人工髋关节假体材料磨损性能及其影响因素

目的：比较不同人工髋关节材料的磨损性能,提出预防假体松动的措施。 方法：以 “假体松动,人工髋关节,磨损,磨损颗粒,髋关节假体为中文关键词;以:“prosthesis loosening,hip,wear debris,hip prosthesis” 为英文关键词,采用计算机检索1993-01/2009-10相关文章。纳入与人工髋关节假体的磨损及其影响因素相关的文章;排除重复研究或Meta分析类文章。以28篇文献为主重点进行分析人工髋关节假体材料摩擦磨损性能及其影响因素。 结果：髋关节手术的方法、假体安装的技术及关节负重引起的假体与宿主骨之间的微动等机械性因素可能是人工髋关节假体松动的启动因素,而生物学因素-磨损颗粒可能调节着人工髋关节假体松动的后期过程,因此对机械性和生物学因素的研究可能会揭示人工髋关节假体松动的奥秘。 结论：人工关节磨损产生微小磨损颗粒是人工关节后期松动的关键因素。通过对宿主骨质量的提高及对假体设计和材料的研究进一步深入,可以更好地预防和治疗髋关节假体的松动。     

人工髋关节置换材料的摩擦和损耗影响因素分析

摘要 目的：从材料学及临床应用方面阐述提高人工髋关节假体性能的重要性，为提高人工髋关节置换质量提供依据。 方法：以“人工髋关节，髋关节置换，假体材料，磨损机制，摩擦磨损性能为中文关键词；以:“hip，hip replacement，prosthesis，wear mechanism，friction and wear propertiest”为英文关键词，采用计算机检索1993-01/2009-10相关文章。纳入与有关人工髋关节假体磨损性能的研究相关的文章；排除重复研究或Meta分析类文章。以30篇文献为主重点讨论了提高人工髋关节假体材料性能的重要性。 结果：人工髋关节从设计应用、改进、再应用已成为一种效果非常肯定的治疗手段，但都面临着不同程度的问题，应从改进人工髋关节设计和制造工艺，提高材料的耐磨性与力学性能，增强假体与宿主骨的结合性，减少应力遮挡，寻找新的人工髋关节假体材料等方面来提高置入物与宿主的生物相容性，从而能够更好地延长假体使用寿命。 结论：低磨损型人工髋关节材料是提高治疗质量的重要因素，人工髋关节置换后基础研究的深入和临床长期随访观察，可能提供更合适的假体材料，需要多方向不断探索。 关键词: 人工髋关节；髋关节置换；假体材料；磨损机制；摩擦磨损性能 doi:10.3969/j.issn.1673-8225.2010.21.026     

人工髋关节置换后假体无菌性松动的因素及其防治

目的：通过对近些年关于人工髋关节置换后假体无菌性松动的不同方面最新进展进行汇总、探讨,进一步认识人工髋关节置换后假体无菌性松动。 方法：应用计算机检索中国期刊全文数据库1997-01/2008-12有关人工髋关节置换后假体无菌性松动的相关文章,检索词“人工关节;置换;无菌性松动”。纳入标准: ①人工髋关节置换后假体无菌性松动的诊断标准、生物及机械因素。②人工髋关节置换后假体无菌性松动的治疗、预防。 结果：人工髋关节置换后假体无菌性松动的发病机制较为复杂,其主要原因是磨损颗粒,其次是力学因素,它们共同结果是造成骨吸收、骨溶解,最终导致假体松动。其过程还与许多细胞因子的参与密切相关。针对引起关节假体无菌性松动的发病机制,可以从关节材料、抑制磨损颗粒移动、促进成骨及抑制骨吸收等方面来防治。 结论：人工髋关节置换后假体无菌性松动发病机制较为复杂,是多种因素作用的结果,涉及不同的学科领域。随着各学科的发展,人工髋关节置换后假体无菌性松动将逐步被彻底认识。     

人工髋关节假体材料生物相容性及其临床应用

摘要 目的：评价不同种类髋关节假体材料的性能以及置入体内与宿主的生物相容性，为其在临床上的应用提供参考依据。 方法：以“髋关节，假体，材料，生物相容性，临床应用”为中文关键词，以“hip joint，prosthesis，materials，biocompatibility，clinical application”为英文关键词，采用计算机检索2000-01/2010-07相关文章。纳入与有关生物材料与宿主生物相容性的文章，排除重复研究或Meta分析类文章。以30篇文献为重点，探讨髋关节置换假体材料的种类、性能及临床应用。 结果：金属材料在人工髋关节假体中占有重要的地位，髋关节置换应用最多的是金属关节头和超高分子量聚乙烯髋臼的组合，但存在耐磨损性差、润滑性差的缺点，且抗腐蚀性较差。陶瓷对陶瓷类型的人工髋关节假体材料，具有很强的抗磨损性能和较小的毒性作用及骨整合作用，但是其易碎性仍是需要解决的问题。 结论：理想的假体材料应具有良好生物相容、耐蚀性、耐磨性、耐疲劳性、强韧性好及弹性模量更接近人体皮质骨的特点，这有待于进一步的开发研制。 关键词：髋关节；临床应用；假体；材料；生物相容性 doi:10.3969/j.issn.1673-8225.2010.34.042     

骨水泥型人工全髋置换技术的临床疗效分析

目的：通过文献检索和临床验证评价骨水泥型人工髋关节假体的治疗效果。 方法：以“全髋关节置换,人工假体;骨水泥”为中文关键词,以“total hip replacement,prosthesis,bone cement”为英文关键词,检索维普数据库和Pubmed数据库1998-01/2009-12相关文献。纳入骨水泥型和非骨水泥型人工髋关节临床应用相关文献;排除重复研究或Meta分析类文献。重点对以下问题进行了探讨：①人工关节置换的分类。②骨水泥髋关节假体材料的发展。③骨水泥髋关节假体材料治疗效果和临床验证结果。④股骨距解剖生理特点及髋关节置换操作注意要点。同时对都匀市黔南州人民医院人工全髋关节置换55例采用骨水泥型人工髋关节治疗效果进行了分析。 结果：人工关节置换分为骨水泥型人工髋关节和非骨水泥型人工髋关节。骨水泥型适用于骨质疏松、老年患者。非骨水泥型适用于骨质条件比较好的中青年患者。针对金属与骨水泥界面抗剪强度差问题,第三代骨水泥技术对假体表面粗糙进行了处理,以增加界面抗剪强度,取得了一定的效果。临床验证结果,通过12个月~6年的随访,按Harrisyg评分标准,优39例,良13例,可3例。术后常规予X射线定期复查,出现髋痛3例、假体脱出1例、松动1例、关节脱位1例,无感染和股骨骨折。 结论：随着多种新型骨水泥材料逐渐面世,骨水泥的性能必将更加完善,接近或达到自体骨,有望成为理想的骨替代材料。     

影响人工全髋关节置换稳定性的因素

背景：人工全髋关节置换后出现假体松动的现象较常见，了解影响人工全髋关节稳定性的因素对提高人工全髋关节置换疗效是十分必要的。 目的：总结近年人工全髋关节置换稳定性影响因素的最新研究进展，进一步认识人工全髋关节的稳定性。 方法：应用计算机检索中国期刊全文数据库1997-01/2010-12有关人工髋关节置换后假体无菌性松动的相关文章，检索词“人工关节，置换，稳定性”。检索文献量总计98篇，最终纳入符合标准的文献30篇。 结果与结论：人工全髋关节置换稳定性的影响因素及发病机制较为复杂，其主要原因是力学因素，其次是生物学因素，它们共同结果是造成骨吸收、骨溶解，最终导致假体松动、骨质破坏。其过程还与许多细胞因子的参与密切相关。针对引起人工全髋关节稳定性的影响因素，可以从关节材料、安放角度、抑制磨损颗粒移动、促进成骨及抑制骨吸收等方面来防治。     

人工假体置换后的无菌性松动

背景：人工关节置换后无菌性松动一直是困扰外科医生的难题。 目的：探讨人工假体置换后发生松动的机制,影响因素及假体松动的防治措施。 方法：以“假体松动;发生机制;影响因素;治疗”为中文关键词,以:“Prosthetic loosening,Mechanism,Factors,Treatment” 为英文关键词,采用计算机检索中国期刊全文数据库、PubMed数据库(1993-01/2010-11)相关文章。纳入与假体松动研究及其影响因素和防治研究相关的文章,排除重复研究或Meta分析类文章。 结果与结论：共入选21篇文章进入结果分析。人工关节置换后,在假体-骨界面处的磨损碎屑颗粒以及周围的骨组织细胞相互作用所引起的一系列生物学反应是引起无菌性松动的关键环节,通过对假体设计和材料的改进,提高置换技巧及合理的防治,可以改善关节置换后假体的松动。     

不同材料髋关节假体在髋关节置换中的应用

背景：金属材料、高分子材料和陶瓷材料等制作的人工髋关节关节都已成功应用于临床,产品也已经发展到比较成熟的阶段,但是每种材料依然存在各自的优缺点。 目的：评价不同材料髋关节假体的特点及临床应用。 方法：采用电子检索的方式在万方数据库中检索1999-01/2011-02有关髋关节假体材料的研究,关键词为“髋关节置换”。排除重复研究、普通综述或Meta分析类文章,筛选纳入18篇文献进行评价。 结果与结论：金属材料在髋关节置换中占有重要的地位,目前髋关节置换临床应用最多的是金属关节头和超高分子量聚乙烯髋臼的组合,但金属的弹性模量与人体骨骼相差甚远,导致应力遮挡效应,容易引起假体的疏松和不稳定;生物惰性陶瓷在活体内具有很高的稳定性和很好的机械强度,而生物活性陶瓷具有骨传导的特点以及与活骨整合的性能;复合材料假体因其可调的弹性模量和足够的力学强度,力学性能接近人体骨骼而逐渐被重视。但目前还缺乏生物相容性好、生物力学相容性好的理想假体材料。因此,应从改进人工髋关节设计和制造工艺,提高材料的耐磨性与力学性能,增强假体与宿主骨的结合性,减少应力遮挡,寻找新的人工髋关节假体材料等方面来提高置入物与宿主的生物相容性,从而能够更好地延长假体使用寿命。     

骨水泥型人工髋关节置换后假体柄的无菌性松动：36例翻修标本分析

背景：无菌性松动是骨水泥型人工髋关节置换后失败的主要原因,探讨其发病机制对于预防松动具有重要意义。 目的：通过对髋关节翻修手术中取出的假体柄及骨水泥外壳的磨损进行观察,结合临床及X射线资料,探讨骨水泥型人工髋关节置换后假体柄无菌性松动的机制。 设计、时间及地点：观察性实验,于2002-07/2003-11在美国休斯敦贝勒医学院骨科研究所完成。 对象：选择休斯敦卫理公会医院(Methodist Hospital at Houston)骨科收治的行骨水泥型人工髋关节置换患者36例,男20例,女16例;年龄38~92岁。包括无菌性松动24例,感染10例,脱位1例,骨折1例。 方法：36例髋关节翻修手术中取出的骨水泥型假体柄及完整的骨水泥外壳,利用立体光学显微镜对骨水泥外壳内外两面及假体柄进行观察分析,按照Grone分区记录其表面磨损位置及磨损程度和骨水泥开裂区域。将主要的假体微动模式分为扭转应力,内翻屈曲应力,柄末端应力,柄领应力。 主要观察指标：骨水泥外壳内外两面磨损位置及磨损程度和骨水泥开裂区域,以及与其相匹配假体柄的磨损位置及磨损程度。 结果：除2例外所有假体柄及与其相匹配的骨水泥内面都有磨损,与假体置入时间无明显关联性。全部无菌性松动翻修取出的标本,其骨水泥外壳表面都有抛光区,只有1例非松动翻修取出的标本骨水泥表面有抛光。根据骨水泥外壳表面磨损大于其内面与假体柄间的磨损,推测骨水泥在髓腔中的微动多于骨水泥与假体柄间的微动。无菌性松动翻修取出的标本中13例发生骨水泥开裂,而因其他原因翻修的标本未发生骨水泥开裂。 结论：早期骨水泥开脱及骨水泥与假体柄微动是骨水泥型假体柄普遍存在的特征。骨水泥外壳表面磨损产生的微粒引起骨溶解进一步加速骨水泥表面的磨损。     

全陶瓷型人工髋关节置换治疗股骨头缺血性坏死23例☆

目的：全髋关节置换存在的主要问题是假体无菌性松动，为此许多不同特质的关节假体界面被研究利用，陶瓷对陶瓷型假体就是其中的一种。观察陶瓷-陶瓷人工髋关节置换治疗股骨头缺血性坏死的中短期疗效，并评估其临床应用价值。 方法：于2006-01/2008-12对23例(28髋)采用陶瓷-陶瓷非骨水泥型假体置换治疗的股骨头缺血性坏死患者进行随访，所有关节假体均使用BiCONTACT®全陶瓷关节假体。应用Harris评分标准进行功能评价，应用股骨Gruen与髋臼Delee-Charnly分区方法进行影像学评价。 结果：平均随访28个月。患者Harris评分从置换前平均39.45分提高至置换后平均88.57分，差异具有显著性意义(P < 0.05)。影像学上无明显的假体松动、下沉。 结论：对于股骨头缺血性坏死患者，新型陶瓷-陶瓷假体短期随访置换效果良好，影像学表现无明显松动。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -