人工关节金属微粒的研究现状与展望  

The present situation and prospect of research on artificial joint metal wear particles

作　　者：刘璠[1] 朱文峰[1] LIU Fan;ZHU Wen-feng(Department of Orthopaedics,Affiliated Hospital to Nantong University,Nantong 226001,Jiangsu,China)

机构地区：[1]南通大学附属医院骨科,南通226001

出　　处：《医学研究生学报》2018年第4期350-354,共5页Journal of Medical Postgraduates

摘　　要：含金属假体部件的人工关节在人体内均存在不同程度的磨损微粒,是局部骨溶解、炎性假瘤及假体松动的主要原因。人工关节置换术后金属磨损碎屑即可来源于负重界面容积性正常磨损,也可来源于非负重界面的边缘性磨损。关节磨损产生的微粒大小以纳米(Nano-sized)级为主,其毒性反应较微米级(Micro-sized)颗粒及离子(ion)强。磨损微粒即可在局部聚积引起局部反应,又可以各种形式进入血液引起全身多系统的毒性症状。在各种金属微粒中,以钴的毒性最明显。氧化应激、超敏反应、内质网应激、自噬、直接破坏是可能的细胞毒性及基因毒性机制,相应的解毒研究也与这些机制相关。体内金属粒子浓度的升高与症状之间尚无确切标准,目前治疗以取出假体及对症治疗为主。未来的研究在临床上将侧重于假体材料的改进及寻找关节疾病的新型替代治疗方案,基础研究上将进一步探讨金属微粒的毒性机理特别是信号通路及易感基因的发现,新型解毒药物的体内、体外研究及临床试验。文章就人工关节置换术后金属微粒的产生机制、体内代谢、毒性反应、解毒研究等进行回顾,并对未来发展方向进行展望。The artificial joints containing metal prosthetic components have different degrees of wear particles in the human body,which is the main reason for local osteolysis,inflammatory pseudotumor and prosthesis loosening.The metal wear debris after artificial joint replacement can be derived from the normal wear of the weight-bearing interface volume,or from the edge wear of the non-weight-bearing interface.The particles produced by joint wear are mainly nano-sized particles,and their toxicity is stronger than that of micro-sized particles and ions.The wear particles can cause either local reactions by local accumulation or toxicity symptoms of multiple systems by entering the blood in various forms.Cobalt has the strongest toxicity among various metal particles.Oxidative stress,hypersensitivity,endoplasmic reticulum stress,autophagy,and direct destruction are the possible cytotoxic and genotoxic mechanisms,and the corresponding detoxification studies are also related to these mechanisms.There is no definite standard for the increase of the concentration of metal particles and the clinical symptoms.At present,the main treatment is to remove the prosthesis and symptomatic treatment.Future research will focus on the improvement of prosthetic materials and finding new alternative treatment for joint diseases.Basic research will further explore the mechanism of toxicity of metal particles,especially the discovery of signal pathways and susceptibility genes as well as the in vivo and in vitro studies and clinical trials of new antidote.

关 键 词：人工关节 磨损微粒 钴 毒性机理 解毒 临床治疗 

分 类 号：R687.4[医药卫生—骨科学]