无菌性人工关节翻修术假体周围组织的临床病理及ALVAL评分分析

Clinicopathological and ALVAL score analysis of pseudotumor-like tissue around aseptic joint arthroplasty

目的观察无菌性人工关节翻修术假体周围组织的临床影像学特征、组织学形态、无菌性淋巴细胞为主型血管炎相关病变(ALVAL)评分及磨损颗粒的形态学鉴别。方法收集2015年5月至2018年8月北京积水潭医院122例无菌性人工关节翻修术假体周围组织标本,包括膝关节置换术10例,髋关节置换术112例。患者女性62例,男性60例,年龄29~86岁,平均56岁。对其进行影像学、大体及HE染色组织形态观察并ALVAL评分。对磨损颗粒进行光镜及偏振光镜下形态观察。结果122例无菌性人工关节翻修术假体周围组织依据Compbell-ALVAL评分系统进行评分,评分指标包括滑膜衬覆、组织机化及炎性细胞浸润。其中低评分(0~4)18例;中评分(5~8)101例;高评分(9~10)3例。依据Oxford-ALVAL评分系统仅对炎性细胞浸润进行评分,其中0级56例;1级51例;2级12例;3级3例。Compbell-ALVAL的高评分病例与Oxford-ALVAL评分3级的病例完全吻合。对磨损颗粒的观察发现光镜下金属颗粒呈黑色细颗粒状,聚乙烯颗粒呈针状结晶,骨水泥部分溶解呈空腔状,部分残留呈圆形结晶,可见黑色硫酸钡颗粒混杂其中。偏振光镜下,聚乙烯颗粒呈双折光性,金属及骨水泥颗粒均不折光。结论Compbell-ALVAL评分系统较易对人工关节术后假体周围组织进行全面评估,Oxford-ALVAL评分系统对淋巴细胞反应进行半定量分析,二者在高度淋巴细胞浸润的病例中评分相吻合。磨损颗粒可通过光镜下形态进行鉴别。

Objective To analyze the clinicopathological features of pseudotumor-like tissue around aseptic joint arthroplasty and aseptic lymphocytic vasculitis-associated lesions (ALVAL) scores. The characters of wear granules were observed. Methods Total 122 cases were retrieved from the surgical pathology files between May 2015 and August 2018 in the department of pathology in Beijing Jishuitan Hospital, which included the knee joint arthroplasty (10 cases) and hip arthroplasty (112 cases). There were 62 females and 60 males. Patients′ age ranged from 29 to 86 years (mean 56 years). The pseudotumor-like tissue around aseptic joint arthroplasty were stained with HE and analyzed by two ALVAL score systems. The characters of wear granules were observed by light microscope and polarized light. Results The cohort included 62 females and 60 males. Patients′ age ranged from 29 to 86 years (mean 56 years). Compbell-ALVAL system includes synovial lining,inflammatory infiltrate and tissue organization. The scores were: low (0-4): 18cases;moderate (5-8): 101 cases;high (9-10): 3 cases. Oxford-ALVAL system only evaluated the inflammatory infiltrate,and the scores were:0 grade:56 cases;1 grade:51 cases;2 grade: 12 cases;3 grade:3 cases. Cases with high score in the Compbell-ALVAL system were concordant with the 3 grade of the Oxford-ALVAL system. Under light microscope,the metal particles were small black granules;the polyethylene fibers were needle-like and easily visible in polarized light. The polymethylmethacrylate showed clear spaces because of particle melting. Conclusions The Compbell-ALVAL scoring system is based on the histologic analysis of pseudotumor-like tissue around aseptic joint arthroplasty, and the Oxford-ALVAL scoring systems is based on lymphocytic response. The wear particles could be differentiated by the features in the light microscope.