仿体条件下关节假体材料的磨损研究

作者采用国内新研制的十二道关节假体材料磨擦磨损筛选机,在模拟人工关节主要工作参数的条件下,在相当于人工关节工作15.75年的试验时间内,采用微量磨损精确测量方法,评估了现用关节假体材料的耐磨性能,比较了超高分子量聚乙烯(UHMWPE)对磨三种金属材料,Ti-6AI-4V合金,Co-Cr-Mo合金和316L不锈钢的磨损率.在试验过程中,着重阐述了UHMWPE吸水对磨损量测量的影响.试验结果表明,国产UHMWPE具有与国外产品相当的耐磨性能,UHMWPE对磨Ti-6AI-4合金和Co-Cr-Mo合金的磨损率接近.     

全髋关节置换术肢体不等长的原因和预防

目的:探讨全髋关节置换术后下肢不等长的原因及预防的方法。方法:2001年1月￣2003年12月30例全髋置换术的病人,男17例,女13例,通过术前拍摄高质量的骨盆X线片健侧下肢内旋15°,X线球管距离1m,用模板测量髋臼的旋转中心和偏心距,标志出需切除骨距位置。术中采用比较双侧膝关节是否等长来调节股骨颈的截骨距离和选取人工股骨头的颈长(双膝应平衡),来避免下肢的不等长。结果:1995年6月～2000年7月43例肢体不等长的原因有髋臼位置不良、股骨头的旋转中心的外移、股骨距过长或过短、髋关节屈曲内收挛缩。2001年1月￣2003年12月经术前模板测量术中的肢体测量后,肢体延长的只有5例,并且均在0.5￣0.7cm,不超过1cm。使下肢不等长的发生率大大降低。结论:通过术前的测量和术中对比双膝的长度,来决定股骨距的截骨平面和选取假体的颈长,从而使全髋关节置换术后下肢不等长的发生率明显降低。     

保留假体清创治疗人工关节置换后的急性感染

文题释义： 保留假体清创：是用于治疗关节置换后感染的一种方法，主要应用于早期治疗，对于感染的关节只是进行垫片或者内衬的更换，清除关节腔内感染及疑似感染的组织，不取出假体，对患者来说是一种痛苦小、花费少的治疗方法。 人工全膝关节置换：用于治疗重度关节磨损、严重关节畸形的患者，用金属假体代替股骨关节面和胫骨关节面并在关节面之间加聚乙烯衬垫，是近代发展非常快的手术，解决了患者膝关节疼痛，纠正了力线，提高了患者生活质量。 背景：与翻修手术比较，保留假体清创治疗假体周围感染具有创伤小、耗时短、花费低等优势，但是关于保留假体清创的适应证和围术期管理还存在争议。 目的：综述清创保留假体手术应用于假体周围感染的术前适应证、术中操作及术后抗生素应用。 方法：英文文献检索PubMed、Web of Science、Embase、The Cochrane Library数据库，年限为2000至2018年，检索关键词为“total knee arthroplasty、periprosthetic joint infection、Diagnose、treatment”。中文文献检索中国知网、万方数据库，检索年限为2000至2018年，检索关键词为“关节置换术、术后感染、保留假体清创术”。筛选相关文献，统计文献保留假体治疗关节置换后感染的成功率，总结最为准确的诊断标准及治疗最有效的方法经验。 结果与结论：目前关于关节置换后感染的诊断国际上没有统一的标准，有很多组织提出了一些共识和指南，其中Parvizi等综合其他共识和指南提出了新的假体周围感染诊断标准，其敏感性和特异性都较高，得到了大多数人的认可。保留假体清创适用于稳定且固定良好的假体、症状持续时间短、软组织良好且无窦道形成的患者。术中应该彻底清除感染坏死组织及疑似感染的组织，碘伏水浸泡半小时，更换新的垫片，清创完全后对重新消毒铺巾更换一套新的手术工具。术后应根据培养结果联合应用敏感的抗生素，院外口服利福平4个月。保留假体清创是治疗早期急性关节置换后感染的最佳方法，具有患者痛苦小、花费少、接受度高、避免翻修等优势。 ORCID: 0000-0002-2784-1542(徐长波) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程        

人工髋关节假体的设计及界面应力分析

背景：骨正确选择与宿主相容性良好的假体是保证全髋关节置换成功的重要因素,与置换后人工关节的生物力学性能和使用寿命有着密切的关系。 目的：总结人工髋关节假体的研究进展,分析人工髋关节假体设计与界面力学对假体植入后生物相容的影响。 方法：采用电子检索的方式在万方数据库中检索2000-01/2011-12有关髋关节假体材料及人工髋关节置换先关的研究,关键词为“髋关节、假体、置换、生物力学”。排除重复研究、普通综述或Meta分析类文章。 结果与结论：共纳入34篇文献进行评价。全髋关节置换后人工关节的生物力学性能与使用寿命有着密切的关系,假体受力可以分解为正应力和剪切应力两部分,正应力有益于假体的固定和力的传递,而剪切力会导致假体松动。假体周围骨质及骨量的变化,假体松动、脱位,假体周围骨折,材料磨损及假体周围感染是髋关节置换后影响中远期效果的常见并发症。目前还缺乏生物相容性好、生物力学相容性好的理想假体,人工髋关节设计、制造工艺、假体材料的耐磨性与界面应力等生物力学性能均有待于进一步提高,从而更好地适应宿主。     

三组件式全踝关节置换假体的设计及应用现状

背景:早期的全踝关节置换假体,由于对踝关节生物力学的认识不足,较高的置入失败率和并发症发生率使得外科医生放弃了这种治疗方案。随着踝关节假体设计理念的不断更新,全踝关节置换越来越受到外科医生的青睐。目前,三组件式全踝关节置换假体被认为更符合正常踝关节生物力学的要求,并且被逐步推广应用于临床。目的:了解踝关节生物力学,总结3种三组件式全踝关节置换假体的设计特点,为进一步的假体设计总结经验。方法:由第一作者应用计算机检索CNKI、Pub Med等数据库建库至2020年2月有关全踝关节置换假体的文献,中文检索词为"全踝关节置换假体设计,STAR假体,HINTEGRA假体,BOX假体",英文检索词为"Total ankle replacement prosthesis design,STAR prosthesis,HINTEGRA prosthesis,BOX prosthesis"。结果与结论:(1)STAR假体、HINTEGRA假体、BOX假体在临床应用中表现出了可接受的生存率及临床结果,但仍然需要大量病例和长时间的随访进行验证;(2)3种全踝关节置换假体的设计都着重于恢复生理踝关节的解剖结构,再现踝关节的运动轴,兼容韧带的几何形状、减少踝关节周围组织的应力和机械对准;(3)要实现最大化的韧带兼容,假体组件的关节面设计必须是2个生理解剖形状或2个非生理解剖形状的关节面;(4)国人踝关节的形态和高加索人踝关节的形态有差异,期待设计研发符合国人踝关节要求的假体。     

关节滑液检测在关节假体周围感染诊断中的研究进展

关节假体周围感染(periprosthetic joint infection,PJI)是人工关节置换术后可能发生的一种严重并发症,其导致的严重后果,无论对于医生还是患者来说,都很难接受。目前,由于多种不确定因素的存在,PJI诊断的准确性较低。传统的血清学检查、影像学检查有一定的价值,但是易受全身情况的影响,导致特异性不高。为了正确诊断关节假体周围感染,不同学科的研究人员采用各种不同的方法进行了大量的诊断研究,并取得了丰富的成果。近年来,关节滑液炎性标志物检测、分子生物学方法等被研究证实具有较高的敏感性和特异性。因此,关节滑液CRP、-防御素、白细胞酯酶、PCR技术等被广泛研究,期望能从中找到诊断关节假体周围感染的特异性指标,提高临床诊断的准确性。     

人工髋关节翻修手术时机的探讨

目的　探讨人工全髋关节翻修术的疗效和手术时机 .方法　对因人工髋关节松动而行翻修术患者 6例 ,手术前后Harris评分 .结果　翻修术后Harris评分较术前增加 2 8分 .结论　术前人工假体周围骨溶解程度轻 ,术后优良率高 .人工髋关节髋臼边缘和股骨近端出现假体周围骨溶解者可选择清除骨溶解区域纤维肉芽组织和植骨术式 ,推迟全髋翻修的时间     

高屈曲型与普通型假体人工全膝关节置换后的早期功能恢复比较

背景：高屈型假体理论上优于普通型假体,尤其是在置入后关节屈曲度方面。 目的：评价高屈曲型与普通型假体单侧人工全膝关节置换后早期的功能康复之间的差异。 方法：回顾性对照分析新疆医科大学第四附属医院骨科中心初次行人工全膝关节置换的133例患者141膝,植入假体分别为高屈曲型与普通型,比较两组患者置入后疗效。 结果与结论：置入后高屈组1例发生一过性腓总神经麻痹,1例置入后切口愈合不良,42 例44 膝获随访,失访2例3膝,随访12~19个月;普通型2例发生切口愈合不良,1例浅静脉血栓,86例91膝获随访,失访3例3膝,随访12~23 个月。置入后1年两组HSS 评分、疼痛评分、肌力评级比较,差异无显著性意义(P > 0.05)。高屈曲型在活动度、屈曲挛缩度方面优于普通型(P < 0.05)。说明高屈曲型假体单侧人工全膝关节置换早期在关节活动范围和屈曲挛缩度方面评分优于普通型。     

关节置换后外周血白细胞中Toll样受体4和9的表达

背景：目前对关节置换后机体内Toll样受体变化和相关机制研究甚少,有研究证实全髋关节置换后松动假体表面生物膜中表达Toll样受体。 目的：观察关节假体置入后Toll样受体4,9在关节置换者外周血白细胞上的表达。 方法：实验组选择11例行关节置换患者,对照组为10例行关节镜检查患者,于入院次日和术后第3天早晨空腹采血,流式细胞术分析外周血白细胞中Toll样受体4,9的阳性表达,同时送血样至检验科检查白细胞计数、血细胞沉降率、C-反应蛋白水平。 结果与结论：两组白细胞计数、血细胞沉降率、C-反应蛋白均在正常范围内。Toll样受体4,9均主要表达于外周血单核细胞,而在外周血淋巴细胞和中性粒细胞的表达率较低;两组患者干预后Toll样受体4,9在外周血单核细胞阳性表达率较置换前明显降低(P > 0.05)。实验组患者Toll样受体9置换前后外周血单核细胞阳性表达率的变化明显大于关节镜组(P < 0.05);而Toll样受体4变化差异无显著性意义(P > 0.05)。说明在无感染的情况下,手术本身的应激和局部损伤不影响Toll样受体4,9的表达,假体置入则下调外周血白细胞对Toll样受体9的表达。     

假体置入患者外周血白细胞Toll样受体2和4的表达

背景：研究证实全髋关节置换后松动假体表面生物膜中表达Toll样受体,但其变化规律尚不清楚。 目的：观察关节假体置入患者外周血白细胞Toll样受体2,4的表达。 方法：选择关节置换患者和同期10例行关节镜检查患者,于入院次日和假体置入后第3天早晨空腹抽取肘静脉血,流式细胞术分析外周血白细胞中Toll样受体2和Toll样受体4的阳性表达,同时送血样至检验科检查白细胞、血沉、C-反应蛋白水平。 结果与结论：两组白细胞、血沉、C-反应蛋白均在正常范围内。Toll样受体2,4均主要表达于外周血单核细胞,而在外周血淋巴细胞和中性粒细胞的表达率较低;关节置换组术后外周血单核细胞Toll样受体2阳性表达率明显低于术前(P < 0.05);关节置换组Toll样受体4、关节镜组Toll样受体2,4手术前后阳性表达率差异无显著性意义(P > 0.05)。关节置换组手术前后外周血单核细胞Toll样受体2阳性表达率低于关节镜组(P < 0.05),两组Toll样受体4表达率无差异。提示在无感染的情况下,手术本身应激和局部损伤不影响Toll样受体2,4的表达,假体的置入下调了外周血Toll样受体2的表达。     

Some new studies of the wear behavior of ultrahigh molecular weight polyethylene.

The wear rate of ultrahigh molecular weight (UHMW) polyethylene over a long campaign of sliding distance is not constant. Both unfilled and graphite filled polyethylene show a high rate early, which reduces to a low value. The graphite-filled product shows a late stage increase in wear rate. Increased molding temperature reduces the molecular weight and increases the wear rate. Titanium articulating with UHMW polyethylene develops frequently an abnormally high wear rate with the generation of a black wear product.     

A quantitative study of the tissue reaction and its relationship to debris production from a joint implant.

An attempt has been made to refine the quantitative evaluation of the tissue response to a prosthesis using the goat hip as an experimental model. Total joint replacement was performed in six goats; in three the cup was made of conventional ultrahigh molecular weight polyethylene and in three a new silane cross-linked ultrahigh molecular weight polyethylene was used. The pseudocapsule of the hips was examined histologically at 15, 19 and 24 months following surgery. Small and large polyethylene debris were visualized using semi-crossed polars and were counted. Giant cells were counted after staining with toluidine blue as were macrophages which were identified by dense staining after the acid phosphatase reaction. The amount of small birefringent debris was closely related to the number of macrophages in the pseudocapsule. This method of assessment may be helpful in comparing the tissue reaction of different polymers.     

人工关节磨屑的提取及表征

背景：磨屑引起生物学反应从而导致人工关节的无菌性松动是假体失效的主要原因,因此获取人工关节磨屑研究其生物学反应对提高人工关节寿命有重要意义。 目的：获取纳米级人工关节磨损磨屑,进一步研究生物学反应。 方法：通过酸消化法和酶降解法获取人工关节磨屑,比较其分离效果,并获取不同尺寸的粒子,观察纳米粒子的形态。 结论与结论：①全髋关节模拟试验机运转循环次数对超高相对分子质量聚乙烯磨屑大小、形貌有一定的影响。②磨屑粒径分布范围很广,大到100 μm以上,小到小于1 μm。③从消化方法上来看,酶消化和酸消化法分离超高相对分子质量聚乙烯磨屑有效可行。     

Development of Acetabular Component for Endoprosthesis of Hip and Knee Joints

The acetabular component for an endoprosthesis of the hip and knee joints was developed based on hydroxyapatite and ultrahigh molecular weight polyethylene. The results of the physicomechanical and tribological tests of the materials allowed the composition of the material to be optimized. Toxicological tests revealed biocompatibility of such materials. Neither toxic nor mutagenic effect was observed. Thus, the prosthesis composed of 50 mass % filler can be recommended.     

Comparison of medical-grade ultrahigh molecular weight polyethylene microstructure by atomic force microscopy and transmission electron microscopy

Atomic force microscopy is used to image the topography of surfaces of bulk medical-grade ultrahigh molecular weight polyethylene (UHMWPE). Comparison with transmission electron microscopy images demonstrates that the AFM can resolve the plate-like stacks of crystalline lamellae characteristic of UHMWPE without aggressive surface treatment. Surface preparation for the AFM must be carried out by cryomicrotomy at extremely low temperatures to prevent smearing of surface features. Chemically-etched surfaces of UHMWPE require substantially less surface preparation for AFM imaging.     

New prospects for a prolonged functional life-span of artificial hip joints by using the material combination polyethylene/aluminium oxide ceramin/metal

Investigations over the years have shown that the mirror-finished Al2O3 ceramic is a much more suitable frictional counterpart to ultrahigh molecular weight (UHMW) polyethylene than metal. Despite the extremely gread hardness difference between polyethylene and Al2O3 ceramic, a considerable lower wear rate is obtained for the polyethylene socked with this new low-friction material combination. The unexpectedly favorable tribological behavior of this ceramic material in contact with polyethylene may be attributed to the following factors: better values for corrosion resistance characteristics, wettability with liquids, surfact gloss, hardness, and scratch resistance of the ceramic material in comparison with those of the hitherto used metallic implant materials (AISI-316L steel or cast Co-Cr-Mo alloy). It appears that, by using this new combination of materials for the socket and the ball, it will be possible to prolong the service life of artificial hip joints considerably without having effecy any fundamental changes in the present design and implantation principle retaining the hitherto used anchorage shaft made of wrought Co-Ni-Cr-Mo-Ti alloy Protasul-10 of extremely high corrosion fatigue strength.     

Continuous intramedullary polymer particle infusion using a murine femoral explant model

In vitro models are important investigative tools in understanding the biological processes involved in wear-particle-induced chronic inflammation and periprosthetic osteolysis. In the clinical scenario, particles are produced and delivered continuously over extended periods of time. Previously, we quantified the delivery of both polystyrene and polyethylene particles over 2- and 4-week time periods using osmotic pumps and collection tubes. In the present study, we used explanted mice femora in organ culture and showed that continuous intramedullary delivery of submicron-sized polymer particles using osmotic pumps is feasible. Furthermore, infusion of 2.60 x 10(11) particles per mL (intermediate concentration) of ultrahigh molecular weight polyethylene (UHMWPE) for 2 weeks and 8.06 x 10(11) particles per mL (high concentration) UHMWPE for 4 weeks both yielded significantly higher scores for bone loss when compared with controls in which only mouse serum was infused.     

Ultrahigh molecular weight polyethylene free volume hole structure studied by positron annihilation lifetime technique

The positron annihilation lifetime technique has been used to study the structure of three types of ultrahigh molecular weight polyethylene, obtained via different supported catalyst systems and hence having different molecular weights and degree of crystallinity. Pores with two different mean radii, about 1.8 Å and 3.3 Å, were observed in the studied samples. A comparison between positron annihilation and wide angle X‐ray scattering and microhardness measurements has been made. There are evidences that crystalline phase contributes to o‐Ps formation. The existence of a shorter long‐lived component τ₃ is explained by the latter fact.     

Fluid sorption of orthopedic grade ultrahigh molecular weight polyethylene in a serum environment is affected by the surface area and sterilization method

It is shown in this work that lubricant sorption in ultrahigh molecular weight polyethylene (UHMWPE) increases with available surface area of the component. This has clinical relevance, because sliding and articulation experienced in simulator studies can result in changes in surface roughness and the creation of new surfaces. This study compares the fluid sorption of orthopedic grade UHMWPE with different surface areas (but equivalent volume) for different sterilization methods. For both the gamma radiation and nonsterile control samples, the gain in total fluid absorbed scaled proportionately with surface area. For the EtO sterilization treatment, the fluid gain was nonlinear and substantially less than the radiated and control groups. The findings from this study clearly indicate that the sterilization and surface area affect the fluid uptake and weight gain of UHMWPE.     

Plasma immersion ion implantation treatment of polyethylene for enhanced binding of active horseradish peroxidase

Robust attachment of active proteins to synthetic surfaces underpins the development of biosensors and protein arrays. This paper presents the results of experiments in which energetic ions, extracted from an inductively coupled nitrogen plasma, are used to modify the surface of ultrahigh molecular weight polyethylene (UHMWPE). The ability of the surface to bind active horseradish peroxidase (HRP) is significantly enhanced by the plasma treatment. The amide signal in infrared spectroscopy indicates an increased quantity of surface-attached protein on the modified surface. The activity of the bound HRP remains high compared with that of protein attached to the untreated surface, after repeated washing in buffer solution. Although Tween 20 was an effective blocking agent for the unmodified polyethylene surface, binding of HRP to the modified surface is not inhibited by its presence. We propose that the treatment produces new binding sites on the surface and that the function of the HRP is retained because the treated surface is substantially more hydrophilic.