人工关节假体周围无菌性松动的发生机制

The mechanism of aseptic loosening around artificial joint prostheses

关节置换手术是关节外科常见的手术方式,是终末期关节疾病最有效的治疗手段,但术后假体周围骨质会因各种生物学因素发生不同程度的溶解,该现象导致的人工假体松动,称为无菌性松动,会极大地影响术后效果。近年来,不同学者提出多种不同观点来阐述其发生机制,例如人工假体材料与骨组织刚度的差异所产生的应力遮挡造成骨代谢的异常,假体在使用过程中产生的磨损颗粒对成骨细胞及破骨细胞代谢的影响,内毒素对骨溶解的影响,植入物造成的免疫应答反应以及个体基因差异性与骨溶解的关系等。本文结合目前的研究成果详细阐述以上各种观点的生物学机制,同时对目前治疗方式存在的问题进行探讨,为后续研究及临床应用提供参考。

Arthroplasty is a common operation in current joint surgery.It is the most effective treatment for end-stage joint diseases.However,postoperative bone around the prosthesis will be happened in the bone tissue around the joint due to various biological factors.This will lead to prosthetic loosening,which is called aseptic loosening,influences the postoperative effect negatively.Based on the previous studies,researchers give different opinions to explain its mechanism,such as the stress shielding produced by the different stiffness between prosthesis and bone tissue on the abnormity of bone metabolism,the effect of wear particles produced by the prosthesis on the metabolism of osteoblast and osteoclasts,the effect of endotoxin on osteolysis,the immune response caused by implants and the relationship between individual genetic differences and osteolysis.This article combines the current research results to elaborate the biological mechanism of the above-mentioned points,and puts forward personal views on the shortcomings of current treatment,which will provide references for follow-up research and clinical appliction.