臺灣博碩士論文加值系統

關節軟骨損傷後自我修補的能力極差，而必須仰賴手術填補、以免進行惡化為退化性關節炎之後遺症。但可供移植使用的自體軟骨來源稀少，必須仰賴生物科技、以組織工程原理產製新生自體軟骨，供做修補所需。此種新生軟骨的建構，主要是將軟骨生成細胞以可分解性生物材料攜帶並固著在軟骨缺損處，令其產製軟骨基質、形成完整軟骨來填補缺損。
親水膠體與固態聚合物是上述生物材料的兩項主要類別，其使用於軟骨損傷修補用途時優劣互見。本研究旨在測試該等材料實用於生體之可行性、效度、以及所生成之新生軟骨品質。研究並以豬建立一標準的動物模式作為一貫之測試平台。研究包括：（一）以明膠微粒貼附軟骨細胞，注射於已經骨膜補丁之軟骨缺損處；（二）聚乳酸固態多孔狀海綿，一部分與磷酸三鈣鹽混合以建構一兩相式骨骼軟骨移植體，直接敷用於軟骨缺損併同其下硬骨處，而免除縫補等固定植體之手續。以上兩種模式，結果都能於軟骨缺損處成功生成透明軟骨，使缺損處得以補平。
本研究並附帶探討此等軟骨損傷修補的臨床可行性。一位罹換解離性骨軟骨炎之病患的膝關節內有一軟骨缺損需要修補，而在該關節內幸運地發現一片可能是脫落下來的軟骨碎片，大小足供修補其缺損。經手術將該碎片縫回缺損部位，六個月後發現已成功癒合並固著於原先缺損處。該發現證實：只要能夠產製合適自體軟骨植體，前述「以新生軟骨修補軟骨損傷」確實可行。

Articular cartilage has very limited ability to repair after damage, and should be replaced surgically to prevent consequential degenerative arthritis. The donor source for autogenous cartilage is extremely short, and regeneration of the cartilage graft by tissue engineering becomes the mainstay in this century. Successful generation of such a tissue depends on chondrogenic cells carried with biodegradable materials to stay at the defect site, where the cell produce extracellular matrix to replace the space.
Hydrogels and solid polymer sponge are the two major categories of such material, both with advantages and shortcomings. This research investigated both these materials to carry chondrogenic cells and generate cartilage at chondral defect. Their efficacy, surgical applicability and quality of generated cartilage were studied. A porcine model was developed as a standard platform to testify all investigated subjects. Research included: (1) Gelatin microsphere was the hydrogel used, and was applied to the defect after patching with periosteum. (2) Polylactic acid sponge partially mixed with beta-tricalcium phosphate was fashioned to a biphasic osteochondral construct to replace the cartilage defect along with the subchondral bone, to avoid additional fixing procedure while applied surgically. In both models, hyaline cartilage successfully generated to replace the space of degraded biomaterial and filled that cartilage defect.
An addendum to this doctoral research was mended to see the clinical relevance of such modern technique of tissue engineering. Cartilage defect in the knee joint of a patient of osteochondritis dissecans was replaced with a piece of autologous cartilage found incidentally in the joint. Satisfactory healing gave evidence that articular cartilage defect can be replaced surgically, providing that an ideal graft can be obtained.

Chapter 1. Diarthrodial joint and cartilage: 6
Chapter 2. Repair of articular cartilage injury: review and prospective: 11
Chapter 3. Repair of porcine articular cartilage defect with autologous chondrocyte transplantation: 22
Chapter 4. Repair of porcine articular cartilage defect with biphasic osteochondral composite: 43
Chapter 5. Clinical relevance: the clinical experience: 68
Chapter 6. Summary and future: 75
References: 78

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