TANER GÜNEŞ, CENGİZ ŞEN, Mehmet ERDEM, Reşid Doğan KÖSEOĞLU, Onuk Nurper FİLİZ

Tam kalınlıkta kıkırdak defektlerinin tedavisinde mikrokırık ve periost transplantasyon tekniklerinin birlikte kullanımı

Amaç: Kıkırdak defekti tedavisinde mikrokırık ve periost transplantasyon teknikleri birlikte kullanılarak tamir kalitesinin artırılması amaçlandı. Çalışma planı: Kırk adet Yeni Zelanda türü olgun tavşanın sağ femoral medial kondillerinin yük binme yüzeyinde 4 mm çapında tam kalınlıkta kıkırdak defekti oluşturuldu. Denekler rastgele yöntemle eşit sayıda dört gruba ayrıldı. Kontrol grubunda sadece defekt yaratılıp, herhangi bir işlem uygulanmadı. İki gruba periost flebi transplantasyonu veya mikrokırık uygulandı. Son grupta ise mikrokırık ve periost flebi birlikte uygulandı. Ameliyat sonrasında tüm tavşanlara iki hafta immobilizasyon uygulandı. Ameliyat sonrası 12. haftada tüm hayvanların yaşamı sonlandırılarak, çıkarılan örnekler ICRS (International Cartilage Repair Society) skalasına, yeni oluşan kıkırdak alanına ve canlı kondrosit sayısına göre değerlendirildi. Sonuçlar: Kombine tedavi grubu, subkondral kemik ölçütü dışında, ICRS skalasının tüm ölçütlerinde (yüzey, matriks, hücre dağılımı, hücre canlılığı, kartilaj mineralizasyonu) diğer gruplara göre anlamlı farklılık gösterdi. Ayrıca, ortalama canlı kondrosit sayısı ve yeni oluşan kıkırdak alanı bu grupta diğer tüm gruplara göre anlamlı derecede yüksek bulundu (p=0.0001). Çıkarımlar: Mikrokırık veya periost flep tekniklerinin tek başına kullanımıyla karşılaştırıldığında, tamir kalitesinde daha belirgin artış meydana getiren kombine tekniğin kıkırdak defektlerinin tedavisinde daha etkin olduğu görünmektedir.

Anahtar Kelimeler:

Modeller, hayvan, Kondrosit, Yenilenme, Kondrogenez, Cerrahi flepler, Tavşanlar, Periost, Kıkırdak, eklem, Yara iyileşmesi

Combination of microfracture and periosteal transplantation techniques for the treatment of full-thickness cartilage defects

Objectives: Microfracture and periosteal transplantation techniques were combined in order to enhance the quality of repair for the treatment of full-thickness cartilage defects. Methods: In 40 mature New Zealand white rabbits, a fullthickness cartilage defect of 4 mm was induced on the weight-bearing surfaces of the medial condyles of the right femur. The rabbits were randomly divided into four groups equal in size. Control animals remained untreated following defect induction. Two groups were either treated with periosteal transplantation or the microfracture technique, while the fourth group underwent combination of the two techniques. All the animals were immobilized for two weeks postoperatively. At the end of 12 weeks, the animals were sacrificed and the specimens were removed for evaluation according to the criteria of the ICRS scale (International Cartilage Repair Society), and with respect to newly regenerated cartilage areas and the number of viable chondrocytes. Results: Specimens treated with the combination of the two techniques exhibited significant differences from the other groups in all criteria of the ICRS scale (surface, matrix, cellular distribution, cell viability, and cartilage mineralization) except for subchondral bone criteria. In addition, the mean number of viable chondrocytes and newly regenerated cartilage areas were the highest in this group (p=0.0001). Conclusion: Due to markedly improved quality of repair, the combination of the microfracture and periosteal flap techniques seems to be more effective than either of the techniques used alone in the treatment of cartilage defects.

Keywords:

Models, Animal, Chondrocytes, Regeneration, Chondrogenesis, Surgical Flaps, Rabbits, Periosteum, Cartilage, Articular, Wound Healing,

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