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

Year 2021, Volume: 28 Issue: 4, 663 - 671, 30.12.2021

İsmail Safa Satoğlu Meric Unal İbrahim Çoban Duygu Gürel Alper Gültekin Necmettin Turgut Osman Karaoğlan

https://doi.org/10.17343/sdutfd.830427

Abstract

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.

Keywords

hyalen kıkırdak, kıkırdak rejenerasyonu, kondral defekt, insan amniyotik sıvısı, insan amniyotik membranı

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

Abstract

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.

Keywords

hyaline cartilage, cartilage regeneration, chondral defect, human amniotic fluid, human amniotic membrane

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