肿瘤坏死因子与人工关节无菌性松动关系的探讨：附7例报告

目的　探讨人工关节无菌性松动的病因。方法　选择 7例松动人工髋关节病例 ,翻修手术时取松动关节周围的界膜组织 ;选择 1 0例骨折内固定患者 ,拆除内固定时取内固定物周围瘢痕组织。标本作组织学检查 ,并作肿瘤坏死因子(TNF)测定。结果　松动人工髋关节周围的界膜组织中含大量组织细胞和纤维母细胞 ;免疫组化染色显示 ,组织细胞标记抗体、溶菌酶和 α1 -抗胰蛋白酶染色阳性。而骨折内固定物周围的瘢痕组织主要为纤维成分。松动人工髋关节周围界膜组织中的TNF浓度明显高于骨折内固定物周围的瘢痕组织 (P<0 .0 1 )。结论　在生物性因素方面 ,磨损微粒是松动发生的关键性因素 ,它可刺激组织细胞分泌 TNF等溶骨性因子 ,这些溶骨性因子直接或间接地激活破骨细胞 ,从而引起人工关节周围骨吸收、骨溶解 ,最终导致人工关节无菌性松动。

Investigation of the Relationship between Tumour Necrosis Factors and Aseptic Loosening of Prostheses (Analysis of 7 Cases)

Objective To explore the etiology and pathogenesis of aseptic loosening of sterile prosthesis. Methods Interfacial tissues around loosened prostheses were harvested from 7 cases, and fibrous tissues around internal fixation devices of fracture were also retrieved from 10 cases. The specimens were studied histologically and their ability of TNF assessed. Results It was found that there were a large number of histiocytes in the interfacial tissues around loosened prostheses. But fibrous tissues around internal fixation devices of fracture consisted of a few histiocytes and numbers of fibrocytes. Levels of TNF were higher in the membrane from loosened prostheses than in tissues around internal fixation devices. Conclusion A great quantity of wear particles emerge after repeated abrasion. These particles would bring about active bone resoption and osteolysis, which at last result in asepetic loosening of prostheses.