全髋关节置换术后假体周围组织的病理生理

全髋关节置换术后远期失败的主要原因是假体无菌性松动和局部软组织不良反应。在置换术后关节假体的长期使用过程中,假体微动、磨损微粒/离子刺激、液压波动、应力遮挡等因素共同作用下,导致假体周围骨组织丢失和软组织不良反应。既往文献对上述因素单一作用导致骨溶解的讨论较多。本文主要从关节置换术后病理生理进程的角度出发,探讨假体微动、磨损微粒/离子刺激、液压波动等因素在人工关节置换术失败中的协同作用。上述致病因素所导致的炎性假瘤、骨溶解甚至是无菌性松动,均可以是无临床症状的,但其持续进展,终将导致置换手术失败。

Pathophysiology of bone-implant interface in total hip replacement

The main causes for a failed total hip replacement are aseptic loosening and adverse local tissue reaction. During long term service of the prosthesis, particle-induced inflammation, micromotion of prosthesis, fluctuation of periprosthetic fluid pressure and stress shielding contribute together to periprosthetic bone loss and adverse soft tissue reaction. Mono factor''s effects on osteolysis has been discussed sufficiently. This review focuses on how these factors work synergistically in the pathophysiology process of periprosthetic tissue. Inflammatory pseudotumor, osteolysis and even aseptic loosening caused by the above pathogenic factors can be asymptomatic, but their continuous progress will eventually lead to the failure of replacement surgery.