Schmalzried T P, Campbell P, Schmitt A K, Brown I C, Amstutz H C
Harbor-UCLA Medical Center, Torrance 90509, USA.
J Biomed Mater Res. 1997 Fall;38(3):203-10. doi: 10.1002/(sici)1097-4636(199723)38:3<203::aid-jbm4>3.0.co;2-t.
Periprosthetic tissue was obtained at revision surgery from 10 posterior cruciate retaining total knee replacement cases (five different manufacturers). The tissues were hydrolyzed and polyethylene particles were isolated from each case. Individual particles were analyzed by scanning electron microscopy combined with computerized image analysis. For comparison, periprosthetic tissues from 10 total hip replacement cases (six different manufacturers) were processed and analyzed simultaneously with identical methods. The morphologies of the isolated polyethylene particles from total knee specimens were distinctly different. There was more variety of size, shape, and texture in the total knee particles. Submicron granules were less prevalent than in hip specimens. Larger flake-shaped particles, some measuring several microns in length and width, were commonly seen in knee specimens but not hip specimens. The overall average area of particles from the total knees (1.2 microns2) was twice that of total hips (0.61 micron2) (p = 0.049). The average perimeter (p = 0.026) and length (p = 0.026) of total knee particles was also greater than the total hip particles. The proportion of the smallest polyethylene particles (those averaging 0.2 micron2) in the total knee specimens was significantly less than that in total hip specimens (p < 0.0001). Although the large flake-shaped particles were visually striking, it is important to note that the majority of the wear particles from the total knee cases were also submicron. These differences in wear particle morphology and size are due to differences in the wear mechanisms of total knees and total hips. Size is only one parameter in wear particle bioreactivity. Other factors include particle shape, surface area, and possibly size/shape variability, as well as surface chemistry and particle concentration. Polyethylene wear particles are not unidimensional; they have complex and variable shapes. The combination of morphologic description and quantitative image analysis used in this study defines several differences in polyethylene wear particles from different sources.
在翻修手术中，从10例后交叉韧带保留型全膝关节置换病例（5个不同制造商）获取假体周围组织。将组织水解并从每个病例中分离出聚乙烯颗粒。通过扫描电子显微镜结合计算机图像分析对单个颗粒进行分析。为作比较，同时采用相同方法对10例全髋关节置换病例（6个不同制造商）的假体周围组织进行处理和分析。全膝关节标本中分离出的聚乙烯颗粒形态明显不同。全膝关节颗粒在尺寸、形状和质地方面更多样化。亚微米颗粒不如髋关节标本中普遍。在膝关节标本中常见较大的片状颗粒，有些长宽达数微米，而在髋关节标本中未见。全膝关节颗粒的总体平均面积（1.2平方微米）是全髋关节颗粒（0.61平方微米）的两倍（p = 0.049）。全膝关节颗粒的平均周长（p = 0.026）和长度（p = 0.026）也大于全髋关节颗粒。全膝关节标本中最小的聚乙烯颗粒（平均面积为0.2平方微米）的比例显著低于全髋关节标本（p < 0.0001）。尽管大的片状颗粒在视觉上很突出，但重要的是要注意到，全膝关节病例中的大多数磨损颗粒也是亚微米级的。磨损颗粒形态和尺寸的这些差异是由于全膝关节和全髋关节磨损机制的不同。尺寸只是磨损颗粒生物活性的一个参数。其他因素包括颗粒形状、表面积、可能还有尺寸/形状变异性，以及表面化学和颗粒浓度。聚乙烯磨损颗粒不是一维的；它们具有复杂多变的形状。本研究中使用的形态学描述和定量图像分析相结合，确定了不同来源的聚乙烯磨损颗粒的几个差异。
