光滑种植体表面对种植体周围纤维化及聚乙烯磨损颗粒迁移的易感性。

The susceptibility of smooth implant surfaces to periimplant fibrosis and migration of polyethylene wear debris.

作者信息

Bobyn J D, Jacobs J J, Tanzer M, Urban R M, Aribindi R, Sumner D R, Turner T M, Brooks C E

机构信息

Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Quebec, Canada.

出版信息

Clin Orthop Relat Res. 1995 Feb(311):21-39.

DOI:
PMID:7634577
Abstract

The purpose of this investigation was to establish whether the tissue response and migration of polyethylene debris differed at noncemented smooth and porous implant surfaces. This was accomplished through 3 separate but closely related studies: (1) a canine cylindrical implant model with smooth and porous surfaces exposed to polyethylene debris; (2) a canine total hip arthroplasty model analyzing the interface between bone and femoral implants with various porous-coating configurations; and (3) a histologic analysis of autopsy-retrieved, human, noncemented hip prostheses with noncircumferential porous coating. The cylindrical implant model involved the placement of split cylinders, 1/2 porous and 1/2 smooth, into the distal femur and proximal tibia of 4 dogs. Four control implants and 10 test implants (chronically exposed to simulated polyethylene debris with a mean size of 4.7 microns) were examined histologically as long as 30 weeks after surgery. The canine hip study involved the study of 54 noncemented hip prostheses at periods of 1, 6, and 24 months. The prostheses possessed 4 different porous surface configurations: 1 with circumferential porous coating, 2 with noncircumferential coating, and 1 without porous coating. The human retrieval analysis involved the study of 7 cadaveric femora (age, 6 months-5 years) implanted with a straight titanium-alloy prosthesis possessing proximal pads of titanium fiber metal on the anterior, posterior, and medial aspects. With all implants in all 3 studies, there was the common finding of bone ingrowth at the porous implant surface and a fibrous interface or periprosthetic cavity around the portion of the implant that was smooth surfaced. The periprosthetic cavity typically was encapsulated by a thin continuous shell of trabecular bone. In addition, polyethylene debris was found to have preferentially migrated along the smooth implant surfaces. In the longer-term canine and human hip retrievals, polyethylene particles in the micron size range were present within histiocytes, whereas larger particles as much as 100 microns were found within foreign-body giant cells. Of importance for the implants from all 3 studies, with the exception of some pronounced cavities on the lateral aspect of the human hip prostheses, the periimplant cavities around the smooth surfaces were not detectable radiographically. This study clearly established a fundamental principle of relative barriers to particulate debris migration. Smooth implant surfaces are more susceptible than porous surfaces to the development of a fibrous tissue filled periimplant cavity and the subsequent migration of polyethylene wear debris.(ABSTRACT TRUNCATED AT 400 WORDS)

摘要

本研究的目的是确定在非骨水泥型光滑和多孔植入物表面,聚乙烯碎屑的组织反应和迁移情况是否存在差异。这是通过3项各自独立但紧密相关的研究完成的:(1)一个犬类圆柱形植入物模型,其光滑和多孔表面暴露于聚乙烯碎屑;(2)一个犬类全髋关节置换模型,分析具有不同多孔涂层配置的骨与股骨植入物之间的界面;(3)对尸检获取的、带有非周向多孔涂层的人类非骨水泥型髋关节假体进行组织学分析。圆柱形植入物模型包括将半多孔和半光滑的劈开圆柱体植入4只狗的股骨远端和胫骨近端。在术后长达30周的时间里,对4个对照植入物和10个测试植入物(长期暴露于平均尺寸为4.7微米的模拟聚乙烯碎屑)进行了组织学检查。犬类髋关节研究涉及在1个月、6个月和24个月时对54个非骨水泥型髋关节假体进行研究。这些假体具有4种不同的多孔表面配置:1种具有周向多孔涂层,2种具有非周向涂层,1种没有多孔涂层。人类取回分析涉及对7具尸体股骨(年龄6个月至5岁)进行研究,这些股骨植入了一个直的钛合金假体,该假体在其前、后和内侧方面具有钛纤维金属近端垫。在所有3项研究的所有植入物中,共同的发现是在多孔植入物表面有骨长入,而在植入物光滑表面部分周围有纤维界面或假体周围腔隙。假体周围腔隙通常被一层薄的连续小梁骨壳包裹。此外,发现聚乙烯碎屑优先沿着光滑的植入物表面迁移。在长期的犬类和人类髋关节取回物中,微米尺寸范围内的聚乙烯颗粒存在于组织细胞内,而在异物巨细胞内发现了高达100微米的较大颗粒。对所有3项研究中的植入物而言重要的是,除了人类髋关节假体外侧的一些明显腔隙外,光滑表面周围的假体周围腔隙在X线片上无法检测到。这项研究明确确立了颗粒碎屑迁移相对屏障的一个基本原理。光滑的植入物表面比多孔表面更容易形成充满纤维组织的假体周围腔隙以及随后聚乙烯磨损碎屑的迁移。(摘要截取自400字)

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