Jacobs Joshua J, Campbell Patricia A, T Konttinen Yrjö
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Am Acad Orthop Surg. 2008;16 Suppl 1:S49-55. doi: 10.5435/00124635-200800001-00011.
Orthopaedic surgeons have new tools that address the problem of aseptic loosening and osteolysis, and these tools are now in widespread clinical use. Hard-on-hard bearing couples as well as metal-on-highly cross-linked polyethylene bearing couples have lower volumetric wear rates and represent promising solutions to reduce the prevalence of osteolysis and aseptic loosening in total joint arthroplasty. Volumetric wear rates alone, however, do not completely predict the osteolytic potential that is also a function of particle composition, size, morphology, and a number of other particle characteristics. Host factors, including differing innate reactivities to wear products and adaptive immune responses, remain important but incompletely defined. Although the toxicologic significance of local and systemic elevations in metal ions has not been definitively established, monitoring patients with metal-on-metal bearings with serum metal ion levels can be useful to determine the state of the bearing. Furthermore, optimization of these bearing systems to further diminish wear and corrosion would be highly desirable.
骨科医生有了新工具来解决无菌性松动和骨溶解问题，这些工具目前已在临床广泛使用。硬对硬关节面以及金属对高交联聚乙烯关节面的磨损率较低，有望减少全关节置换术中骨溶解和无菌性松动的发生率。然而，仅体积磨损率并不能完全预测骨溶解潜力，骨溶解潜力还取决于颗粒成分、大小、形态以及许多其他颗粒特性。宿主因素，包括对磨损产物不同的固有反应性和适应性免疫反应，仍然很重要，但尚未完全明确。尽管金属离子局部和全身升高的毒理学意义尚未明确确定，但监测金属对金属关节面患者的血清金属离子水平有助于确定关节面状态。此外，非常需要优化这些关节面系统以进一步减少磨损和腐蚀。
