Abdullah Meriç ÜNAL, Necmettin TURGUT, Duygu GÜREL, İsmail Safa SATOĞLU, İbrahim ÇOBAN, Alper GÜLTEKİN, Osman KARAOĞLAN

İNSAN AMNİYOTİK SIVISI VE MEMBRANININ BİR TAVŞAN DİZİ KIKIRDAK DEFEKTİ MODELİNDE KONDRAL İYİLEŞME ÜZERİNE ETKİLERİ

Amaç Artiküler kıkırdağın kısıtlı intrensek iyileşmesi ve tamir kapasitesinin az olması nedeniyle çoğu tedavi metodları ile normal hyalen kıkırdak rejenerasyonu sağlanamamakta ve sonuç olarak osteoartroz gelişebilmektedir. Bu çalışmada insan amniyotik sıvısı ve membranının tavşanlardaki kondral defektlerdeki etkilerini incelemek amaçlanmıştır. Gereç ve Yöntem 32 immatür albino Yeni Zelanda tavşanının 64 dizi bu çalışmaya dahil edildi. Tam kat kıkırdak defektleri tavşanların medial kondillerinin yük taşıma yüzeylerinde cerrahi olarak oluşturuldu. Tavşanlar randomize olarak dört gruba bölündü: ek tedavi verilmeyenler Grup 1, 0,3 ml insan amniyotik sıvısı (İAS) verilenler Grup 2, sadece insan amniyotik membranı (İAM) verilenler Grup 3, hem 0,3 ml İAS hem İAM verilenler Grup 4’ü oluşturdu. Kondiller histopatolojik olarak 4. ve 12. haftalarda modifiye O’Driscoll evreleme skalası ile değerlendirildi. Sonuçlar Mann-Whitney U ve ANOVA testleri ile istatistiksel olarak analiz edildi. Bulgular Gruplar arasında rejenere dokunun kalitesi açısından istatistiksel olarak anlamlı fark bulunmadı (p>0.05). Grupların ortalama sonuçları 12. haftada, 4. hafta sonuçlarından daha kötü olarak saptandı; buna rağmen bu farkın, sadece Grup 1 (sham grubu) ve Grup 4 açısından anlamlı olduğu görüldü (İAS+İAM) (sırasıyla, p=0,007 ve p=0,014). Sonuç Sadece İAS, sadece İAM ve her iki biyomateryalin kombine edildiği tedavi yöntemlerinin hiçbirinde kıkırdak defekt iyileşmesi daha iyi ve kaliteli olmadığı ve birbirlerine de bir üstünlüğü olmadığı görüldü. Bu çalışmada gösterilmiş olan 4. hafta sonuçlarının 12. hafta sonuçlarından daha iyi olmasının çalışmada kullanılan immatür tavşanlardaki intrensek tamir mekanizmasındaki erken rejenerasyon kapasitesinden kaynaklandığını düşünmekteyiz.

THE EFFECTS OF HUMAN AMNIOTIC FLUID AND MEMBRANE ON CHONDRAL HEALING IN A RABBIT KNEE CARTILAGE DEFECT MODEL

Objective Due to the limited intrinsic healing and repair capacity of the articular cartilage, most treatment methods cannot achieve reliable regeneration of normal hyaline cartilage, resulting in early development of osteoarthritis. The purpose of this study was to determine the effects of human amniotic fluid and membrane on chondral defects. Material and Methods Sixty-four knees of 32 immature New Zealand rabbits were included in the study. Full thickness chondral defects were created in the weight-bearing surface of the medial condyles of the rabbits. The rabbits were divided randomly into four groups: no adjunct treatment was given in group 1, 0.3 ml human amniotic fluid (HAF) alone in group 2, human amniotic membrane (HAM) alone in group 3 and both of 0.3 ml HAF and HAM in group 4 was administered. The condyles were histopathologically evaluated at 4th and 12th week using the modified O’Driscoll Grading Scale. Results There were no significant differences in the quality of the regenerated tissue within and between groups (p>0.05). The mean results of groups at the 12th week were worse than results at the 4th week; however, the difference was statistically significant for only the sham group (group 1) and the combined therapy group (group 4) (p=0.007 and p=0.014, respectively). Conclusion HAF alone, HAM alone, and combined administration of both biomaterials neither affected chondral defect healing nor had any differences between each other. Nevertheless, we believe that some early regeneration due to an intrinsic repair mechanism is possible in immature rabbits as this study showed better results at 4th week than those at 12th week, although they are prone to degenerative processes in long-term follow-up. We suggest that a larger sample size in an experimental study would probably display a statistically significant difference when investigating effects of HAF, HAM, or both.

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