[髋关节置换术无菌性松动中假体周围骨溶解的免疫组织化学分析]

Gravius S, Mumme T, Delank K S, Eckardt A, Maus U, Andereya S, Hansen T

Orthopädische Universitätsklinik der RWTH Aachen, Aachen.

Z Orthop Unfall. 2007 Mar-Apr;145(2):169-75. doi: 10.1055/s-2007-965184.

AIMS

The main complication in total hip arthroplasty is aseptic loosening. Wear-induced inflammatory processes lead to periprosthetic granulation tissue, which induces bone degradation due to aseptic osteolysis. At the site of bone degradation,the cell populations have not been further analysed so far. Therefore, the present study was designed to analyse bone degradation tissue in comparison to periprosthetic granulation tissue.

METHODS

Tissue specimens of 14 patients with failed modular cup components of cementless total hip arthroplasties were obtained during revision surgery. Immunohistochemistry was performed by using anti-CD 31 (endothelial cells),anti-CD 45 (granulocytes and lymphocytes) and anti-CD 68 antibodies (mononuclear phagocyte system, MPS). Fibroblasts and osteoblasts were immunohistochemically distinguished as CD 31/45/68-negative cells. Semiquantitative analyses,including a morphometric study, were then performed both in the bone degradation zone and in the periprosthetic granulation tissue.

RESULTS

At the site of bone degradation, the majority of cells belonged to MPS (73.6 +/- 3.31%),while fibroblasts were significantly less frequent (9.6 +/-1.67%). A distinct population of endothelial cells (7.75+/- 1.4%) as well as lymphoplasmacellular cells (5.75+/-2.35%) were observed. In addition,only a small amount of neutrophilic granulocytes (0.7 +/- 0.4 %) were detected. In the periprosthetic granulation tissue, findings were very similar to those of the bone degradation zone,with the exception of higher amounts of fibroblasts (15.69 +/- 2.74%).

CONCLUSIONS

This study confirms that, in aseptic hip arthroplasty loosening, the majority of cells detected at the site of bone degradation are of the MPS, which are predominantly involved in osteolytic processes. There is no pathologically significant difference between the cell population of periprosthetic granulation tissue and granulation tissue at the sites of bone degradation.

目的

全髋关节置换术的主要并发症是无菌性松动。磨损引发的炎症过程会导致假体周围肉芽组织形成，进而因无菌性骨溶解引发骨质破坏。目前，尚未对骨质破坏部位的细胞群进行深入分析。因此，本研究旨在对比分析骨质破坏组织与假体周围肉芽组织。

方法

在翻修手术中获取了14例非骨水泥型全髋关节置换术模块化髋臼组件失败患者的组织样本。采用抗CD 31（内皮细胞）、抗CD 45（粒细胞和淋巴细胞）和抗CD 68抗体（单核吞噬细胞系统，MPS）进行免疫组织化学检测。成纤维细胞和成骨细胞通过免疫组织化学方法鉴定为CD 31/45/68阴性细胞。随后，在骨质破坏区和假体周围肉芽组织中进行了包括形态计量学研究在内的半定量分析。

结果

在骨质破坏部位，大多数细胞属于MPS（73.6±3.31%），而成纤维细胞的比例明显较低（9.6±1.67%）。观察到有明显的内皮细胞群（7.75±1.4%）以及淋巴浆细胞（5.75±2.35%）。此外，仅检测到少量嗜中性粒细胞（0.7±).4%）。在假体周围肉芽组织中，除了成纤维细胞数量较多（15.69±2.74%）外，其他结果与骨质破坏区非常相似。