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…     

人工关节无菌性松动动物模型研究

社会老龄化使得骨性关节炎频繁发生,需行关节假体置换患者不断增加.作为关节假体置换远期并发症之一的人工关节无菌性松动,始终是临床上存在的问题并亟需解决.该文就人工关节无菌性松动动物模型的动物选择、假体设计、实验方法、模型特点等方面的研究作一简要综述.     

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。     

人工关节无菌性松动的基因治疗

人工关节置换术是治疗各种终末期关节疾病普遍而有效的方法,能极大地改善患者的活动功能及提高病人的生活质量.但是术后出现的假体无菌性松动严重影响了人工假体的使用寿命.目前,对于人工关节无菌性松动的具体原因仍不明确,各种非手术治疗的疗效也并不显著,大多数患者需行翻修手术[1].     

内毒素与人工关节无菌性松动

越来越多的体内外实验提示内毒素在人工关节松动方面起着重要的作用.内毒素与磨损颗粒在很多方面具有相似的作用机制,内毒素可能在磨损颗粒诱导骨溶解的同时发生相互协同作用.该文就内毒素对人工关节无菌性松动的影响作一简要综述.     

趋化因子与人工关节无菌性松动

趋化因子是一类能趋化细胞定向迁移的分泌性蛋白,在多种生理病理过程中起重要作用。在人工关节无菌性松动过程中,趋化因子不仅是人工关节周围炎症反应的主要参与者,还是调节破骨细胞分化成熟的重要因子。深入研究趋化因子与人工关节无菌性松动的关系,有助于为人工关节无菌性松动的防治研究开辟新途径。该文就近年有关趋化因子与人工关节无菌性松动方面的研究作一综述。     

人工关节无菌性松动的防治研究进展

从20世纪60年代初,Charley[1]首先采用低磨损人工髋关节置换术到现在,人们对人工关节无菌性松动的发病机理和防治进行了不懈的探索。大家较一致地认为:微动、应力遮挡等机械性因素,磨损颗粒引起的假体(或骨水泥)、骨界面产生的IL1β、IL6、TNFα、PGE2、MCSF、RANKL[2]、和Casp     

肿瘤坏死因子与人工关节无菌性松动

人工关节无菌性松动是影响关节置换术长期疗效的重要因素.许多研究表明无菌性松动与肿瘤坏死因子的关系密切.肿瘤坏死因子可募集并直接或间接激活破骨细胞,影响其他细胞因子的释放,刺激核因子-κB受体活化因子配体的表达,使成骨细胞凋亡并影响其分泌细胞因子.该文就近年肿瘤坏死因子与人工关节无菌性松动机制的研究进展作一综述.     

磨屑在人工关节无菌性松动中作用的实验研究

目的：观察磨屑在动物体内引起的组织学反应，比较了不同磨屑所致反应差别，比较磨屑在羟基磷灰石涂层钛合金棒－骨界面和光滑钛合金棒－骨界面间移动差别，探讨人工关节无菌性松动机制。方法：６４只家兔分为８组（ｎ＝８），分别将羟基磷灰石涂层钛合金棒和光滑钛合金棒经膝关节置入股骨远端，定期膝关节注入聚乙烯，钛合金及两者的混合磨屑。光镜、偏振光显微镜和电镜观察关节滑膜、两种钛合金棒－骨界面的组织学和超微结构。结果     

骨基质明胶防治人工关节无菌性松动的实验研究

目的：探讨骨基质明胶（ＢＭＧ）防治人工关节无菌性松动的可行性。方法：大白兔４０只,分成２组。行右人工股骨头置换。一组植入ＢＭＧ,另一组不植ＢＭＧ作对照。不同时期作生物力学测定、组织学检查、立体显微摄影、电子探针检查。结果：ＢＭＧ组各时期拔出强度明显高于对照组。ＢＭＧ组人工关节周围成骨速度及量明显高于对照组。结论：ＢＭＧ能防止无菌性桧的发生。     

人工关节置换术后假体无菌性松动的早期诊断

人工关节置换术(TJA)是临床治疗各种终末期关节疾病最为常用且有效的方法,随着手术量的增大,其并发症越来越得到人们的重视,尤其是假体无菌性松动,严重影响了假体的使用寿命,需要进一步行翻修手术。因此,如何提高假体无菌性松动早期诊断的敏感性和特异性,将对评估假体磨损状态、延长假体寿命以及改善患者生活质量有重要意义。在此,本文对人工关节假体无菌性松动的早期诊断进展作一综述。     

Bone-membrane interface in aseptic loosening of total joint arthroplasties

In 19 patients who underwent revision arthroplasty for aseptic loosening of total joint arthroplasty, specimens were taken at the time of operation to include the bone-membrane interface. In 16 (84%) of the specimens, sufficient visualization of the interface was possible to allow histologic interpretation. In 13 of these cases, there was prominent evidence of classic bone remodeling with osteoclastmediated resorption and active new bone formation. These results suggest that the osteolysis in aseptic loosening is mediated through osteoclastic bone resorption and that the bone found in such areas is extremely active. The findings help to explain the efficacy of impacted morselized bone-graft in the treatment of bone lysis in aseptic loosening.     

骨质疏松症对人工关节远期无菌性松动的影响

骨质疏松症（OP）已经成为全球关注的社会健康问题，骨质疏松性髋部骨折是其最严重的并发症之一。人工关节置换术是治疗该并发症最有效的方法之一，它可以显著地提高患者的生存质量。目前全球每年有超过100万套的关节假体被植入，但是该手术后10年时因无菌性松动导致的关节失效翻修累积超过12％。但OP对人工关节置换术的远期无菌性松动是否有影响，如何影响，目前尚不清楚。我们拟从手术方式的选择、人工关节远期无菌性松动的机制和抗0P药物的作用来探讨OP对人工关节置换术后远期无菌性松动的影响。     

人工关节置换术后假体无菌性松动的研究进展

人工关节置换术已经作为骨科的一种标准治疗手段,用于治疗累及关节的骨折、重度骨关节炎、骨肿瘤和先天性关节发育不良等疾病,术后效果较好,但并发症也不容忽视。其中术后假体无菌性松动成为影响患者恢复的最大问题之一。本文主要从机械性因素(假体微动、应力遮挡、高液压等)及生物学因素(磨损颗粒、细胞、分子等)两方面全面阐述了关节置换术后假体发生无菌性松动的影响因素及发生机制。     

Mechanisms of cellular recruitment in aseptic loosening of prosthetic joint implants

The association of macrophages engaged in polymethylmethacrylate (PMMA) particle phagocytosis with pockets of inflammatory cells is a pathognomonic feature of the aseptically loose interface not present at the well-fixed interface. The mechanism by which the presence of PMMA particles leads to cellular recruitment, bone resorption, and ultimate loosening is poorly understood. Granulocyte macrophage colony stimulating factor (GM-CSF) and interleukin 6 (IL-6), cytokines released by osteoblasts, stimulate the recruitment of macrophages into sites of inflammation. We show that exposure of macrophages to PMMA particles stimulated release of tumor necrosis factor (TNF), but no increase in prostaglandin E2 (PGE-2) or interleukin 1. Incubation of osteoblasts with conditioned medium from macrophages exposed to PMMA particles led to release of GMCSF, IL-6, and PGE-2. Incubation of the PMMA/macrophage medium with antibodies to TNF prior to osteoblast exposure inhibited release of GM-CSF, IL-6, and PGE-2 by the osteoblasts. Our data demonstrate that exposure of macrophages to PMMA particles leads to the release of TNF which then stimulates osteoblasts to produce GMCSF, IL-6, and PGE-2. Based upon the results of this study, we propose that the process of cellular recruitment in aseptic loosening is initiated when the mechanical failure of the cement mantle leads to the production of PMMA particles. These particles are phagocytized by macrophages leading to the production of TNF. TNF stimulates surrounding osteoblasts to produce GM-CSF, IL-6, and PGE-2 which leads to recruitment of macrophages and osteoclasts into the area of the bone-cement interface. The recruitment of these cells potentiates this process leading to bone resorption and ultimately, clinical loosening of prosthetic joint implants.     

细胞凋亡与假体无菌性松动

人工关节无菌性松动仍是影响人工关节使用寿命的主要原因.理化性质稳定的各种磨损颗粒与界膜周围的细胞接触或被吞噬后,可出现细胞凋亡甚至细胞坏死.近年许多研究表明,多种细胞凋亡相关途径参与假体无菌性松动的病理过程,假体周围组织中存在的细胞凋亡在假体无菌性松动发生和发展中的作用日益受到重视.该文就细胞凋亡与假体无菌性松动之间的关系,以及病理机制的研究现状作一综述.     

RANK-ligand and osteoprotegerin as biomarkers in the differentiation between periprosthetic joint infection and aseptic prosthesis loosening

AIM To assess serum levels of RANK-ligand(RANKL) and osteoprotegerin(OPG) as biomarkers for periprosthetic joint infection(PJI) and compare their accuracy with standard tests.METHODS One hundred and twenty patients presenting with a painful total knee or hip arthroplasty with indication for surgical revision were included in this prospective clinical trial. Based on standard diagnostics(joint aspirate, microbiological, and histological samples) and Musculoskeletal Infection Society consensus classification,patients were categorized into PJI, aseptic loosening,and control groups. Implant loosening was assessed radiographically and intraoperatively. Preoperative serum samples were collected and analyzed for RANKL, OPG, calcium, phosphate, alkaline phosphatase(AP), and the bone-specific subform of AP(b AP). Statistical analysis was carried out, testing for significant differences between the three groups and between stable and loose implants. RESULTS All three groups were identical in regards to age, gender, and joint distribution. No statistically significant differences in the serum concentration of RANKL(P = 0.16) and OPG(P = 0.45) were found between aseptic loosening and PJI, with a trend towards lower RANKL concentrations and higher OPG concentrations in the PJI group. The RANKL/OPG ratio was significant for the comparison between PJI and non-PJI(P = 0.005). A ratio 60 ruled out PJI in all cases(specificity: 100%, 95%CI: 89, 11% to 100.0%) but only 30% of non-PJI patients crossed this threshold. The positive predictive value remained poor at any cut-off. In the differentiation between stable and loose implants, none of the parameters measured(calcium, phosphate, AP, and b AP) showed a significant difference, and only AP and b AP measurements showed a tendency towards higher values in the loosened group(with P = 0.09 for AP and P = 0.19 for b AP). CONCLUSION Lower RANKL and higher OPG concentrations could be detected in PJI, without statistical significance.