Mercuri Louis G, Urban Robert M, Hall Deborah J, Mathew Mathew T
Visiting Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL; Clinical Consultant, TMJ Concepts, Ventura, CA.
Associate Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
J Oral Maxillofac Surg. 2017 Oct;75(10):2076-2084. doi: 10.1016/j.joms.2017.03.044. Epub 2017 Apr 1.
The purpose of this study was to determine whether failed alloplastic temporomandibular joint replacement (TMJR) devices can elicit the aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) reaction seen in some patients with metal-on-metal hip arthroplasties.
This study involved analysis of paraffin-embedded sections of peri-implant tissue from failed TMJ implant cases obtained from 3 independent sources. Hematoxylin and eosin staining, conventional and polarized light microscopy, back-scattered electron imaging, and energy-dispersive x-ray analysis were used. Immunohistochemical methods were used to identify T and B lymphocytes and macrophages.
The total TMJR device specimens showed primary macrophage and lymphocytic responses similar to responses reported previously for failed total hip implants, including ALVAL. No chronic or acute inflammation was apparent in the failed hemiarthroplasty TMJR cases.
In this limited preliminary study, the local tissue responses to the failed TMJR implants showed similar primary macrophage and lymphocyte responses to previously reported failed metal-on-metal and metal-on-polyethylene orthopedic total joint replacement devices. No such local inflammatory responses were seen with the failed TMJR hemiarthroplasty devices.
本研究旨在确定失败的人工颞下颌关节置换（TMJR）装置是否会引发在一些金属对金属髋关节置换患者中所见的无菌性淋巴细胞为主的血管炎相关病变（ALVAL）反应。
本研究对从3个独立来源获取的失败TMJ植入病例的植入物周围组织石蜡包埋切片进行分析。使用苏木精和伊红染色、常规和偏光显微镜检查、背散射电子成像以及能量色散X射线分析。采用免疫组织化学方法鉴定T淋巴细胞、B淋巴细胞和巨噬细胞。
总的TMJR装置标本显示出与先前报道的失败全髋关节植入物（包括ALVAL）相似的原发性巨噬细胞和淋巴细胞反应。在失败的半关节置换TMJR病例中未观察到慢性或急性炎症。
在这项有限的初步研究中，对失败的TMJR植入物的局部组织反应显示出与先前报道的失败的金属对金属和金属对聚乙烯骨科全关节置换装置相似的原发性巨噬细胞和淋巴细胞反应。失败的TMJR半关节置换装置未观察到此类局部炎症反应。
