松动的人工髋关节界膜的研究

目的：通过对松动假体界膜的研究分析人工髋关节松动的原因。方法：通过对38例人工髋关节翻修术中松动假体周围界膜组织进行肉眼外观、普通光镜及扫描电镜的观察来分析人工髋关节无菌性松动与界膜之间的相关联系。结果：所有本组38例松动假体周围均充填有薄厚大小不一的界膜组织,多数颜色为暗红色,约1／3的界膜部分有黑色;界膜较厚处质韧类似瘢痕结缔组织,薄处似纤维薄膜。光镜可见较多巨噬细胞和异物巨细胞及磨损微粒;扫描电镜观察可以见到大量的粗细不等排列无序的胶原纤维组织和大小不一分布不均的异物颗粒和骨碎屑,胶原纤维内有成纤维细胞分布。结论：人工假体与骨空隙的产生导致界膜充填,磨损微粒刺激界膜释放炎性细胞因子导致骨溶解而出现假体松动,如何尽可能地减少活动中产生的磨损碎屑从而减少炎性介质的释放,减少由充填性界膜向溶骨性界膜的转变,从生物学的角度降低人工髋关节置换术后松动的发生率。     

松动的人工髋关节界膜的研究

[目的] 通过对松动假体界膜的研究分析人工髋关节松动的原因.[方法] 通过对38例人工髋关节翻修术中松动假体周围界膜组织进行肉眼外观、普通光镜及扫描电镜的观察来分析人工髋关节无菌性松动与界膜之间的相关联系.[结果] 所有本组38例松动假体周围均充填有薄厚大小不一的界膜组织,多数颜色为暗红色,约1/3的界膜部分有黑色;界膜较厚处质韧类似瘢痕结缔组织,薄处似纤维薄膜.光镜可见较多巨噬细胞和异物巨细胞及磨损微粒;扫描电镜观察可以见到大量的粗细不等排列无序的胶原纤维组织和大小不一分布不均的异物颗粒和骨碎屑,胶原纤维内有成纤维细胞分布.[结论] 人工假体与骨空隙的产生导致界膜充填,磨损微粒刺激界膜释放炎性细胞因子导致骨溶解而出现假体松动,如果尽可能地减少活动中产生的磨损碎屑从而减少炎性介质的释放,减少由充填性界膜向溶骨性界膜的转变,就可从生物学的角度降低人工髋关节置换术后松动的发生率.     

松动人工髋关节界膜的研究

目的：确定松动人工关节界膜的组织学、超微结构及免疫组化特性，分析假体磨屑对界膜生物学特性的影响。方法：将８例在松动人工关节翻修术中获取的股骨假体－骨间界膜进行光镜、偏振光显微镜、电镜及免疫组化观察。结果：致密纤维结缔组织中有弥温的巨噬细胞及异物巨细胞浸润，纤维母细胞增生，少量淋巴细胞润浸。界膜中和异物巨细胞及巨噬细胞内有大量聚乙烯、骨水泥、金属磨屑。界膜中有大量抗白介素－１β（ＩＬ－１β）抗体染色     

人工关节无菌松动界膜中破骨细胞分化因子受体免疫阳性的多核巨细胞

人工关节置换术后最重要的并发症是假体周围骨溶解导致的假体无菌松动 ,松动的机理还不完全清楚。随着骨代谢研究的进展 ,调节破骨细胞形成和功能的肿瘤坏死因子家族 (ＴＮＦｓ)新成员 :骨保护蛋白 (ＯＰＧ)、破骨细胞分化因子 (ＲＡＮＫＬ)及其受体 (ＲＡＮＫ)相继被发现 ,它们在人工关节置换术后无菌松动中的作用成为人工关节研究的新热点[1] 。本研究拟建立界膜多核巨细胞分离培养法 ,并初步探讨ＲＡＮＫ在多核巨细胞上的表达。1.资料和方法 :(1)界膜多核巨细胞分离培养 :人工髋关节置换术后无菌松动病人的界膜经手术翻修取得。新鲜界膜…     

聚乙烯微粒细胞因子与人工髋关节松动的相关性研究

[目的]研究聚乙烯微粒、细胞因子与人工髋关节松动的相关性.[方法]根据假体的类型及假体中是否含有聚乙烯将38例人工髋关节翻修病例分为3组:全髋置换组、双动头组和一体式单动头组,对各组术中松动假体周围界膜组织进行光镜下炎性细胞计数的半定量分析和肿瘤坏死因子(TNF)的测定,分析人工髋关节无菌性松动与聚乙烯微粒、细胞因子之间的相关关系.[结果]根据Joseph的半定量标准,全髋置换组和双动头组在光镜下界膜中炎症反应程度无显著性差异(P>0.05),而单动头组与另外两组相比炎性细胞反应程度有显著性差异(P<0.05);经统计学分析显示全髋置换组与双动头组界膜中TNF含量无显著性差异(P>0.05),而全髋置换组与单动头组界膜中TNF含量有显著性差异(P<0.05),双动头组与单动头组界膜中TNF含量有显著性差异(P<0.05). [结论]聚乙烯微粒比其他微粒(如金属微粒、水泥微粒等)更可以刺激界膜中巨噬细胞释放更多的溶骨性的细胞因子TNF导致骨溶解加剧,人工关节的材料中尽量不用聚乙烯或改变聚乙烯的特性以减少磨损微粒和其刺激巨噬细胞所释放溶骨性的细胞因子(如TNF)的数量,从生物学角度降低假体松动的发生率.     

聚乙烯微粒、细胞因子与人工髋关节松动的相关性研究

目的：研究聚乙烯微粒、细胞因子与人工髋关节松动的相关性。方法：根据假体的类型及假体中是否含有聚乙烯将38例人工髋关节翻修病例分为三组：全髋置换组和双动头组和一体式单动头组,对各组术中松动假体周围界膜组织进行光镜下炎性细胞计数的半定量分析和肿瘤坏死因子（TNF）的测定,分析人工髋关节无菌性松动与聚Zr烯微粒、细胞因子之间的相关关系。结果：根据Joseph的半定量标准,全髋置换组和双动头组在光镜下界膜中炎症反应程度无显著性差异（P〉0．05）,而单动头组与另外两组相比炎性细胞反应程度有显著性差异（P〈0．05）;经统计学分析显示全髋置换组与双动头组界膜中TNF含量无显著性差异（P〉0．05）,而全髋置换组与单动头组界膜中TNF含量有显著性差异（P〈O．05）,双动头组与单动头组界膜中TNF含量有显著性差异（P〈0．05）。结论：聚乙烯微粒比其他微粒（如金属微粒,水泥微粒等）可以刺激界膜中巨噬细胞释放更多的溶骨性的细胞因子TNF导致骨溶解加剧,人工关节的材料中尽量不用聚乙烯或改变聚乙烯的特性可以减少磨损微粒和其刺激巨噬细胞所释放溶骨性的细胞因子（如TNF）的数量,从生物学角度降低假体松动的发生率。     

T淋巴细胞与人工关节无菌性松动

许多研究都表明人工关节置换术后 ,机体能对假体材料中的钴 (Ｃｏ)、铬 (Ｃｒ)等金属离子或骨水泥单体 (ＭＭＡ)产生Ｔ淋巴细胞介导的迟发性超敏反应[1] 。在松动假体界膜中 ,除了占主要比例的巨噬细胞外 ,还发现不同程度的Ｔ淋巴细胞浸润[1～ 3 ] 。下面就人工关节置换术后Ｔ淋巴细胞的意义及其与人工关节置换术后的骨吸收和假体无菌性松动的关系作一综述。1　人工关节置换术后Ｔ淋巴细胞的意义松动假体周围界膜按形态学可分为三种类型 ,Ⅰ型 :大量的纤维组织 ,散在巨噬细胞和其他细胞 ,几乎没有Ｔ淋巴细胞 ;Ⅱ型 :界膜中有大量的Ｔ淋巴细…     

人工髋关节无菌性松动与骨溶解

无菌性松动是人工髋关节置换术晚期失败的一个主要原因,多表现为骨溶解,其产生机理复杂且有多因素参与。本文从力学因素和生物学因素两方面综述了骨溶解的产生机制,提出通过改进假体设计,提高手术技术以及应用药物减少人工髋关节无菌性松动。     

磨损碎屑与人工全髋关节置换术后晚期松动

磨损碎屑与人工全髋关节置换术后晚期松动曹力马忠泰假体无菌性松动是人工全髋关节置换术后晚期的主要并发症，其严重影响了此类手术的远期效果。Ｓｔａｕｆ〔１〕报告用第一代骨水泥技术（手填式）治疗的病例经平均１０年随访，其松动率为２９％；Ｓｕｔｈｅｒｌａｎｄ等...     

人工关节无菌性松动的生物学防治

人工关节置换术后假体无菌性松动的防治是研究的热点之一。在药物防治研究领域,二膦酸盐类化合物在体内外试验及临床观察方面均证实具有正面效应,有望成为防治无菌性松动的有效药物。非甾体类消炎镇痛药防治无菌性松动的研究呈正反两方面意见,实验研究方面认为其具有正面效应,临床观察方面则认为其可能增加翻修的危险。其他药物如他汀类、大环内脂类抗生素红霉素、血管生成抑制剂沙利度胺、肿瘤坏死因子-α抑制剂己酮可可碱、N-乙酰半胱氨酸等均证实可有效防治假体无菌性松动。基因治疗主要采用腺相关病毒载体、逆转录病毒载体和自杀基因三种方式,研究认为这三种基因治疗方式均可有效防治假体无菌性松动。     

Related Analysis between the Interface Membrane and Loosening Prosthesis of Hip

Objective： To analyze the reason of loosening prosthesis by observing the interface membranes harvested during the hip revision operation. Methods： 28 specimens of interface membrane around the loosening prosthesis were harvested from 28 patients who underwent the revision of total hip replaeement. All the specimens were observed by appearance, light microscope and scanning electronic microscope （SEM）. Results： All the gap around the loosening prothesis were flled with different thickness of interface membranes. The color of the most interface membranes was madder red, and other one third of membranes was black. The thicker membrane was similar to scar connective tissue, the thinner was similar to fiber membrane. A large number of wear debris, macrophage and foreign-body giant cells were found under light microscope. With SEM observation, a large number of different diameter collagen fibra structures looked like scar tissue arranged disorderly in a great mass, different size of foreign particles and bone debris distributed unevenly, and the fibroblast distributed in the collagen fiber. Conclusion： Wear debris is relevant to inflammatory ceils response around the interface membrane of the loosening prosthesis. The wear debris engulfed by macrophage stimulated the interface membrane to release bone resorption factors （such as TNF） which lead to osteolysis, and this was one of the most importment reasons of the prosthesis loosening.     

The role of hereditary hemochromatosis in aseptic loosening following primary total hip arthroplasty.

Hereditary hemochromatosis (HH) results in increased iron absorption and subsequent deposition in tissue. This condition occurs predominantly in individuals of Northern European and Celtic origin with Ireland having one of the highest allele frequencies in the world. This study examines the hypothesis that homozygosity for either the C282Y or H63D mutations in the HFE gene may be associated with aseptic loosening following total hip arthroplasty (THA). Two groups of individuals were screened for the C282Y and H63D mutations associated with HH. Group 1 were individuals who had undergone primary hip arthroplasty and group 2 were individuals who had undergone revision hip arthroplasty for aseptic loosening. Exclusion criteria included rheumatoid or other inflammatory arthropathies and revision due to causes other than aseptic loosening. Significantly more patients in the revision THA group were homozygous for the C282Y genotype (P = 0.014). Aseptic loosening occurred earlier in these patients (P = 0.009), in particular in the patients who had clinical signs of hemochromatosis. No association was seen with the H63D mutation and revision THA. The incidence of HH in the group of primary THA patients was no higher than the background incidence. Patients who require primary THA and who are homozygous for the C282Y mutation have an increased risk of developing aseptic loosening, leading to revision THA. Moreover C282Y homozygosity appears to be associated with earlier aseptic loosening than in individuals without the C282Y mutation.     

阿仑膦酸钠预防比格犬人工假体松动的生物力学研究

目的 探讨阿仑膦酸钠对比格犬人工假体与骨界面间骨强度的影响.方法 选取12只成年比格犬制备人工假体模型,采用随机数字表法分成试验组和对照组,各6只.试验组给予口服阿仑膦酸钠,而对照组给予等量的安慰剂.12周后处死动物,取出含有人工假体的标本,进行生物力学检测.采用两独立样本t检验进行统计学分析.结果 试验组人工假体与骨界面间的拔出强度显著高于对照组,差异有统计学意义（P＜0.05）,试验组人工假体与骨界面间的扭转强度也高于对照组,差异有统计学意义（P＜0.05）.结论 阿仑膦酸钠能够显著增加人工假体与骨界面间的强度,进而预防了比格犬人工假体的松动.这对于预防和治疗人工关节的无菌性松动有好的指导意义.     

全髋关节置换术后聚乙烯内衬磨损的测量及其临床意义

目的以计算机数字化方法计测人工全髋假体二维线性磨损,并探讨磨损程度与长期随访结果的临床相关性。方法利用计算机软件测量股骨头中心相对于髋臼中心的矢量位移,来决定关节面磨损的大小和方向。对 104髋非骨水泥型人工假体进行磨损计测、临床和放射学检查,平均随访时间为 8.4年。结果 14髋股骨或髋臼假体松动,假体松动率为 13.5％。平均线性磨损值为 1.14 mm,磨损率为 0.15 mm/年。聚乙烯磨损与髋臼侧骨溶解及假体松动相关 (P< 0.05)。多因素回归分析未发现磨损和患者年龄、体重、髋杯大小和外展角、活动量水平以及 Harris髋关节评分的相关关系。结论此方法可应用于各种不同设计的人工假体内衬的二维磨损测量。磨损与骨溶解显著相关,并与假体松动互为因果。因此,在进行临床随访、放射学观察的同时,磨损情况也是全面评价全髋置换术临床结果的一个重要指标。     

Reliability of detecting prosthesis/cement interface radiolucencies in total hip arthroplasty.

A laboratory study assessed the reliability of detecting radiolucencies at the prosthesis/cement interface in femoral components for total hip replacement. Radiolucencies (thicknesses = 0.1, 0.3, 0.5 and 0.7 mm) were created by randomly masking non-tip Gruen zones (six per stem) in a group of 72 matte-finish femoral components. Only half of all Gruen zones were masked. The femoral components were reproducibly implanted in composite fiberglass replicate femurs. Anteroposterior and lateral radiographs taken using conventional techniques were then presented to 10 experienced readers, who scored each of 432 non-tip Gruen zones for radiolucency presence or absence. The series-average radiolucency detection rate was 47.1%, with a breakdown of 9.8%, 20.7%, 69.8% and 88.0, for radiolucency thicknesses of 0.1, 0.3, 0.5 and 0.7 mm, respectively. The false positive rate was 7.5%. The findings argue strongly that in many or most instances, initial cement-prosthesis debonding is not reliably detected from conventional plain film radiographs. Radiolucencies of at least 0.7 mm width are necessary to be accurately detectable by most viewers.     

Early loosening of hip replacements: causes, course and diagnosis

Abstract Early loosening of joint implants is largely determinated by a combination of five factors (patient, material, implant design, fixation and operative technique). To preserve bone stock, avoid complex reconstructive surgery, obtain good functional results and relief of pain the indication for revision should be made at an early stage on the basis of the diagnostic trio history, clinical findings, radiography and not delayed unnecessarily. Regular clinical examination and control radiographs following discharge from hospital enable surgeons to recognize early signs of complications. A useful algorithm is radiographs in two planes taken after one, two, and five years and in cases without visible morphological changes and pain also after ten years (cumulative risk of failure <5%). If there is an evidence of one or two radiographic criteria for loosening (sintering, migration, radiolucency, osteolysis) the risk that the implant will fail is increased by 5 to 10 times.     

Role of free radicals in aseptic loosening of hip arthroplasty.

Fibrous pseudocapsule around hip implants is an invariable finding at revision operations and is believed to release inflammatory mediators that stimulate bone resorption. Reactive oxygen species have been proposed to be causative factors in various disorders with tissue fibrosis. We were interested in investigating whether aseptic loosening is connected with high oxidative stress, and in showing the underlying mechanism of periprosthetic fibrosis and its role in loosening. Levels of oxidative stress markers reduced (GSH) and oxidized (GSSG) gluthatione and malondialdehyde (MDA) were assayed in 28 loose hips and in 12 stable hips revised for high rate of wear and osteolysis. Collagen in the periprosthetic tissues was measured as hydroxyproline content. Osteolysis and polyethylene wear were graded. Increased oxidative stress measured by low GSH/GSSG ratio as well as by increased MDA level was established in patients compared to controls. Oxidative stress markers intercorrelated significantly. MDA and both GSH and GSSG levels correlated significantly with hydroxyproline level. Levels of GSSG and MDA were higher in hips with greater polyethylene wear. The results suggest that high oxidative stress may play a role in formation of a fibrous membrane observed at revision of loose hips. The fibrous pseudocapsule is probably related to high intraarticular pressure and expansion of the effective joint space. This study may elicit some aspects of the pathogenesis of aseptic hip loosening and aid in future investigations aiming at prevention of this complication.     

实验性髋关节假体柄-骨接触面积与松动的关系

目的了解不同类型的髋关节假体柄与骨的接触面积,并探讨接触面积的大小与假体松动的关系.方法用尸体股骨15根,分为三组,分别行直柄、弯柄和解剖型假体置换,测量各类型假体的柄-骨接触面积,包括近段内侧面、远段外侧面和总接触面积.结果解剖型假体三个面积(78%,49%,37%)均高于另两种假体;直柄与弯柄假体相比,总的接触面积无明显差别(25%,26%),直柄假体近段内侧接触面积小于弯柄(52%,70%),远段外侧大于弯柄(43%,36%).结论①三种假体的总接触面积均较低,而应力集中的近段内侧和远段外侧接触面积高,有利于负荷向骨的转移.②解剖型假体与骨的配合更好.③直柄假体容易下沉,而弯柄假体容易外翻摆动.