软骨修复的组织学评估:国际软骨修复学会(ICRS)组织学终点委员会的报告

P. Mainil-Varlet, T. Aigner, M. Brittberg, P. Bullough, A. Hollander, E. Hunziker, R. Kandel, S. Nehrer, K. Pritzker, S. Roberts, E. Stauffer
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引用次数: 568

摘要

身体损伤经常导致组织损伤,包括撕裂伤。修复损伤通常会导致疤痕的形成;完全解剖愈合和真正的再生是罕见的。结缔组织只有在损伤轻微的情况下才会自然愈合。如果损伤较严重,那么只有在手术干预的辅助下,自然才能获得良好的功能效果。这些措施的有效性已经在骨和肌腱损伤的情况下得到了证实,但在软骨损伤的情况下还没有得到证实。在后一种情况下,我们仍然被希波克拉底的观点所偏见,即“普遍认为软骨溃疡是一种麻烦的疾病”。此外,我们的观点必然受到成功治疗方式缺乏的影响。关节软骨是一层狭窄的特化结缔组织,可使腹泻关节平滑、无摩擦地运动。它由相对少量的细胞(软骨细胞)包埋在丰富的细胞外基质中4。后者主要由ii型胶原蛋白、蛋白聚糖和水组成,还有少量的其他胶原蛋白和非胶原蛋白。组织学上,关节软骨分为三个区,以软骨细胞的形状和ii型胶原纤维的排列来区分。浅表区表现为扁平的盘状软骨细胞,蛋白多糖含量低,直径均匀的胶原原纤维密集堆积,水平排列。当关节软骨从软骨下骨中释放出来时,这一层具有弯曲的倾向,因此被描述为抗张力隔膜。在中间区,软骨细胞获得更圆的轮廓,蛋白多糖含量增加,胶原纤维相互交叉,在浅表切向区和深径向区之间提供倾斜的过渡网络。深径向区是…
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Histological Assessment of Cartilage Repair: A Report by the Histology Endpoint Committee of the International Cartilage Repair Society (ICRS)
Physical injury frequently causes tissue damage, including laceration. Repair of the damage usually results in the formation of a scar; complete anatomic healing and true regeneration are rare. Connective tissues tend to heal naturally and successfully only if the injury is minor. If the damage is more severe, then a good functional result can be achieved only if Nature is assisted by surgical intervention. The efficacy of such measures has been established in the cases of bone and tendon injuries but not in the case of cartilage damage 1. In the latter situation, we are still prejudiced by Hippocrates' opinion that "ulcerated cartilage is universally allowed to be a troublesome disease." 2 In addition, our view is necessarily colored by the scarcity of successful therapeutic modalities 3. Articular cartilage is a narrow layer of specialized connective tissue that permits smooth, frictionless movement of diarthrodial joints. It is comprised of a relatively small number of cells (chondrocytes) embedded in an abundant extracellular matrix 4. The latter consists predominantly of type-II collagen, proteoglycans, and water, along with smaller amounts of other collagen types and noncollagenous proteins. Histologically, articular cartilage is divided into three zones, which are distinguished by the shape of the chondrocytes and the arrangement of type-II collagen fibers. The superficial zone is characterized by flattened disc-like chondrocytes, a low proteoglycan content, and densely-packed, horizontally-arranged collagen fibrils of uniform diameter. This layer has been described as a tension-resisting diaphragm 5 by virtue of its tendency to curl when the articular cartilage is released from the subchondral bone 6. In the middle zone, chondrocytes attain a more rounded profile, proteoglycan content increases, and the collagen fibers decussate to provide an oblique transitional network between the superficial tangential zone and the deep radial zone. The deep radial zone is …
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