ISOLATION AND CHARACTERIZATION OF WEAR PARTICLES GENERATED IN PATIENTS WHO HAVE HAD FAILURE OF A HIP-ARTHROPLASTY WITHOUT CEMENT
ISOLATION AND CHARACTERIZATION OF WEAR PARTICLES GENERATED IN PATIENTS WHO HAVE HAD FAILURE OF A HIP-ARTHROPLASTY WITHOUT CEMENT
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DOI：
10.2106/00004623-199509000-00002
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发表时间：
1995-09-01
影响因子：
5.3
通讯作者：
RUBASH, H
中科院分区：
文献类型：
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作者：
MALONEY, WJ;SMITH, RL;RUBASH, H
在用木瓜蛋白酶消化软组织后，研究了髋关节置换术翻修手术中获得的35个膜的磨损颗粒。分离颗粒，并使用光镜和扫描电镜技术，x射线微量分析和自动颗粒分析仪进行表征。聚乙烯颗粒的平均尺寸为0.5微米，金属颗粒的平均尺寸为0.7微米，这是用扫描电子显微镜确定的。自动颗粒分析仪显示，平均颗粒直径为0.63微米（超过90%的颗粒小于0.95微米），平均每克组织有17亿个颗粒，而对照样本每克组织只有1.43亿个颗粒。x射线微分析显示，在消化后的35个膜中有16个（46%）有金属碎片。围绕钛合金杆的26个膜中有13个（50%）含有金属颗粒，而围绕铬钴杆的9个膜中有3个含有金属颗粒。没有多孔涂层的钛合金阀杆周围的12个膜中只有一个膜中存在金属碎片，而有多孔涂层的钛合金阀杆周围的14个膜中有12个膜中存在金属碎片。这10倍的患病率差异是显著的（p < 0.005）。平均而言，与双极髋臼组件相关的颗粒总数（以每克组织百万计）是与固定髋臼组件相关的两倍。此外，与双极杯相关的聚乙烯颗粒的平均尺寸有较大的趋势。我们的数据表明，在没有水泥的情况下插入的股骨假体周围的组织中，颗粒假体碎片构成了一类颗粒，其大小主要小于1微米，每克组织中存在超过10亿个颗粒。常规的组织学方法没有检测到这类磨损碎片，导致对这些膜中碎片数量的严重低估。临床意义：在目前的研究中，磨损颗粒的表征将允许更好地评估和理解体内的生物反应。我们的数据还证明了植入物的设计特征与颗粒产生之间的关系。对于进行关节置换手术的外科医生来说，重要的是要认识到可能影响磨损碎片产生的因素，从而影响植入物的固定并限制重建的寿命。
Wear particles from thirty-five membranes obtained during revision hip-replacement operations were studied after digestion of the soft tissue with papain. The particles were isolated and were characterized with use of light and scanning electron microscopic techniques, x-ray microanalysis, and an automated particle analyzer.The mean size of the polyethylene particles was 0.5 micrometer, and the metal particles were a mean of 0.7 micrometer, as determined with scanning electron microscopy. The automated particle analyzer revealed a mean particle diameter of 0.63 micrometer (more than 90 per cent of all particles were less than 0.95 micrometer) and a mean of 1.7 billion particles per gram of tissue, compared with only 143 million per gram of tissue for the control samples.X-ray microanalysis revealed metal debris in sixteen (46 per cent) of the thirty-five membranes after digestion. Thirteen (50 per cent) of the twenty-six membranes surrounding a titanium-alloy stem contained metal particles, compared with three of the nine membranes surrounding a chromium-cobalt stem. Metal debris was present in only one of the twelve membranes surrounding a titanium-alloy stem without a porous coating, compared with twelve of the fourteen membranes surrounding a titanium-alloy stem with a porous coating. This tenfold difference in prevalence was significant (p < 0.005).On the average, the total number of particles (expressed in millions per gram of tissue) associated with the bipolar acetabular components was twice that associated with the fixed acetabular components. In addition, there was a trend toward a larger mean size of the polyethylene particles in association with the bipolar cups.Our data indicate that particulate prosthetic debris in the tissues around failed femoral components that have been inserted without cement constitutes a class of particles that are predominantly less than one micrometer in size and are present in amounts of more than one billion particles per gram of tissue. Routine histological methods did not detect this class of wear debris and led to a gross underestimation of the amount of debris in these membranes.CLINICAL RELEVANCE: Characterization of wear particles, as performed in the current study, will permit a better assessment and understanding of the biological response in vivo. Our data also demonstrate the relationship between the design features of implants and the generation of particles. It is important for surgeons who perform joint-replacement operations to be cognizant of factors that may influence the production of wear debris and thus affect the fixation of the implant and limit the longevity of the reconstruction.