松动的人工髋关节界膜的研究

Related analysis between the interface membrane and loosening prothesis of hip

[目的]通过对松动假体界膜的研究分析人工髋关节松动的原因。[方法]通过对38例人工髋关节翻修术中松动假体周围界膜组织进行肉眼外观、普通光镜及扫描电镜的观察来分析人工髋关节无菌性松动与界膜之间的相关联系。[结果]所有本组38例松动假体周围均充填有薄厚大小不一的界膜组织,多数颜色为暗红色,约1/3的界膜部分有黑色;界膜较厚处质韧类似瘢痕结缔组织,薄处似纤维薄膜。光镜可见较多巨噬细胞和异物巨细胞及磨损微粒;扫描电镜观察可以见到大量的粗细不等排列无序的胶原纤维组织和大小不一分布不均的异物颗粒和骨碎屑,胶原纤维内有成纤维细胞分布。[结论]人工假体与骨空隙的产生导致界膜充填,磨损微粒刺激界膜释放炎性细胞因子导致骨溶解而出现假体松动,如果尽可能地减少活动中产生的磨损碎屑从而减少炎性介质的释放,减少由充填性界膜向溶骨性界膜的转变,就可从生物学的角度降低人工髋关节置换术后松动的发生率。

[ Objective] To study the reason of loosening prothesis by observing the interface membranes harvested during the hip revision operation. [ Method] Thirty eight specimens of interface membranes around the loosening prothesis were harvested from thirty eight patients who underwent the revision of total hip replacement. All the specimens were underwent outer observation,light and scanning electronic microscopic observation. [ Result] All the gap of the loosening prothesis were filled with interface membranes with different thickness. A large number of the foreign pelletand bone pieces were found under scanning electronic microscope. [ Conclusion] Interface membranes growed and filled in the gap between the loosening prothesis and bone（ or bone cement）. The wear debris stimulated the interface membrane to release bone resorption factors which caused the prothesis loosening, and the more loosening, the more large gap appeared, and the more resorption factors released from the interface membranes due to the debris stimulating,which formed vicious circle. Cutting the link of the circle could decrease the loosening rates.