摘要
目的：探讨人工关节松动的病因。方法：选择７例松动人工髋关节，翻修手术时取松动关节周围的界膜组织；同时选择１０例骨折内固定患者，拆除内固定物时取内固定物周围瘢痕组织。标本做组织学检查和肿瘤坏死因子（ＴＮＦ）测定。选择１０只成年兔，将２０只模拟假体分别置入双侧股骨远端。分别于术后第６、８、１０、１２、１４周向右侧膝关节腔注射聚乙烯微粒悬液，作为实验侧；左侧膝关节腔注射生理盐水，作为对照侧。第１６周取股骨远端标本，做组织学检查。结果：松动人工髋关节周围的界膜组织主要含大量的组织细胞和聚乙烯微粒，而骨折内固定物周围的瘢痕组织主要为纤维成分，无聚乙烯微粒。松动关节周围界膜组织中的ＴＮＦ浓度明显高于骨折内固定物周围的瘢痕组织（Ｐ＜０．０１）。动物实验发现，实验侧模拟假体周围有一层充满组织细胞的纤维结缔组织界膜，并有明显骨吸收和骨溶解现象，而对照侧无明显纤维结缔组织界膜，也无骨破坏现象。结论：人工关节磨损后，产生大量的磨损微粒，微粒刺激组织细胞分泌ＴＮＦ等溶骨性因子，这些溶骨性因子直接或间接地激活破骨细胞，从而引起假体周围骨吸收、骨溶解，最终导致假体松动。假体松动后又可加重磨损，产生更多的微粒。
Objective: To explore the etiological pathogensis of loosening of prosthesis. Methods: Interfacial tissues around loosened prosthesis were harvested from 7 patients, and fibrous tissues around internal fixation devices of fracture were also procured from 10 patients. The specimens were studied histologically and the TNF was determined. Twenty imitative prostheses were implanted into the distal femur of 10 adult rabbits. Polyethylene wear particles were injected into the right knee joint at 6, 8, 10,12 and 14 postoperative weeks. The normal saline was injected into the left knee joints as the control. Sixty weeks later, the rabbits were killed, and distal ends of the femur were taken for examination. Results: There were a large number of histiocytes and polyethylene particles in the interfacial tissues around loosened prostheses. However, fibrous tissus around internal fixation devices of fracture mainly consisted of fibrocytes and a few histiocytes. Levels of TNF were higher in the membrans around loosened prostheses than those in the tissues around the internal fixation devices. In the right knee, there was a layer of fibrous connective tissue filled with numbers of histiocytes around the imitative prosthesis, and the active bone resorption and osteolysis were also found. However,in the control knees, there was a shell of new bone around the imitative prosthesis,and there was no fibrous connective tissue and no evidence of bone resorption. Conclusion: A large quantity of wear particles resulted from repeated abrasion. These wear particles would bring about active bone resorption and osteolysis,which at last results in loosening of the prostheses. Furthermore, abrasion becomes more serious,and more wear particles come into being after loosening.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
1998年第9期518-521,I001,共5页
Chinese Journal of Orthopaedics
基金
江苏省卫生厅基金
