Higgins James P, Borumandi Farzad, Bürger Heinz K, Benlidayı Mehmet Emre, Vasilyeva Anna, Sencar Leman, Polat Sait, Gaggl Alexander J
Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria; Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom.
J Hand Surg Am. 2018 Feb;43(2):188.e1-188.e8. doi: 10.1016/j.jhsa.2017.09.014. Epub 2017 Oct 14.
Subchondral perfusion of osteochondral grafts has been shown to be important in preventing long-term cartilage degeneration. In carpal reconstruction, subchondral perfusion from the graft bed is limited. This study's purpose was to compare the histological characteristics of cartilage in osteochondral grafts supported by synovial imbibition alone to cartilage of vascularized osteochondral flaps that have both synovial and vascular pedicle perfusion.
Two adjacent osteochondral segments were harvested on the medial femoral trochlea in domestic 6- to 8-month-old pigs. Each segment measured approximately 12 mm × 15 mm × 17 mm. One segment was maintained on the descending geniculate artery vascular pedicle. The adjacent segment was separated from the pedicle to serve as a nonvascularized graft. A thin layer of methylmethacrylate cement was used to line the harvest site defect to prevent vascular ingrowth to the subsequently replaced specimens. The pigs were maintained on a high-calorie feed and returned to ambulation and full weight-bearing on the surgical legs. The animals were sacrificed after 6 months and the specimens were reharvested, sectioned, and examined. The cartilage was graded by 2 pathologists blinded to the origin of specimens as vascularized flaps or nonvascularized grafts.
All specimens were assigned scores utilizing the International Cartilage Repair Society grading system. Scoring for chondrocyte viability, cartilage surface morphology, and cell and matrix appearance was significantly higher in the vascularized osteochondral group than in the graft group.
When deprived of subchondral perfusion from underlying bone, osteochondral vascularized flaps in an intrasynovial environment demonstrate superior cartilage quality and survival compared with nonvascularized grafts.
In locations in which perfusion from surrounding bone may be limited (ie, proximal scaphoid or proximal lunate reconstruction), articular reconstruction using vascularized osteochondral flaps will yield superior cartilage organization and architecture than nonvascularized osteochondral grafts. The clinical and functional relevance of this finding requires further study.
已证明软骨下灌注对防止骨软骨移植长期软骨退变很重要。在腕关节重建中，来自移植床的软骨下灌注有限。本研究的目的是比较仅由滑膜吸收支持的骨软骨移植中软骨的组织学特征与具有滑膜和血管蒂灌注的带血管蒂骨软骨瓣的软骨组织学特征。
在6至8月龄的家猪内侧股骨滑车处采集两个相邻的骨软骨段。每个段的尺寸约为12毫米×15毫米×17毫米。一段保留在膝降动脉血管蒂上。相邻段与蒂分离作为非血管化移植。用一层薄的甲基丙烯酸甲酯骨水泥衬里采集部位缺损，以防止血管长入随后替换的标本。猪维持高热量饲料喂养，并恢复手术肢体的行走和完全负重。6个月后处死动物，重新采集标本，切片并检查。由2名对标本来源为带血管蒂瓣或非血管化移植不知情的病理学家对软骨进行分级。
所有标本均使用国际软骨修复协会分级系统进行评分。带血管蒂骨软骨组在软骨细胞活力、软骨表面形态以及细胞和基质外观方面的评分显著高于移植组。
在滑膜内环境中，当缺乏来自下方骨的软骨下灌注时，带血管蒂骨软骨瓣与非血管化移植相比，表现出更好的软骨质量和存活率。
在周围骨灌注可能受限的部位（即舟骨近端或月骨近端重建），使用带血管蒂骨软骨瓣进行关节重建将比非血管化骨软骨移植产生更好的软骨组织和结构。这一发现的临床和功能相关性需要进一步研究。
