人工髋关节置换术假体固定与骨溶解的研究

Comparative study on the effects of different prothetic wear particles on osteogenesis at the bone-implant interface

目的探讨人工髋关节置换术后假体的固定与骨溶解之间的关系,以减少术后假体无菌性松动。方法选取我院2005年3月~2011年11月人工关节无菌性松动行髋关节翻修术者28例30髋。首次行全髋关节置换术10髋,年龄38~80岁,平均66岁。分别将金属头与金属臼组合、金属头与高分子聚乙烯臼组合、陶瓷头与高分子聚乙烯臼组合、首次行全髋关节置换术者,设为A、B、C、D四组,每组10髋。手术中取假体周围磨损颗粒及周围各组织,组织学观察成骨情况,颗粒分布及其周围的组织细胞学反应。采用计算机图像分析在OLYMPUS-BX51镜下将组织切片分成若干个视野,测量每个视野中小梁骨面积﹙bone area,BA﹚和该视野组织总面积﹙totaltissue area,TTA﹚,并计算BA/TTA比值。所得数据在各处理组间进行比较,以方差分析法作显著性检验﹙a=0.05﹚。结果 A、B、C组与D组之间有显著性差异﹙〈0.05﹚,说明A、B、C组均明显抑制周围网织骨形成,并有以巨噬细胞为主的炎症反应及纤维组织大量增生。结论人工髋关节置换后无菌性松动及假体周围磨损颗粒除可激活巨噬细胞为主的炎症产生骨溶解外,还可抑制网织骨形成。其造成的人工髋关节假体—骨界面骨重建障碍可能是骨吸收增加和骨形成减少协同作用的结果。这可能是磨损颗粒刺激下细胞因子介导的骨—假体界面骨代谢异常在人工髋关节无菌性松动中发挥重要作用的关键所在。

Objective To study the effects of different prosthetic wear particles on osteolysis at the bone-implant interface and to reduce postoperative prosthesis aseptic loosening.Methods The hospital From March 2005 to November 2011,28 cases,30 hip prosthesis aseptic loosening of hip arthroplasty,aged 38 to 80 years,mean 66 years,head of metals and metal mortar mix﹙A﹚,metal head and polyethylene mortar mix﹙B﹚,ceramic head and polyethylene mortar mix﹙C﹚,the first of hip arthroplasty﹙D﹚,groups of 10 hips.Surgery to take and wear particles from periprosthetic tissue surrounding the histological observation of bone conditions,particle size distribution in and around the histological response.Using computer image analysis in the olympus-BX51 microscope,the tissue sections divided into several fields of vision,vision measuring small beam of each bone surface Volume﹙bone area,BA﹚and the vision of the organization of the total area ﹙total tissue area,TTA﹚,and calculate the BA / TTA ratio.The data in each treatment group compared to analysis of variance for significance test ﹙a = 0.05﹚.Results A、B、C group and D group significantly different between ﹙ 〈0.05﹚,shows A、B、C group was significantly inhibited weeks fence woven bone formation,and the macrophage-based inflammation and fibrous tissue proliferated.Conclusions After hip arthroplasty and aseptic loosening around the prosthesis wear particles in addition to activated macrophages produce mainly inflammatory osteolysis,it can also inhibit the reticulated bone formation.Therefore,the result of artificial hip prosthesis-bone interface disorder of bone remodeling may increase bone resorption and bone formation decreased synergy results.This may be stimulated by wear particles and cytokine-mediated bone-implant interface bone metabolism in the aseptic loosening of artificial hip joints play an important role in the key.