Wu Wen, Yan Mengning, Zhu Zhen'an, Dai Kerong
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Jan;30(1):39-43.
To observe the vascularity in periprosthetic tissues of aseptic loosening after total hip arthroplasty (THA) and to explore the relationship between expression of vascularity and osteolysis.
Between October 2009 and June 2012, interface tissues were obtained from 22 patients (22 hips) who underwent revision of THA because of prosthetic aseptic loosening, including 12 males and 10 females with the age range of 53-81 years and prosthesis survival range of 6-14 years. The interface tissues were divided into osteolysis group and non-osteolysis group based on preoperative X-ray findings and intraoperative observation. The synovial tissues were harvested from another 8 patients (3 males and 5 females, aged 58-72 years) with osteoarthritis undergoing THA as control group. HE stainging was used to observe the histological character, and low-wear or high-wear was identified according to metal or polyethylene particles amount in osteolysis group. The CD34 immunohistochemical staining was used to mark the blood vessels. Microvessel density and microvessel index were calculated with the use of image analysis software. RESULTS :Histological observation showed that wear particles and numerous macrophages/multinucleated giant cells accumulated in the membrane of osteolysis group, while many fibroblasts and synovial cells existed in non-osteolysis group. The microvessels density and microvessel index were significantly lower in non-osteolysis group than those in osteolysis group and control group (P < 0.05), and there was no significant difference in microvessel density and microvessel index between osteolysis group and control group (P > 0.05). There were less microvessel density and microvessel index in heavy-loaded metal or polyethylene wear particles areas than those in low-loaded metal or polyethylene wear particles areas (P < 0.05), and there for either polyethylene or metal particles (P > 0.05).
The phagocytosis of macrophage in periprosthetic tissues need vicinal microvessels formation and blood supply to some extent. Vascular injury and decreased blood supply at the implant-bone interface seem to be one of the reasons for insufficient implant osseointegration and aseptic loosening.
观察全髋关节置换术（THA）后无菌性松动假体周围组织中的血管情况，并探讨血管表达与骨溶解之间的关系。
2009年10月至2012年6月，从22例因假体无菌性松动而行THA翻修术的患者（22髋）中获取界面组织，其中男性12例，女性10例，年龄53 - 81岁，假体使用年限6 - 14年。根据术前X线表现及术中观察将界面组织分为骨溶解组和非骨溶解组。另外选取8例因骨关节炎行THA的患者（男性3例，女性5例，年龄58 - 72岁）的滑膜组织作为对照组。采用苏木精-伊红（HE）染色观察组织学特征，并根据骨溶解组中金属或聚乙烯颗粒数量确定低磨损或高磨损情况。采用CD34免疫组织化学染色标记血管。使用图像分析软件计算微血管密度和微血管指数。结果：组织学观察显示，骨溶解组膜内有磨损颗粒及大量巨噬细胞/多核巨细胞聚集，而非骨溶解组有许多成纤维细胞和滑膜细胞。非骨溶解组的微血管密度和微血管指数显著低于骨溶解组和对照组（P < 0.05），骨溶解组与对照组的微血管密度和微血管指数无显著差异（P > 0.05）。高负荷金属或聚乙烯磨损颗粒区域的微血管密度和微血管指数低于低负荷金属或聚乙烯磨损颗粒区域（P < 0.05），聚乙烯或金属颗粒区域之间无差异（P > 0.05）。
假体周围组织中巨噬细胞的吞噬作用在一定程度上需要临近微血管的形成和血液供应。种植体-骨界面的血管损伤和血液供应减少似乎是种植体骨整合不足和无菌性松动的原因之一。
