Goodman Stuart B
Department of Orthopaedic Surgery, Stanford University Medical Center, #R153 300 Pasteur Drive, Stanford, CA 94305-5326, USA.
Biomaterials. 2007 Dec;28(34):5044-8. doi: 10.1016/j.biomaterials.2007.06.035. Epub 2007 Jul 23.
The immune system modulates many key biological processes in humans. However, the exact role of the immune system in particle-associated periprosthetic osteolysis is controversial. Human tissue retrieval studies, in vivo and in vitro experiments suggest that the immune response to polymer particles is non-specific and macrophage-mediated. Lymphocytes may modulate this response. However direct lymphocyte activation by polymer particle-protein complexes seems unlikely. However, metallic byproducts may complex with serum proteins and lead to a Type IV, lymphocyte-mediated immune reaction. In predisposed individuals, this reaction may rarely lead to persistent painful joint effusions, necessitating debridement and excision of the bearing surfaces of the prosthesis. In these patients, retrieved periprosthetic tissues exhibit histological evidence of perivascular lymphocytic cuffing. These findings are worrisome, given the fact that increasing numbers of metal-on-metal joint implants are being implanted in younger more active individuals worldwide.
免疫系统调节人体许多关键的生物学过程。然而，免疫系统在与颗粒相关的假体周围骨溶解中的确切作用存在争议。人体组织回收研究、体内和体外实验表明，对聚合物颗粒的免疫反应是非特异性的且由巨噬细胞介导。淋巴细胞可能调节这种反应。然而，聚合物颗粒 - 蛋白质复合物直接激活淋巴细胞似乎不太可能。然而，金属副产品可能与血清蛋白结合并导致IV型淋巴细胞介导的免疫反应。在易感个体中，这种反应可能很少导致持续性疼痛性关节积液，需要对假体的承重表面进行清创和切除。在这些患者中，回收的假体周围组织显示出血管周围淋巴细胞套袖状的组织学证据。鉴于全球范围内越来越多的金属对金属关节植入物被植入更年轻、更活跃的个体中，这些发现令人担忧。
