人工关节无菌性松动的老话新说  

Aseptic loosening of artificial joint:old story and advances

作　　者：郑秋坚[1] 邓展涛 ZHENG Qiu-jian;DENG Zhan-tao(Department of Orthopaedics,Guangdong General Hospital,Guangzhou 510000,Guangdong,China)

机构地区：[1]广东省人民医院骨科中心,广州510000

出　　处：《医学研究生学报》2018年第4期361-367,共7页Journal of Medical Postgraduates

摘　　要：人工关节无菌性松动是导致关节置换术后远期翻修的常见原因,严重影响关节假体使用寿命,给患者带来巨大的精神和经济负担。因此,如何攻克人工关节无菌性松动这一难题成为关节外科研究的重点。目前无菌性松动的发病机制仍不明确,国内外研究提出了多种发病理论,包括磨损微粒诱导骨溶解理论、微动理论、应力遮挡理论、高流体压力理论、内毒素理论和个体遗传差异理论等。其中磨损微粒诱导骨溶解理论为目前最被广泛接受的发病机制。最新的研究表明,自噬水平异常、表观遗传学调控、免疫系统紊乱等因素均参与了磨损微粒诱导的骨溶解过程;而无菌性松动方向从预防、治疗甚至概念目前仍具有较大争议。文章旨在对当前无菌性松动的现状、发病机制、最新研究进展以及尚存在的争议进行探讨,以期为无菌性松动的防治提供更多的理论依据。Aseptic loosening is the most common chronic complication of total joint arthroplasty,which significantly shortens the life span of prosthesis and leads to mental stress and heavy economic burden of patients.Hence,how to overcome aseptic loosening is a focus in the research of joint arthroplasty.A series of mechanisms participates the pathogenesis of aseptic loosening,including osteolysis induced by wear particles,micromotion,stress shielding,high fluid pressure,endotoxin and genetic factors.Osteolysis induced by wear particles is the most recognized mechanism.The latest study suggested that autophagy,epigenetic regulation and immunologic derangement all participate the development of osteolysis induced by wear particles.However,the prevention,treatment and even the concept of aseptic loosening is still controverial.We hope that the future study will provide a definite mechanism for aseptic loosening and provide new theoretic evidence for the prevention and treatment of aseptic loosening.

关 键 词：人工关节无菌性松动 发病机制 磨损微粒 骨溶解 

分 类 号：R687.4[医药卫生—骨科学]