关节腔内注射富血小板血浆联合微骨折介导关节软骨修复的动物实验研究

An Animal Experimental Study on Articular Cartilage Repair Mediated by Serial Platelet-Rich Plasma Intra-Articular Injection Combined with Microfracture

摘要: 目的：探讨关节腔内注射富血小板血浆联合微骨折处理，对新西兰大白兔膝关节全层透明软骨损伤修复的影响。方法：27只成年雄性新西兰大白兔，体重2.5~3.0 kg，建立右膝关节全层透明软骨缺损模型，平均分为3组，分别为：对照组(CTL组，n = 9)、微骨折组(MF组，n = 9)及关节腔内注射富血小板血浆联合微骨折组(MF@PRP组，n = 9)。术后观察动物一般情况，分别于术后4周、8周及12周取兔右膝关节标本，行大体观察、国际软骨修复协会(International Cartilage Repair Society, ICRS)软骨修复评分、Wakitani评分、苏木精–伊红(Hematoxylin-eosin, HE)染色、过碘酸雪夫(Periodic acid Schiff, PAS)染色等检测。结果：所有实验用兔术后均存活。取材后大体观察及组织学检测可见CTL组、MF组及MF@PRP组中兔膝关节全层软骨缺损得到不同程度的修复，组织学检测可见MF@PRP组中全层软骨缺损处再生组织中可见软骨样细胞及软骨基质，CTL组全层软骨缺损处再生组织主要为纤维软骨。造模后8、12周，MF@PRP组中新西兰大白兔ICRS评分均明显优于CTL组、MF组(P < 0.05)。造模后4、8、12周，MF@PRP组中新西兰大白兔Wakitani评分均明显优于CTL组、MF组(P < 0.05)。结论：与单纯微骨折技术相比，关节腔内注射富血小板血浆联合微骨折有利于新西兰大白兔膝关节透明软骨全层缺损修复再生。

Abstract: Purpose: To investigate the effect of intra-articular injection of platelet-rich plasma combined with microfracture treatment on the repair of full-thickness articular cartilage defects of knee joint in New Zealand white rabbits. Methods: A total of 27 New Zealand White rabbits (2.5~3.0 kilograms) were used to establish animal model and randomly divided into 3 groups: a control group (n = 9), a microfracture group (n = 9) and a microfracture combined with platelet-rich plasma group (n = 9). To evaluate the repair of articular cartilage defects, macroscopic and histological assessments were performed at 4, 8 and 12 weeks after surgery via macroscopic evaluation, the International Cartilage Repair Society (ICRS) macroscopic scoring system, Wakitani scoring system, hematoxylin-eosin (HE) staining and periodic acid-Schiff (PAS) staining, respectively. Results: All rabbits survived after operation. The results of macroscopic and histological examination showed that the full-thickness articular cartilage defects of the knee joint of rabbits in CTL group, MF group and MF@PRP group were repaired to varying degrees. The histological examination showed that chondroid cells and cartilage matrix were visible in the regenerated tissue of the full-thickness articular cartilage defect in MF@PRP group, while fibrocartilage was the main regenerated tissue of the full-thickness cartilage defect in CTL group. At 8 and 12 weeks after surgery, ICRS scores of New Zealand white rabbits in MF@PRP group were significantly better than those in CTL group and MF group (P < 0.05). At 4, 8 and 12 weeks after surgery, the Wakitani score of New Zealand white rabbits in MF@PRP group was significantly better than that in CTL group and MF group (P < 0.05). Conclusion: Macroscopic and histological evaluation revealed that microfracture combined with serial platelet-rich plasma injection yields better outcomes for the repair of full-thickness articular cartilage defects than microfracture alone.