Brown Bryan N, Chung William L, Pavlick Matthew, Reppas Serafim, Ochs Mark W, Russell Alan J, Badylak Stephen F
Department of Clinical Sciences, Cornell University, Ithaca, NY, USA.
J Oral Maxillofac Surg. 2011 Dec;69(12):e488-505. doi: 10.1016/j.joms.2011.02.130.
A device consisting of powdered porcine urinary bladder extracellular matrix (UBM-ECM) encapsulated within sheets of the same material was investigated as a scaffold for temporomandibular joint (TMJ) meniscus reconstruction.
Five dogs underwent unilateral resection of the native meniscus and replacement with a UBM-ECM device. Necropsies were performed at 3, 4, 8, 12, and 24 weeks. Two additional dogs underwent bilateral resection of the meniscus with replacement with a UBM-ECM device on 1 side, leaving the contralateral side empty as a control. Necropsies were performed at 24 weeks for bilaterally treated animals.
Macroscopically, the UBM-ECM implants were remodeled rapidly and were indistinguishable from newly deposited host tissue at all time points. Microscopically, remodeling was characterized by a dense infiltration of predominantly CD68(+) mononuclear cells and smooth muscle actin-positive fibroblast-like cells at early time points changing with time to a sparse population of smooth muscle actin-negative spindle-shaped cells resembling those of the native fibrocartilaginous TMJ meniscus. Furthermore, the remodeling process showed deposition of predominantly type I collagen, the density and organization of which resembled those of the native meniscus by the 24-week time point. Ingrowth of calsequestrin-positive skeletal muscle tissue was also observed at the periphery of the remodeled UBM-ECM device and was similar to that found at the attachment site of the native meniscus to the surrounding soft tissues. Histologic results were identical for samples excised from both unilaterally and bilaterally treated animals. No adverse changes in the articulating surfaces of the condyle or fossa were observed in UBM-ECM-implanted joints. In the bilaterally treated animals, the unimplanted control side was characterized by degeneration and pitting of the articulating surfaces of both the condyle and the fossa, with disorganized bands of fibrous connective tissue observed within the joint space.
Results of this study suggest that the UBM-ECM device provides an effective interpositional material while serving as an inductive template for reconstruction of the TMJ meniscus.
研究一种由粉末状猪膀胱细胞外基质（UBM - ECM）包裹在相同材料薄片内构成的装置，作为颞下颌关节（TMJ）半月板重建的支架。
5只犬接受了单侧天然半月板切除术，并用UBM - ECM装置进行替代。分别在3、4、8、12和24周进行尸检。另外2只犬接受双侧半月板切除术，一侧用UBM - ECM装置替代，对侧作为对照保持空缺。对双侧治疗的动物在24周时进行尸检。
宏观上，UBM - ECM植入物迅速重塑，在所有时间点都与新沉积的宿主组织难以区分。微观上，重塑的特征是在早期主要为CD68(+)单核细胞和平滑肌肌动蛋白阳性的成纤维细胞样细胞的密集浸润，随着时间推移变为稀疏的平滑肌肌动蛋白阴性的梭形细胞群体，类似于天然纤维软骨性TMJ半月板的细胞。此外，重塑过程显示主要为I型胶原的沉积，到24周时其密度和组织结构与天然半月板相似。在重塑的UBM - ECM装置周边还观察到钙结合蛋白阳性骨骼肌组织的长入，与天然半月板与周围软组织附着部位的情况相似。从单侧和双侧治疗动物切除的样本的组织学结果相同。在植入UBM - ECM的关节中，髁突或关节窝的关节表面未观察到不良变化。在双侧治疗的动物中，未植入的对照侧表现为髁突和关节窝关节表面的退变和凹陷，关节间隙内可见纤维结缔组织带紊乱。
本研究结果表明，UBM - ECM装置提供了一种有效的插入材料，同时作为TMJ半月板重建的诱导模板。
