasion was performed on the patella in another forty rabbits. In both procedures, a three-millimeter-diameter defect was created. After the operation, twenty animals from each group were allowed intermittent active motion; the remainder were treated by continuous passive motion for two weeks, followed by intermittent active motion. Half of the animals from each group were killed at four weeks and the other half, at twelve weeks. There was no evidence of repair tissue in the defects at either four or twelve weeks after chondral shaving, regardless of the postoperative treatment. The remaining underlying cartilage, however, had degenerated. After abrasion of subchondral bone, the defects in animals that were treated with only intermittent active motion healed at twelve weeks, although the quality of the repair tissue varied. All ten of the animals that were treated with continuous passive motion, however, had mature, hyaline-like cartilage as the predominant repair tissue at twelve weeks, compared with six of the ten animals that were treated with intermittent active motion (p less than 0.05). We concluded that, in this model, partial-thickness defects created by chondral shaving do not heal; rather, the remaining underlying cartilage degenerates. Full-thickness defects created by subchondral abrasion can heal by regeneration of hyaline-like cartilage. Such healing is enhanced by continuous passive motion for two weeks postoperatively.
为了解决关于软骨刮除术和软骨下骨磨削术后修复组织性质的争议,并确定持续被动运动对修复组织质量的影响,创建了软骨刮除和软骨下骨磨削的动物模型。对40只青春期兔的髌骨进行软骨刮除术,对另外40只兔的髌骨进行软骨下骨磨削术。在这两种手术中,均制造了直径3毫米的缺损。术后,每组20只动物进行间歇性主动运动;其余动物接受持续被动运动两周,然后进行间歇性主动运动。每组一半动物在4周时处死,另一半在12周时处死。软骨刮除术后4周和12周,无论术后治疗如何,缺损处均无修复组织的证据。然而,剩余的深层软骨已经退化。软骨下骨磨削后,仅接受间歇性主动运动治疗的动物的缺损在12周时愈合,尽管修复组织的质量各不相同。然而,在12周时,所有接受持续被动运动治疗的10只动物均以成熟的透明软骨样组织作为主要修复组织,而接受间歇性主动运动治疗的10只动物中有6只如此(P<0.05)。我们得出结论,在该模型中,软骨刮除造成的部分厚度缺损不会愈合;相反,剩余的深层软骨会退化。软骨下骨磨削造成的全层缺损可通过透明软骨样组织的再生而愈合。术后持续被动运动两周可促进这种愈合。