目的：探讨含自体富集骨髓干细胞松质骨移植修复兔关节软骨大面积缺损的生物学特性和效果。方法30只新西兰大白兔用利刀切除股骨髁全层关节软骨达关节软骨表面积的20%以上，制成关节软骨大面积缺损模型。实验组30条膝关节取含自体富集骨髓干细胞松质骨移植修复关节软骨缺损；对照组30条膝关节软骨缺损不作任何处理。于术后4、8、12周分批处死动物取材，分别进行膝关节活动度测定、大体观察、光镜观察，并对观察指标进行统计学分析。结果各观察节点实验组兔膝关节活动度均优于对照组（P<0.01），于术后12周膝关节活动度已基本接近正常。实验组兔膝关节再生软骨的表面积已基本完全填充造模缺损区，而对照组造模区缺损依然严重，仅修复20%左右，两组差异有统计学意义（P<0.01）；实验组再生软骨与周边软骨愈合良好，再生软骨的厚度为周边正常软骨的三分之二左右，表面较光滑平整，无凹陷。电镜下，造模缺损区被再生软骨组织覆盖，表面光滑平整，周围和正常软骨组织接合较好，基质染色变深，软骨细胞数量增多，且大多为透明软骨细胞，可见潮线。结论含自体富集骨髓干细胞松质骨移植能以类透明软骨形式修复兔关节软骨的大面积缺损。%Objective To evaluate the therapeutic efficacy of cancellous bone enriching bone marrow stem cells in treatment of large area defects of articular cartilage in weight-bearing joints. Methods Sixty knees from 30 adult rabbits were randomly divided into experimental and control groups (n=30 in each). Full-thickness articular cartilage defects in the femoral condyle of the knees were created. Cancellous bone enriching bone marrow stem cells was implanted for repair of the defects in experimental group. Spontaneous evolution occurred in control group. Rabbits were sacrificed in both groups at 4,8 and 12 weeks. Range of motion, macroscopic, and histological evaluation were observed. Results The range of motion was better in experimental group than that in control group at any time point (P<0.01); at 12 weeks, the range of motion was almost normal in experimental group. Cancellous bone enriching bone marrow stem cell transplant completely repaired the lesions, but complete repair were not seen in control group(only about 20% lesions were repaired), with a significant difference between two groups(P<0.01). The articular cartilage defect was well healed with regenerated cartilage that was with a 2/3 thickness of normal cartilage with smooth surface. Histological examination also showed a complete repair in the defect by bone marrow stem cell-derived cartilage. Conclusion Cancellous bone enriching bone marrow stem cell implantation can repair large, full-thickness articular cartilage defects by regenerating hyaline-like cartilage.
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