Severe impingement of lumbar disc replacements increases the functional biological activity of polyethylene wear debris.
Severe impingement of lumbar disc replacements increases the functional biological activity of polyethylene wear debris.
复制标题
DOI：
10.2106/jbjs.k.00522
复制
发表时间：
2013-06
期刊：
影响因子：
--
通讯作者：
Ryan M. Baxter;D. MacDonald;S. Kurtz;M. Steinbeck
中科院分区：
文献类型：
--
作者：
Ryan M. Baxter;D. MacDonald;S. Kurtz;M. Steinbeck
背景：在手术翻修后，观察到超高分子量聚乙烯全椎间盘置换组件的磨损、氧化，特别是边缘撞击损伤。然而，无论是体外试验还是基于回收的证据都没有显示撞击对聚乙烯磨屑特征的影响。因此，我们试图确定（1）与轻度或重度边缘撞击相对应的聚乙烯颗粒尺寸、形状、数量或生物活性的差异，以及（2）在所有全椎间盘置换术的分析中，无论撞击分类如何，区域损伤程度与聚乙烯磨屑特征之间是否存在相关性。方法：在平均植入时间为9.7年（范围：4.6 - 16.1年）后，对翻修手术中取出的11个聚乙烯芯进行圆顶和边缘损伤程度表征。使用硝酸从假体周围组织中分离聚乙烯磨屑，并使用环境扫描电子显微镜进行成像。随后，测定颗粒大小、形状、数量、生物活性和慢性炎症评分。结果：与严重撞击队列相比，轻度撞击队列中代表高度生物相关性（10 μm颗粒）的颗粒尺寸范围内的颗粒体积分数增加，其中<0.1至1 μm和1至10 μm尺寸范围内的颗粒体积分数增加。增加的体积分数导致轻度撞击队列中每单位颗粒体积的比生物活性高于严重撞击队列。然而，功能性生物活性（通过颗粒体积（mm 3/g组织）标准化）在严重撞击队列中显著更高。这种增加是由于所有三个尺寸范围内的颗粒体积较大。在两个队列中，功能性生物活性与慢性炎症反应相关，边缘渗透程度与颗粒大小、数量和功能性生物活性的增加呈正相关。结论：本研究的结果表明，严重的边缘撞击增加了保留运动的腰椎全椎间盘置换组件的生物学相关颗粒的产生。证据等级预后IV级。有关证据等级的完整描述，请参见作者说明。
BACKGROUND Wear, oxidation, and particularly rim impingement damage of ultra-high molecular weight polyethylene total disc replacement components have been observed following surgical revision. However, neither in vitro testing nor retrieval-based evidence has shown the effect(s) of impingement on the characteristics of polyethylene wear debris. Thus, we sought to determine (1) differences in polyethylene particle size, shape, number, or biological activity that correspond to mild or severe rim impingement and (2) in an analysis of all total disc replacements, regardless of impingement classification, whether there are correlations between the extent of regional damage and the characteristics of polyethylene wear debris. METHODS The extent of dome and rim damage was characterized for eleven retrieved polyethylene cores obtained at revision surgery after an average duration of implantation of 9.7 years (range, 4.6 to 16.1 years). Polyethylene wear debris was isolated from periprosthetic tissues with use of nitric acid and was imaged with use of environmental scanning electron microscopy. Subsequently, particle size, shape, number, biological activity, and chronic inflammation scores were determined. RESULTS Grouping of particles by size ranges that represented high biological relevance (10-μm particles) revealed an increased volume fraction of particles in the <0.1 to 1-μm and 1 to 10-μm size ranges in the mild-impingement cohort as compared with the severe-impingement cohort. The increased volume fractions resulted in a higher specific biological activity per unit particle volume in the mild-impingement cohort than in the severe-impingement cohort. However, functional biological activity, which is normalized by particle volume (mm3/g of tissue), was significantly higher in the severe-impingement cohort. This increase was due to a larger volume of particles in all three size ranges. In both cohorts, the functional biological activity correlated with the chronic inflammatory response, and the extent of rim penetration positively correlated with increasing particle size, number, and functional biological activity. CONCLUSIONS The results of this study suggest that severe rim impingement increases the production of biologically relevant particles from motion-preserving lumbar total disc replacement components. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.