人工髋关节假体磨损微粒的研究进展

The study progress of wear debris from hip prostheses

回顾近年来关于髋关节假体磨损微粒的研究。聚乙烯微粒的大小在 1μm以下直至 30 0 μm之间 ,金属微粒的大小有相似的发现 ,近期的研究显示 ,这两种微粒绝大多数 <1μm(亚微米 )。而对于骨水泥及陶瓷微粒的大小尚无准确报道 ,一般认为骨水泥微粒相对较大 ,有粒状、杆状、纤维状、不规则状等各种形状。机体对各种微粒的反应非常复杂 ,多种细胞及介质参与这一反应 ,其中的确切机制还不清楚 ,其大体过程为微粒引起巨噬细胞的趋化和吞噬 ,进一步释放各种炎性介质 ,激活成纤维细胞和破骨细胞 ,引起假体周围纤维化和骨质吸收 ;同时还直接抑制成骨细胞的活性 ,引起骨重建的改变。

In this paper, the authors reviewed the study of wear debris from hip prostheses in the last 10 years. The size of ultra high molecular weight polyethylene (UHMWPE) wear debris ranged from 0.5 to 300 μm. The size of metal wear particles was similar as UHMWPE wear debris. The majority of these particles were less than 1 μm in size (submicron). There was a paucity of data on the size and shape of cement and ceramic particulate debris. The majority of cement particles were relatively large. These particles were described as granules, beads, fibrils and so on. The tissue reactions to wear debris are very complex. Many types of cells and inflammatory factors are involved in this biologic effect. It is wildely thought that particulate debris elicits foreign body reactions and macrophages in turn release inflammatory mediators that stimulate osteoclastic bone resorption. These inflammatory factors also activate fibroblasts, and this leads to fibrogenesis around the prosthesis. On the other hand, wear debris inhibit the activity of osteoblasts, and suppress bone formation.