电刺激半月板无血区愈合的组织学特征

半月板无血运区的损伤是不能自然愈合的，如何能使半月板无血区愈合已经成为骨科临床上的一大难题。我们根据微电流刺激骨生长的理论，采用自行设计的微量直流电刺激器，用２０只成年杂种狗作为实验动物，在每只狗双后肢膝外侧半月板无血运区造成纵形裂伤，随机分为实验组和对照组。１２周后实验组均出现愈合，自身对照组均未愈合。本文对电刺激半月板愈合光镜、电镜组织学特征进行了观察及讨论，认为半月板无血运区组织细胞并非惰性细胞，它们具备有潜在的再生能力，而电刺激具有诱导软骨细胞分化、增殖作用，并能促进毛细血管趋向性增生和胶原合成及排列。     

自体骨髓基质细胞移植治疗兔膝关节半月板无血运区损伤

目的 观察自体骨髓基质细胞在体内分化为软骨细胞的能力及对半月板无血运区损伤修复的影响。方法 将体外培养的自体骨髓基质细胞收集后与纤维蛋白凝胶混合,植入４０只成年兔一侧膝半月板无血运区损伤的裂口内,另侧设空白对照或单纯纤维蛋白凝胶植放。分别于术后１（１２只）、２（１２只）、３（１５只）个月取村,行肉眼、光镜组织学观察。结果 术后２个月１２个膝半月板损伤处在量的软骨细胞并有胶原纤维形成,３个月１３个膝     

纤维蛋白粘合剂治疗半月板无血运区损伤的实验研究

目的　研究纤维蛋白粘合剂 (FS)对半月板无血运区损伤愈合的作用。　方法　选用健康成年青紫兰兔2 4只 ,首先在兔半月板上造成统一的无血运区损伤模型。随机将兔分成 2组 ,分别为空白对照组、FS治疗组。术后 2周、6周、12周分批处死动物 ,进行大体形态观察和组织学检查。　结果　空白对照组半月板裂口均未见愈合 ,FS治疗组能形成疤痕组织愈合。　结论　应用FS治疗半月板无血运区的损伤是一条有效的治疗途径     

半月板无血运区损伤治疗进展

半月板是维持膝关节内环境的基本结构,半月板损伤后膝关节力学稳定性发生重大变化,常导致早期骨关节炎.半月板再生潜力很小,尤其是半月板无血运区损伤,以往认为不能自然愈合.如何促进半月板无血运区损伤的愈合,一直是骨科医生面临的最具有挑战性的难题之一.该文就半月板无血运区损伤后的愈合特点、传统治疗和目前治疗现状作一综述.     

胫骨平台骨折对半月板愈合影响的实验研究

[目的]胫骨平台骨折常可合并包括半月板在内的膝关节软组织损伤,而骨折的发生对半月板愈合会产生何种影响尚未见报道。本文通过建立胫骨平台骨折合并半月板损伤的动物模型,试图观察骨折引起的膝关节改变对半月板修复产生的影响。[方法]建立12只新西兰兔外侧胫骨平台骨折,以及半月板非全层撕裂伤和打孔缺损模型,设立无骨折对照,12周后通过大体与光镜观察两组半月板损伤模型修复的差异。[结果]在无血运区,无论有无合并平台骨折,半月板损伤均未见任何修复迹象;两组有血运区的半月板撕裂伤均已修复裂隙,与正常组织难以区分;而在半月板外1/3区的打孔缺损模型,仅胫骨平台骨折组可见部分蛋白凝块的填充。[结论]胫骨平台骨折同时合并半月板损伤时,未见骨折阻碍半月板愈合的证据,相反,骨折能促使缺损区域的组织填充,但是否有益于半月板愈合尚有待进一步研究。     

关节软骨和半月板组织碎块移植研究进展

关节软骨和半月板无血运区损伤后不能自然愈合,软骨组织碎块移植为之修复提供了新思路。体外和体内实验研究均证实,关节软骨及半月板无血运区切成碎块后细胞能有效地从碎块组织释放,与周围支架材料复合或直接导致组织修复。自体软骨植入系统（CAIS）及同种畀体幼年关节软骨碎块移植物（DeNovoNT）,已应用于,临床。该文就关节软骨及半月板组织碎块移植的基础研究及临床应用研究及其进展作一综述。     

骨髓基质干细胞复合藻酸钙凝胶修复全层半月板无血运区缺损

目的 观察骨髓基质干细胞复合藻酸钙凝胶注射式修复全层半月板无血运区缺损的效果.方法 2008年6月至2009年2月制造成年山羊半月板前角无血运区全层缺损模型.以自体骨髓基质干细胞复合可注射藻酸钙凝胶修复半月板缺损(Ⅰ组),同时设立单纯载体组(Ⅱ组)和空白对照组(Ⅲ组).术后4、8、16周处死动物,行大体观察,组织学观察、电镜观察和MRI检查并比较修复效果.结果 Ⅰ组缺损完全被修复组织填充,结合紧密,与正常半月板组织相似,在4～16周效果逐渐改善,大体观察优于其他各组.光镜见细胞随凝胶纤维排列分布,载体纤维间隙大多为细胞分泌基质所充填,细胞排列密集,基质分布均匀.透射电镜见Ⅰ组细胞呈软骨细胞样形态,细胞突起较多,细胞器丰富,细胞为不同走向排列的纤维包绕.MRI检查发现Ⅰ组修复效果较好.结论 骨髓基质干细胞复合藻酸钙凝胶注射可有效地修复全层半月板无血运区缺损.     

骨髓基质细胞移植修复半月板无血运区损伤的实验研究

目的比较自体与同种异体骨髓基质细胞移植对半月板无血运区损伤修复的影响。方法 40只成年新西兰大白兔随机平均分为 A、 B两组。 A组兔的骨髓基质细胞 (MSC)经体外培养后与纤维蛋白凝胶 (FG)混合,自体移植于其一侧的膝关节半月板缺损区,即 FG＋自体 MSC（自体移植组）;另一侧单纯植入 FG(FG植入组 )。于 B组兔的一侧膝关节半月板缺损区移植 FG＋同种异体 MSC(异体移植组 ),另一侧缺损不予修复 (空白对照组 )。分别于术后第 1、 2、 3个月取材,观察半月板损伤部位的组织形态学变化。结果 (1)自体移植组 :术后 1个月缺损区可见纤维组织,内有大量成纤维细胞;术后 2个月见大量软骨细胞并有胶原纤维形成;术后 3个月损伤区呈纤维软骨愈合。 (2)空白对照组 :术后 1～ 3个月缺损区始终未愈合。 (3)单纯 FG植入组 :术后 1～ 3个月缺损区可见纤维组织,内有少量成纤维细胞,没有软骨细胞生长,呈瘢痕样愈合。 (4)同种异体移植组 :与自体移植组所见大致相同,但有 3侧缺损区可见大量淋巴细胞浸润,胶原纤维少。结论骨髓基质细胞移植可促进半月板无血运区损伤的愈合,同种异体骨髓基质细胞移植修复半月板无血运区损伤发生免疫排斥反应的机率较低。     

半月板损伤的临床处理及实验研究进展

就半月板损伤的临床处理及实验研究一系统介绍。临床上由过去单一的半月板切除术发展到半月板修复术，部分切除术及本半月板移植术。无血运区的损伤修复取得成功，半月板离体组织培养及可吸收胶原为基本构成材料的半月板假体研究是未来发展方向。     

微量直流电刺激促进软组织伤口修复的研究

作者对微量直流电刺激后能否促进表皮再生进行了实验研究。44只荷兰猪的脊柱两侧各切除直径20mm的全层皮肤,创缘固定,形成直径20mm的组织窗,创口的头尾两侧置电极。一侧伤口接通电流,另一侧不接通。观察10μA、30μA、50μA、和0μA直流电刺激下创口的愈合速度。结果显示:同一个体,直接电刺激侧表皮再生和创口愈合速度快于不直接电刺激侧,且阴极区快于阳极区;不直接电刺激侧创口愈合速度快于不刺激的创口。临床治疗厚断层皮片供区,获较好疗效。     

Free synovium promotes meniscal healing: Synovium, muscle and synthetic mesh compared in dogs

We studied the effect of free synovium on the healing of tears in the avascular portion of the menisci in dogs. A longitudinal incision was made in the medial meniscus. In 35 dogs, a free graft of synovium was inserted into the tear and sutured. In 10 dogs, a free graft of quadriceps muscle was used. In 10 dogs, a Dacron mesh was inserted. In the contralateral knee, the tear was sutured without implantation as a control. 2, 4, 6, 8, and 12 weeks after the operation, the menisci were dissected. 11 of the 35 with free synovium were healed. The menisci with muscle grafts, those with Dacron mesh and those in the control group did not heal. Histology showed that tears were repaired with fibrous tissue. Microangiography showed that capillaries grew from the periphery, but they did not reach the tear.     

Treatment of longitudinal injuries in avascular area of meniscus in dogs by trephination

A study promoting the healing of longitudinal injuries in an avascular area of the meniscus in 21 male dogs is reported. One horizontal hole from the peripheral vasculature to one of the artificial longitudinal injuries to both medial menisci of the knee in each dog was made with a needlelike trephine. The knee joints were not immobilized and the samples were taken 2, 4, 8, 12, and 24 weeks, respectively, after the operation. [3H]Thymidine was injected into the joint cavity 72 h before the sample was taken. Healed lengths were measured, and pathologic examinations and autoradiography were performed. The results showed that all of the injuries treated with trephination were partly or totally healed whereas those in controls were not healed at all, suggesting that trephination may be the procedure of choice for clinic orthopedists dealing with such injuries. By the 8th week, the healed length stopped increasing, the scar tissue began to mature, and the DNA synthesis of the fibroblasts in the granulation tissue and the fibrochondrocytes in the trephined meniscus reduced. It is thought that the fibrochondrocyte of the meniscus and the fibroblast in the granulation might be capable of obtaining the thymidine directly from the synovia of knee joint for their DNA metabolism. Multiplication of the fibrochondrocyte in the injured meniscus was also found.     

Meniscal rasping for repair of meniscal tear in the avascular zone.

We examined experimentally whether a longitudinal tear in the avascular zone of a rabbit meniscus can be healed by meniscal rasping. A full-thickness longitudinal tear 5-mm long was artificially created in the avascular zone of the anterior segment of both medial menisci. Meniscal rasping was then done on the femoral surface of the right meniscus from the parameniscal synovium to the inner segment including the tear. The left meniscus was left without further treatment as control. Two to 4 weeks after surgery, the hypertrophic synovium was observed invading from the parameniscal region to the injured portion. Eight to 16 weeks after surgery, the tear was almost completely healed. In contrast, neither hypertrophy of the synovium covering the tear nor healing was induced in the control meniscus. The mechanical test showed that there was a significant difference in the tensile strength and the stiffness of the injured portion between the rasped meniscus and the control meniscus. Meniscal rasping is easy to do, is effective, and causes few adverse effects with menisci. This procedure may be a treatment option for clinical cases of meniscal tear in the avascular zone for which we have no effective and clinically applicable methods at present, although further investigation is needed before clinical application.     

Experimental study on healing of old tear in the avascular portion of menisci in dogs

32 adult mongrel dogs (male 14, female 18, average weight 16.7 kg) were used to study the healing process of old tear in the avascular portion of the menisci. They were divided into two groups--Control group and repair group which were divided into two subgroups, that is, debrided and undebrided groups. Dogs were sacrificed 2.4 weeks and 4.5 months and one year after repair respectively. Finally results were analysed by means of light and electron microscopy. The following conclusions were drawn: (1) A meniscal tear in the avascular portion would not heal by itself despite some cellular response on the edge of the tear. (2) Tear would not heal after simple vascular access channel procedure. (3)Tear healed with fibrocartilage when vascular access channel with synovial flap implantation was used. Therefore this technique can be considered as an alternative to meniscectomy in the management of torn meniscus clinically. (4) Debridement has a bad effect on the healing process because it makes the tear wider and longer and remove the activated cells. (5) The vascular access channel about one half of the thickness of the peripheral edge of the meniscus does not change the shape of the meniscus.     

Meniscus repair: results of an arthroscopic technique

A prospective study of arthroscopically repaired peripheral meniscal tears in 24 patients (19 men and five women) was initiated in 1983. Two patients were lost to follow-up. Seventeen medial and five lateral tears were followed an average of 29 months (15-42 months) with 17 having clinically apparent healing (77%). Sixteen had ACL tears, 10 of which were stabilized. Thirteen of 16 stable knees healed their menisci (81%), whereas only 4 of 6 unstable knees had healed menisci (67%). Fifteen were acute tears repaired within 2 weeks of injury, and 7 were chronic tears. Four acutely repaired menisci failed. One lateral meniscus tore in the previously sutured site 12 months later, whereas 1 medial meniscus tore 24 months after repair in a new area associated with significant trauma. Repair of a longitudinal peripheral meniscal tear permits salvage of this structure in a high percentage of cases. No serious complications such as peroneal nerve or popliteal vascular damage occurred. Transient saphenous neuropraxia (22%) and posterior portal adhesions (9%) were temporary problems. The procedure is recommended only for the advanced arthroscopist, who is advised first to establish the anatomical relationships clearly by cadaver dissections.     

Free synovium grafting for the repair of the avascular portion of canine knee joint meniscus]

To evaluate the effect of free synovium on repair of avascular portion of the meniscus in the knee, two round full-thickness defects of 2 mm phi were made in the medial menisci of 57 dogs, followed by transplantation of free synovium or blood clots in the holes. Defects with no grafting served as control. Specimens were evaluated histologically at intervals from 1 day to 12 weeks after grafting. The portions of the medial menisci filled with blood clots gradually retracted after surgery and showed no complete repair 6 and 12 weeks after the operation as in the control. In the group which received synovial graft, however, fibrous reparation was observed in 62% of total 13 defects 3 weeks after grafting. Six and 12 weeks after the synovial transplantation, complete reparation by fibrocartilaginous tissue with no signs of tissue retraction was observed in more than 65% of total 17 defects. Therefore, synovial grafting seemed to be a potential method for the repair of the avascular portion of the canine knee joint meniscus.     

Hi-frequency electrical cautery stimulation in the treatment of displaced meniscal tears

This is a preliminary report of four cases of meniscal displaced tears: two bucket handle medial meniscus tears, one complex tear in the avascular zone or lateral meniscus, and one longitudinal full-thickness tear on the lateral meniscus. These tears were treated by applying hi- frequency current stimulation to the tissues and obtaining total meniscal visual healing on a second arthroscopic view after 6 weeks.Arthroscopy 1998 Sep;14(6):566-71     

Effects of abrasion therapy on tears in the avascular region of sheep menisci

This study was designed to test the hypothesis that abrasion of the parameniscal synovium aids healing of a stable tear in the avascular region of the meniscus in a sheep model. In six sheep, a 5-7-mm longitudinal full-thickness tear was made in the avascular inner half of the anterior part of the lateral meniscus. The parameniscal synovium was abraded superiorly and inferiorly from the meniscus periphery to the lesion. Three animals in a control group received identical meniscal tears but no abrasion treatment. A harness prevented weight bearing and maintained the knee fully flexed after surgery. Twelve weeks after the operation, no healing was seen in any tears. Histologic examination revealed in both groups increased numbers of dividing chondrocytes on either side of the tear. In the test group, several layers of fibroblasts, which appeared in two menisci to derive from the upper meniscal surface, were seen covering both cut surfaces of the tear. It is concluded that the distance from the periphery to the defect is too far for abrasion therapy to stimulate sufficient cellular ingrowth to facilitate repair of tears in the avascular region of the meniscus.     

中药胶剂修复半月板损伤的实验研究

目的 观察中药胶剂促进半月板损伤修复的效果,并探讨其作用机理。方法 选用同样条件饲养,体重３ｋｇ左右的健康成年日本大耳白兔８０只,雌雄不拘,每组４０只,均采用左右侧自身对照,侧别由掷币法随机决定。一组动物为空白对照,即一侧半月板裂伤植入中药胶剂,另一侧裂伤不做任何处理;另一组动物为实验对照,即一侧裂伤植入中药胶剂,另一侧裂伤植入物理性状与该中药胶剂相似的明胶。在日本大耳白兔双侧下肢内侧半月板前１／