人工髋膝关节置换术后假体翻修原因及周围组织病理学特征

Surgical pathology of revision after knee and hip arthroplasty

目的：观察髋膝关节置换后假体周围组织的病理学特征。方法回顾性分析67例髋膝关节置换后翻修术患者的临床特征及其翻修标本的病理学变化。结果67例患者中男25例，女42例，髋、膝关节置换翻修例数为42∶25，平均年龄64岁，翻修原因中感染20例（29．9％，其中假体植入后＜3个月9例，3～24个月3例，＞24个月8例）、疼痛14例（20．9％）、假体松动13例（19．4％）、关节僵硬9例（13．4％）、假体脱位8例（11．9％）、假体断裂3例（4．5％）。病理学表现主要为假体磨屑肉芽肿、组织细胞反应、急性炎性改变、慢性非特异性炎性改变、色素性绒毛结节性滑膜炎（ PVNS）、“假膜”、钙化、坏死、死骨等，在一个标本内往往几种病变同时存在。结论髋膝关节置换后翻修原因主要为感染、疼痛等；假体周围组织的病理特征为磨屑肉芽肿、慢性非特异性炎性改变、PVNS等。

Objective To investigate clinical characteristics and pathological changes of tissue surrounding prosthesis after hip and knee arthroplasty.Methods A total of 67 patients receiving hip and knee arthroplasty were included in the study and pathological changes of the revision specimens were evaluated by microscopic examination.Results Of 67 patients, there were 25 males and 42 females（ ratio of 0.6） with a mean age of 64 years.There were 42 cases of revision hip prosthesis and 25 cases of knee prosthesis.The primary causes for the revision varied, including 20 cases of infection （ 29.9%, within 3 months in 9 cases,3 to 24 months in 3 cases and over 24 months in 8 cases） , 14 cases of pain （20.9%） , 13 cases of loosening of the prosthesis （19.4%） , 9 cases of joint stiffness （13.4%） , 8 cases of prosthetic dislocation （ 11.9%） , and 3 cases of prosthesis fracture （ 4.5%） .Pathological findings in the tissue surrounding the prostheses included debris reaction, histiocytes, acute inflammatory, chronic non-specific inflammation, pigmented villonodular synovitis （ PVNS ） , “pseudomembranous”, calcification, necrosis, sequestrum, etc.These histological changes were frequently admixed.Conclusions Various reasons may lead to hip and knee revision arthroplasty.The main pathological findings include infection, debris granulomas, chronic non-specific inflammatory changes, PVNS.The surgical pathology of the prosthesis provids guidances for clinical treatment and basic research.