中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (53): 8051-8056.doi: 10.3969/j.issn.2095-4344.2016.53.020

• 骨与关节综述 bone and joint review • 上一篇    

人工关节置换后不同磨损颗粒对全身多系统的影响

邱晓明1,甄 平2,李光勇3   

  1. 1兰州大学第二医院,甘肃省兰州市 730000;2解放军兰州军区兰州总医院骨科,甘肃省兰州市 730000;3临潭县第一人民医院外科,甘肃省临潭县 747500
  • 修回日期:2016-10-22 出版日期:2016-12-23 发布日期:2016-12-23
  • 通讯作者: 甄平,教授,硕士生导师,主任医师,解放军兰州军区兰州总医院骨科,甘肃省兰州市 730000
  • 作者简介:邱晓明,男,1986年生,甘肃省临潭县人,藏族,兰州大学第二临床医学院在读硕士,主要从事关节外科方面的研究。
  • 基金资助:

    国家自然科学基金资助项目(81371983);甘肃省自然科学基金资助项目(1308RJZA146)

Effects of different wear particles on multiple systems after artificial joint replacement

Qiu Xiao-ming1, Zhen Ping2, Li Guang-yong3   

  1. 1Second Hospital, Lanzhou University, Lanzhou 730000, Gansu Province, China; 2Department of Orthopedics, Lanzhou Military Region General Hospital, Lanzhou 730000, Gansu Province, China; 3Surgical Department, Lintan First People’s Hospital, Lintan 747500, Gansu Province, China
  • Revised:2016-10-22 Online:2016-12-23 Published:2016-12-23
  • Contact: Zhen Ping, Professor, Master’s supervisor, Chief physician, Department of Orthopedics, Lanzhou Military Region General Hospital, Lanzhou 730000, Gansu Province, China
  • About author:Qiu Xiao-ming, Studying for master’s degree, Second Hospital, Lanzhou University, Lanzhou 730000, Gansu Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81371983; the Natural Science Foundation of Gansu Province, No. 1308RJZA146

摘要:

文章快速阅读:

 
 
 
文题释义:
假体磨损颗粒:①骨水泥颗粒:它的产生主要有以下两种方式,骨组织-骨水泥-假体界面上微动磨损产生和假体-假体界面研磨产生,其产生的数量多少不等,与假体置换术中的操作有很大关系;②聚乙烯颗粒:虽然金属-聚乙烯界面假体的材质技术和力学技术都在不断改进,但仍有大量聚乙烯颗粒产生;③金属颗粒:金属磨损颗粒的大小一般认为在30-200 nm之间,平均< 50 nm,而那些孤立的金属颗粒大多数小于10 nm;④陶瓷颗粒:陶瓷是金属和非金属元素的稳定化合物,这些化合物处在一个非常低的能量状态,也会产生磨损颗粒,其直径为0.13-7.2 nm ,体积更小,产生数量比其他材料少。
磨损颗粒对循环系统的影响:由于金属颗粒纳米级别的直径和独特的生物学效应,这些颗粒可以通过血液或微淋巴循环,沉积在心脏内皮细胞和肌肉纤维束之间,引起内皮细胞肿胀,血清中乳酸脱氢酶含量上升,提示心肌受损。也有报道称这种纳米级别颗粒进入血液后可引起血小板增多、红细胞数目减少、血红蛋白含量下降等血液疾病。
 
摘要
背景:研究显示磨损颗粒可导致假体无菌性松动,并播散至全身对全身多系统产生影响。
目的:对磨损颗粒的产生、特性、转移至全身的途径及不同磨损颗粒对全身多系统影响的研究现状及新进展做一综述。
方法:计算机检索 CNKI 和 PubMed 数据库中 1999 年1月至 2016 年4月关于人工关节置换后磨损颗粒的文章,排除其中磨损颗粒对假体松动相关文章,中文检索关键词为“磨损颗粒”,英文检索关键词“wear particles”。
结果与结论:无论人工关节置换采用何种固定方式或采用何种材质假体,假体之间的摩擦和假体与骨界面之间的微动都会产生磨损颗粒。目前还没有发现骨水泥、聚乙烯、陶瓷磨损颗粒对人体短期影响而导致的临床并发症。相比之下,金属磨损颗粒引起的全身反应比较多见,其产生的金属离子不仅对全身多系统产生影响,长期累积还可对人体造成损伤。如今关于假体置换磨损颗粒相关机制的研究多为体外细胞层面研究,却少有完整动物模型层面上的分析,学者们普遍认为颗粒介导的疾病具有长期潜伏期,暴露于金属颗粒后的长期影响仍然不清楚,需要不断探究。

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

ORCID:
0000-0003-3122-4042(甄平)

关键词: 骨科植入物, 人工关节, 关节置换, 磨损颗粒, 人工关节, 全身多系统, 综述, 国家自然科学基金

Abstract:

BACKGROUND: Studies demonstrated that wear particles can lead to aseptic loosening of the prosthesis, and spread to the whole body, and have systemic effects on multiple systems.

OBJECTIVE: To summarize research status and new progress of the generation, characteristics of wear particles, and pathways that are transferred to the body, as well as effects of different wear particles on systemic multi-system. 
METHODS: We retrieved database of CNKI and PubMed for particles concerning wear particles after artificial joint replacement published from January 1999 to April 2016. The articles regarding effects of wear particles on prosthesis loosening were excluded. Key words were “wear particles”.
RESULTS AND CONCLUSION: Regardless of the fixation or prosthesis material used for artificial joint replacement, friction between the prosthesis and fretting between the prosthesis and the bone interface can produce wear particles. At present, there are no clinical complications of short-term effects of bone cement, polyethylene, ceramic wear particles on human. In contrast, systemic reactions caused by metal wear particles are more common. The metal ions not only affect the whole body, but also can cause damage to the human body. Nowadays, the research on the mechanism of prosthesis replacement wear particles mainly concerns in vitro cells, but there are few complete animal models. Scholars generally agreed that particle-mediated disease has a long-term latency; the long-term effects of exposure to metal particles are still unclear, and need to be explored.

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

Key words: Prostheses and Implants, Arthroplasty, Replacement, Hip, Tissue Engineering

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