短期免疫抑制的外科血管生成可维持兔同种异体膝关节移植的骨活力。
Surgical angiogenesis with short-term immunosuppression maintains bone viability in rabbit allogenic knee joint transplantation.
机构信息
Rochester, Minn.; and Ludwigshafen and Murnau, Germany From the Department of Orthopedic Surgery, Microsurgery Research Laboratory, Mayo Clinic; Department of Hand, Plastic, and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen; and Plastic and Reconstructive Microsurgery, BG Trauma Center Murnau.
出版信息
Plast Reconstr Surg. 2013 Feb;131(2):148e-157e. doi: 10.1097/PRS.0b013e3182789ad4.
BACKGROUND
Vascularized composite allotransplantation has the potential for reconstruction of joint defects but requires lifelong immunosuppression, with substantial risks. This study evaluates an alternative, using surgical angiogenesis from implanted autogenous vessels to maintain viability without long-term immunotherapy.
METHODS
Vascularized knee joints were transplanted from Dutch Belted donors to New Zealand White rabbit recipients. Once positioned and revascularized microsurgically, a recipient-derived superficial inferior epigastric fascial flap and a saphenous arteriovenous bundle were placed within the transplanted femur and tibia, respectively, to develop a neoangiogenic, autogenous circulation. There were 10 transplants in group 1. Group 2 (n = 9) consisted of no-angiogenesis controls with ligated flaps and arteriovenous bundles. Group 3 rabbits (n = 10) were autotransplants with patent implants. Tacrolimus was used for 3 weeks to maintain nutrient flow during angiogenesis. At 16 weeks, the authors assessed bone healing, joint function, bone and cartilage mechanical properties, and histology.
RESULTS
Group 1 allotransplants had more robust angiogenesis, better healing, improved mechanical properties, and better osteocyte viability than ligated controls (group 2). All three groups developed knee joint contractures and arthritic changes. Cartilage thickness and quality were poorer in allograft groups than in autotransplant controls.
CONCLUSIONS
Surgical angiogenesis from implanted autogenous tissue improves bone viability, healing, and material properties in rabbit allogenic knee transplants. However, joint contractures and degenerative changes occurred in all transplants, regardless of antigenicity or blood supply. Experimental studies in a larger animal model with improved methods to maintain joint mobility are needed before the merit of living joint allotransplantation can be judged.
背景
血管化复合组织同种异体移植具有重建关节缺损的潜力，但需要终身免疫抑制，存在很大的风险。本研究评估了一种替代方法，即通过植入的自体血管进行手术血管生成，在不进行长期免疫治疗的情况下维持组织活力。
方法
从荷兰带兔供体向新西兰白兔受体移植血管化膝关节。一旦通过显微外科技术定位和再血管化，将受体来源的腹壁下浅动脉筋膜瓣和隐静脉动静脉束分别放置在移植的股骨和胫骨内，以形成新的血管生成的自体循环。第 1 组有 10 个移植物。第 2 组（n = 9）为无血管生成对照物，带有结扎的皮瓣和动静脉束。第 3 组（n = 10）的兔子进行自体移植，移植体保持通畅。在血管生成期间，使用他克莫司治疗 3 周以维持营养物质的流动。在 16 周时，作者评估了骨愈合、关节功能、骨和软骨力学特性以及组织学。
结果
第 1 组同种异体移植的血管生成更旺盛，愈合更好，力学性能改善，骨细胞活力更高，优于结扎对照组（第 2 组）。三组均发生膝关节挛缩和关节炎变化。同种异体移植组的软骨厚度和质量均较自体移植对照组差。
结论
从植入的自体组织进行手术血管生成可改善兔同种异体膝关节移植的骨活力、愈合和材料特性。然而，无论抗原性或血液供应如何，所有移植物都发生了关节挛缩和退行性变化。在更大的动物模型中进行实验研究，并改进维持关节活动度的方法，这对于判断活体关节同种异体移植的价值是必要的。
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