Holt G, Murnaghan C, Reilly J, Meek R M D
Department of Orthopaedic and Trauma Surgery, Southern General Hospital, Glasgow, Scotland, UK.
Clin Orthop Relat Res. 2007 Jul;460:240-52. doi: 10.1097/BLO.0b013e31804b4147.
Total hip arthroplasty is one of the most commonly performed and successful elective orthopaedic procedures. However, numerous failure mechanisms limit the long-term success including aseptic osteolysis, aseptic loosening, infection, and implant instability. Aseptic osteolysis and subsequent implant failure occur because of a chronic inflammatory response to implant-derived wear particles. To reduce particulate debris and their consequences, implants have had numerous design modifications including high-molecular-weight polyethylene sockets and noncemented implants that rely on bone ingrowth for fixation. Surgical techniques have improved cementation with the use of medullary plugs, cement guns, lavage of the canal, pressurization, centralization of the stem, and reduction in cement porosity. Despite these advances, aseptic osteolysis continues to limit implant longevity. Numerous proinflammatory cytokines, such as interleukin-1, interleukin-6, tumor necrosis factor-alpha, and prostaglandin E2, have proosteoclastogenic effects in response to implant-derived wear particles. However, none of these cytokines represents a final common pathway for the process of particle-induced osteoclast differentiation and maturation. Recent work has identified the fundamental role of the RANKL-RANK-NF-kappaB pathway not only in osteoclastogenesis but also in the development and function the immune system. Thus, the immune system and skeletal homeostasis may be linked in the process of osteoclastogenesis and osteolysis.
全髋关节置换术是最常实施且成功的择期骨科手术之一。然而，众多失败机制限制了其长期成功率，包括无菌性骨溶解、无菌性松动、感染和植入物不稳定。无菌性骨溶解及随后的植入物失败是由于对植入物磨损颗粒产生慢性炎症反应所致。为减少颗粒碎片及其后果，植入物进行了诸多设计改进，包括使用高分子量聚乙烯髋臼杯和依靠骨长入固定的非骨水泥型植入物。手术技术通过使用髓腔塞、骨水泥枪、冲洗髓腔、加压、使柄中心化以及降低骨水泥孔隙率等方法改进了骨水泥固定。尽管有这些进展，无菌性骨溶解仍然限制着植入物的使用寿命。许多促炎细胞因子，如白细胞介素 -1、白细胞介素 -6、肿瘤坏死因子 -α和前列腺素 E2，在对植入物磨损颗粒的反应中具有促进破骨细胞生成的作用。然而，这些细胞因子均不代表颗粒诱导破骨细胞分化和成熟过程的最终共同途径。最近的研究已经确定了RANKL - RANK - NF - κB途径不仅在破骨细胞生成中，而且在免疫系统的发育和功能中都起着重要作用。因此，在破骨细胞生成和骨溶解过程中，免疫系统和骨骼稳态可能存在关联。
