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。

A Relative Study of Polyethylene Debris,Cytokine and Loosening Hip Prosthesis

Objective： To study the relativity of polyethelene debris, cytokine and loosening hip prosthesis. Methods： Thirty eight patients with loosening hip prothesis were divided into three groups： total hip arthoplasty, double hip arthoplasty and integrated arthoplasty. To observe and analyse the inflammative reaction under light microscopic arrerding to the half-ration standard of Joseph, and determine the content of tumor necrosis factor （TNF） in samples of interface membranes. Results： In the observation of inflammative reaction under light microscopic, there was no significant differences between total hip arthoplasty group and double hip arthoplasty group（P〉O.05）, but the integrated arthoplasty group had a significant differences when compareed with other two groups（P〈0.05）. Results of the determination of TNF content in three groups was the same. Conclusion： The polyethelene debris can stimu- late the interface membrane to release more bone resorption factors which caused the prothesis loosening than oth- er debris. Reduce the dosage or change the charicteristic of polyethelene can decrease the loodening rates of arthoplasty.