磨损颗粒对关节假体周围组织的影响

Effects of wear particles on periprosthetic tissues

人工关节置换术是20世纪外科领域最重要的技术创新，目前全髋关节置换已成为治疗髋关节严重创伤和骨病的金标准。全球每年约有150万例患者进行人工关节置换术。人工关节置换术为广大终末期骨关节病的患者解除病痛，并大大提高了生活质量，术后10年优良率达到90％甚至更高。近年来，我国人工关节置换术发展迅猛，置换例数已接近每年20万例。根据世界卫生组织（WTO）估测，到2015年我国骨关节疾病患者将达1．5亿例，其中相当一部分需要接受关节置换术。

Artificial joint replacement is the most important technical innovation in the field of surgery in the 20th century, and at present total hip replacement has become the gold standard in the treatment of severe hip joint trauma and bone diseases. However, with the increase in the number of cases of replacement and the extension of the usage time, the problem of advanced loosening of artificial prostheses has become more and more prominent. Wear particle-mediated osteolysis is a major cause of aseptic loosening of artificial prostheses, but the mechanism is unclear. Circulating blood mononuclear ceils can be activated by wear particles, and also be recruited around the prostheses. While the differentiation and transformation of the mononuclear ceils have begun in the circulation process. At the same time, osteoclast precursor cells will also gather around the foreign body monocytes. The periprosthetic phagocytic cells are stimulated by wear particles of the joint prostheses, and the osteoclast formation and bone resorption are induced by various cytokines that are produced by fibroblast cells. Wear particles not only exist around the prostheses, but also could enter the marrow cavity and further affect the differentiation of bone marrow mesenchymal stem ceils into osteoblasts and the function of osteoblasts. The osteoclast differentiation will be increased and the bone resorption will be enhanced. In the meanwhile, the osteoblast differentiation and mineralization and the bone formation will be inhibited. Wear particles may be swallowed by many cells in the periprosthetic tissues. Finally, a series of biological reactions of the periprosthetic tissues will occur, which are induced by wear particles, with the results of periprosthetic osteolysis. So the occurrence and development of prosthetic failure are mainly caused by the periprosthetic osteolysis that is mediated by various wear particles produced in the prosthetic activities. In the paper, the recent research progress of biological changes of the periprosthetic tissues caused by wear particles are reviewed.