观察兔关节软骨下骨缺损后行骨水泥＋自体骨或骨水泥＋同种异体骨修复术后不同时间点移植骨组织学变化情况。

选取30只成年健康新西兰大白兔，随机分为自体骨和同种异体骨组，每组各15只。模拟临床骨巨细胞瘤病灶刮除术，建立关节软骨下骨缺损动物模型，分别填充不同材料修复骨缺损。自体骨组填充骨水泥＋自体骨，同种异体骨组填充骨水泥＋同种异体骨，分别于术后4、6、8周取出植入骨。先行大体观察，然后通过HE染色切片观察其组织学变化。两组术后4、6、8周植入骨内成骨细胞和破骨细胞数量比较采用两因素方差分析，组间两两比较采用LSD法。P<0.05为差异有统计学意义。

术后4周自体骨组植入骨骨小梁开始吸收，植骨周围存在部分新生毛细血管和少量中性粒细胞，移植骨与宿主骨相邻的骨基质内可见少量骨细胞和破骨细胞，骨再生现象形成；同种异体骨组植入骨骨小梁未见明显吸收，植骨区可见肉芽组织，骨再生现象不明显。术后6周自体骨组植入骨骨小梁大部分被吸收，骨基质边缘新生毛细血管和新生成骨细胞增多，移植骨周边可见多核破骨细胞和排列不规则的编织骨，为成骨初期；同种异体骨组植入骨可见散在骨小梁及纤维结缔组织包绕死骨，存在溶骨现象，骨基质边缘可见少量新生毛细血管，破骨细胞及成骨细胞数量极少，无编织骨形成。术后第8周自体骨组植入骨骨小梁被吸收，可见大量新生骨、新生毛细血管和板层骨，骨基质边缘有排列较密集的成骨细胞，编织骨较术后6周时体积变小且排列逐步规整；同种异体骨组植入骨周围可见少量新生毛细血管，部分区域钙盐沉积较明显，少量新生骨小梁形成，其周围可见少量成骨细胞和破骨细胞，部分坏死钙化区内有板成骨形成。同种异体骨组术后第4、6、8周成骨细胞数量及术后第4、8周破骨细胞数量均低于自体骨组(P均<0.05)。自体骨组和同种异体骨组术后第6、8周成骨细胞数量均高于术后第4周(P均<0.05)，自体骨组术后第8周成骨细胞数量高于术后第6周(P<0.05)。自体骨组术后第8周破骨细胞数量均高于术后第4、6周(P均<0.05)，同种异体骨组术后第6周破骨细胞数量高于术后第4、8周(P均<0.05)。

关节软骨下骨缺损填充骨水泥＋自体骨较填充骨水泥＋同种异体骨植入骨区骨融合率高，成骨效能较好，术后不同时间点自体骨成骨细胞和破骨细胞表达较同种异体骨活跃。

To observe histological change of autogenous bone or allogeneic bone grafts after subchondral bone defects in New Zealand white rabbits at different time points.

Thirty New Zealand white healthy rabbits were randomy divided into autogenous bone group and allogeneic bone group. To establish subchondral bone defects animal models, clinical giant cell tumor of bone with tumor curettage was simulated. Different materials were filled in the bone defects focus (autogenous bone group was filled with bone cement and autogenous bone, allogeneic bone group was filled with bone cement and allogeneic bone). The bone grafts were got at 4, 6, 8 weeks postoperatively. General observation and histological study were performed respectively. The amount of osteoblast and osteoclast in bone grafts between the two groups was compared, two-way analysis of variance was used to compare the amount of osteoblast and osteoclast between the two groups, least significant difference method was used to compare the amount of osteoblast and osteoclast between any two timepoints in the same group, difference was statistically significant when P<0.05.

At 4 weeks postoperatively in autogenous bone group, bone trabeculas were absorbed and some newly born capillaries and neutrophils were found around bone grafts, a few osteoblasts and osteoclasts were found in bone matrix between bone grafts and host bones; no bone trabeculas were absorbed and just some granulation tissue was found in allogenic bone group. At 6 weeks postoperatively in autogenous bone group, the majority of bone trabeculas were absorbed and more newly born capillaries and neutrophils were found around bone matrix, multinucleated osteoclasts and irregular arrangement woven bones were around bone grafts; while in allogenic bone group, sporadic bone trabeculas were found and sequestrum was surrounded by fibrillar connective tissues, some newly born capillaries were found around bone matrix, osteoblasts and osteoclasts were rare. At 8 weeks postoperatively in autogenous bone group, all the bone trabeculas in bone grafts were absorbed, many new bones, newly born capillaries and lamellar bones could be found, osteoblasts were closely spaced around bone matrix and the woven bones were smaller, also had more regular arrangement; while in allogenic bone group, a few newly born capillaries and bone trabeculas, osteoblasts, osteoclasts and lamellar bones were found, calcium deposition was evident in some regions.

The rate of sacralization and bone formation were higher when subchondral bone defects were filled with bone cement and autogenous bone, and there are more osteoblasts and osteoclasts.