Burçin ÇELİK, Mehmet KEFELİ, Ömer Serdar BEKDEMİR, Hale ÇELİK KEFELİ, Evin GÜLEN KOÇ

Effects of hyperbaric oxygen treatment on cartilage regeneration:an experimental study

Amaç: Bu deneysel çalışmada bir tavşan modelinde hiperbarikoksijen tedavisinin perikondriyal yatakta bulunan kıkırdakrejenerasyonuna olan muhtemel etkileri değerlendirildi.Çalışmaplanı: Yirmi dört Yeni Zelanda tavşanı, her birinde altıtavşan olmak üzere, dört gruba ayrıldı. Tüm gruplarda, her ikihemitorakstaki üçüncü ve dördüncü kostal kıkırdaklar tamamençıkarıldı. Her iki hemitorakstaki perikondriyal yataklar kapatıldı;ancak sol hemitoraksta, yeniden şekillendirilen kıkırdak greftiyerleştirildi. Grup 1 ve grup 2 kontrol grupları olarak seçildi.Grup 3 ve 4e, cerrahi sonrası bir hafta boyunca günde bir kez2.5 ATA basınç altında hiperbarik oksijen tedavisi uygulandı.Cerrahi sonrası grup 1 ve 3deki tavşanlar ameliyat sonrasıdördüncü haftada ve grup 2 ve 4deki tavşanlar ameliyat sonrasısekizinci haftada sakrifiye edildi. Neokondrogenez ve skar dokuoluşumunu değerlendirmek için, kırık iyileşmesinin histolojikdeğerlendirilmesinden modifiye edilmiş sayısal puanlama sistemikullanıldı. Histopatolojik puanlama, her bir örnek için perikondriyalyataktaki fibröz doku ve kıkırdak miktarına göre yapıldı.Bul gu lar: Sayısal puanlama şemasına göre, grup 4ünsol perikondriyal yataktaki puanı, diğer gruplarlakarşılaştırıldığında, anlamlı olarak yüksekti (p=0.027). Ancak,bu sağ perikondriyal yatakta anlamlı değildi (p=0.063). Gruplararasında yeni oluşan kıkırdak çapları açısından anlamlı birfarka rastlanmadı (p>0.05).Sonuç: Çalışmamız tavşanlarda, cerrahi sonrası hiperbarikoksijen tedavisi uygulamasının pektus deformitelerinindüzeltilmesinden sonra esnek ve stabil bir göğüs duvarı eldeetmek için çok önemli olan, perikondriyal yataktaki kondrogeneziartırdığını gösterdi.

Hiperbarik oksijen tedavisinin kıkırdak rejenerasyonu üzerine etkileri: Deneysel çalışma

Background: This experimental study evaluated possible effectsof hyperbaric oxygen treatment on cartilage regeneration in theperichondrial bed of costal cartilage in a rabbit model. Methods: Twenty-four New Zealand rabbits were divided intofour groups, each of which included six rabbits. The third andfourth costal cartilages in both hemithoraces were excisedtotally in all groups. The perichondrial beds were closed atboth hemithoraces, but reshaped cartilages were implantedinto the left hemithorax. Group 1 and group 2 were selectedas control groups. After surgery, groups 3 and 4 receivedhyperbaric oxygen treatment of 2.5 ATA pressure once a dayfor one week. The rabbits in groups 1 and 3 were sacrificedat the fourth week and in groups 2 and 4 at the eighth weekafter the operation. A numerical scoring scheme modified fromhistological evaluations of fracture healing was used to assess theneochondrogenesis and scar tissue formation. Histopathologicalscoring was made according to the amount of fibrous tissue andcartilage in perichondrial bed for each specimen. Results: According to the numerical scoring scheme, thescore of left perichondrial bed was significantly higher forgroup 4, compared to the other groups (p=0.027). However, itwas not significant in the right perichondrial bed (p=0.063). Thedifferences in the diameter of the newly developed cartilage wasnot significant among the groups (p>0.05). Conclusion: Our study indicated that receiving postoperativehyperbaric oxygen treatment increased the chondrogenesis in theperichondrial bed in rabbits, which is very important to obtaina flexible and stable chest wall after the correction of pectusdeformities.

PDF

___

1. Williams AM, Crabbe DC. Pectus deformities of the anterior chest wall. Paediatr Respir Rev 2003;4:237-42.
2. Shamberger RC, Hendren III WH, Congenital deformities of the chest wall and sternum. In: Pearson FG, Cooper JD, editors. Thoracic Surgery. Philadelphia: Churchill Livingstone; 2002. p. 1351-73.
3. Shamberger RC, Chest wall deformities. In: Shields TW, LoCicero III J, editors. General Thoracic Surgery. Philadelphia: Lippincott Williams Wilkins; 2005. p. 653-81.
4. Kuenzler KA, Stolar CJ. Surgical correction of pectus excavatum. Paediatr Respir Rev 2009;10:7-11.
5. Genc O, Gurkok S, Gözübüyük A, Dakak M, Caylak H, Yücel O. Repair of pectus deformities: experience and outcome in 317 cases. Ann Saudi Med 2006;26:370-4.
6. Chen AC, Lee MS, Lin SS, Pan LC, Ueng SW. Augmentation of osteochondral repair with hyperbaric oxygenation: a rabbit study. J Orthop Surg Res 2010;5:91.
7. Sirin Y, Olgac V, Dogru-Abbasoglu S, Tapul L, Aktas S, Soley S. The influence of hyperbaric oxygen treatment on the healing of experimental defects filled with different bone graft substitutes. Int J Med Sci 2011;8:114-25.
8. Gungor A, Poyrazoglu E, Cincik H, Sali M, Candan H, Ay H. The effectiveness of hyperbaric oxygen treatment in tracheal reconstruction with auricular cartilage grafts (experimental study). Am J Otolaryngol 2003;24:390-4.
9. Gorur R, Hahoglu A, Uzun G, Kutlu A, Turut H, Yiyit N, et al. Effects of hyperbaric oxygen therapy on wound healing after tracheal resection and end-to-end anastomoses in rats: results of early observations. Thorac Cardiovasc Surg 2008;56:359-62.
10. Celik B, Meydan AD, Kefeli M, Gülen EK, Okumus NO. The effects of hyperbaric oxygen treatment on the healing of tracheal anastomosis following irradiation in rats. Thorac Cardiovasc Surg 2010;58:481-5.
11. Wang C, Schwaitzberg S, Berliner E, Zarin DA, Lau J. Hyperbaric oxygen for treating wounds: a systematic review of the literature. Arch Surg 2003;138:272-9.
12. Mills C, Bryson P. The role of hyperbaric oxygen therapy in the treatment of sternal wound infection. Eur J Cardiothorac Surg 2006;30:153-9.
13. Huo MH, Troiano NW, Pelker RR, Gundberg CM, Friedlaender GE. The influence of ibuprofen on fracture repair: biomechanical, biochemical, histologic, and histomorphometric parameters in rats. J Orthop Res 1991;9:383-90.
14. Robicsek F, Watts LT. Surgical correction of pectus excavatum. How did we get here? Where are we going? Thorac Cardiovasc Surg 2011;59:5-14.
15. Meyer WL. Zur chirurgischen Behandlung der angeborenen Trichterbrust. Berl Klin Wschr 1911;84:1563-6.
16. Sauerbruch F. Operative beseitigung der angeborenen Trichter-brust. Deutsch Zeitschr Chirurgie 1931;234:760-4.
17. Ravitch MM. Operative technique of pectus excavatum repair. Ann Surg 1949;129:429-44.
18. Nuss D, Kelly RE Jr, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 1998;33:545-52.
19. Malek MH, Berger DE, Marelich WD, Coburn JW, Beck TW, Housh TJ. Pulmonary function following surgical repair of pectus excavatum: a meta-analysis. Eur J Cardiothorac Surg 2006;30:637-43.
20. Malek MH, Berger DE, Housh TJ, Marelich WD, Coburn JW, Beck TW. Cardiovascular function following surgical repair of pectus excavatum: a metaanalysis. Chest 2006;130:506-16.
21. Martinez D, Juame J, Stein T, Pena A. The effect of costal cartilage resection on chest wall development. Ped Surg Int 1990;5:170-3.
22. Cherng JH, Chang SC, Chen SG, Hsu ML, Hong PD, Teng SC, et al. The effect of hyperbaric oxygen and air on cartilage tissue engineering. Ann Plast Surg 2012;69:650-5.
23. Roughley PJ, Lee ER. Cartilage proteoglycans: structure and potential functions. Microsc Res Tech 1994;28:385-97.
24. Panasyuk A, Frati E, Ribault D, Mitrovic D. Effect of reactive oxygen species on the biosynthesis and structure of newly synthesized proteoglycans. Free Radic Biol Med 1994;16:157-67.
25. Ueng SW, Yuan LJ, Lin SS, Niu CC, Chan YS, Wang IC, et al. Hyperbaric oxygen treatment prevents nitric oxide-induced apoptosis in articular cartilage injury via enhancement of the expression of heat shock protein 70. J Orthop Res 2013;31:376-84.
26. Carlevaro MF, Cermelli S, Cancedda R, Descalzi Cancedda F. Vascular endothelial growth factor (VEGF) in cartilage neovascularization and chondrocyte differentiation: auto- paracrine role during endochondral bone formation. J Cell Sci 2000;113:59-69.
27. Weber TR, Kurkchubasche AG. Operative management of asphyxiating thoracic dystrophy after pectus repair. J Pediatr Surg 1998;33:262-5.
28. Tokat AO, Tastan E, Karasu S, Yucel O, Gamsızkan M, Arslan S, et al. An enhanced method of raapid cartilage healing after costal cartilaage resection. Turk Gogus Kalp Dama 2012;20:323-8.
29. Calik M, Aribas OK, Kanat F. The effect of costal cartilage resection on the chest wall development: a morphometric evaluation. Eur J Cardiothorac Surg 2007;32:756-60.
30. Yuan LJ, Ueng SW, Lin SS, Yeh WL, Yang CY, Lin PY. Attenuation of apoptosis and enhancement of proteoglycan synthesis in rabbit cartilage defects by hyperbaric oxygen treatment are related to the suppression of nitric oxide production. J Orthop Res 2004;22:1126-34.