AGGRESSIVE GRANULOMATOUS LESIONS ASSOCIATED WITH HIP-ARTHROPLASTY - IMMUNOPATHOLOGICAL STUDIES
AGGRESSIVE GRANULOMATOUS LESIONS ASSOCIATED WITH HIP-ARTHROPLASTY - IMMUNOPATHOLOGICAL STUDIES
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DOI：
10.2106/00004623-199072020-00014
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发表时间：
1990-02-01
影响因子：
5.3
通讯作者：
LINDHOLM, TS
中科院分区：
文献类型：
--
作者：
SANTAVIRTA, S;KONTTINEN, YT;LINDHOLM, TS
对六名因侵袭性肉芽肿病变而进行全髋关节假体翻修的患者和六名因假体柄常见松动而进行翻修的患者的局部免疫病理学反应进行了分析。所有 12 名患者均因原发性骨关节病接受了全关节置换术。所有的假肢都已用水泥固定。侵袭性肉芽肿由组织良好的结缔组织组成，其中含有组织细胞-单核细胞和成纤维细胞反应区。肉芽肿高度血管化，在许多部位观察到绒毛结构。相反，松散的骨水泥茎周围区域的特征是致密的结缔组织。免疫组织学评估显示，侵袭性肉芽肿组织中的大多数细胞是多核巨细胞和C3bi受体以及非特异性酯酶阳性单核巨噬细胞。这一细胞学发现表明异物型反应与放射照相显示的病变的快速进展溶解性质相一致。侵袭性肉芽肿病和伴随假体松动的更多病变之间存在明显的区别，即肉芽肿病中活化的成纤维细胞相对缺乏。我们认为肉芽肿病涉及单核细胞-巨噬细胞介导的异物和组织碎片清除的正常序列的解偶联，通常随后是成纤维细胞介导的细胞外基质的合成和重塑。我们还认为，与骨水泥髋关节假体相关的侵袭性肉芽肿病是一个独特的实体，不仅在临床和放射学上，而且在组织病理学上。
The local immunopathological response was analyzed in six patients who had revision of a total hip prosthesis because of an aggressive granulomatous lesion and in six patients who had a revision because of common loosening of the prosthetic stem. All twelve patients had had a total replacement arthroplasty for primary osteoarthrosis. All of the prostheses had been cemented. The aggressive granulomas consisted of well organized connective tissue containing histiocytic-monocytic and fibroblastic reactive zones. The granulomas were highly vascularized, and villous structures were observed at many sites. In contrast, the areas around the loose cemented stems were characterized by dense connective tissue. Immunohistological evaluation revealed that most of the cells in the aggressive granulomatous tissue were multinucleated giant cells and C3bi-receptor and nonspecific esterase-positive monocyte-macrophages. This cytological finding suggests a foreign-body-type reaction compatible with the rapidly progressive lytic nature of the lesion that was shown radiographically. There was a clear-cut difference between aggressive granulomatosis and the more lesion accompanying prosthetic loosening .sbd.namely, the relative lack of activated fibroblasts in granulomatosis. We suggest that granulomatosis involves an uncoupling of the normal sequence of monocyte-macrophage-mediated clearance of foreign material and tissue debris that is normally followed by fibroblast-mediated synthesis and remodeling of the extracellular matrix. We also suggest that aggressive granulomatosis in association with a cemented hip prosthesis is a distinct entity, not only clinically and radiographically, but also histopathologically.