摘要
人工关节置换术(total joint arthroplasty,TJA)是治疗终末期关节疾病最常用且有效的方法,但常常伴有一系列并发症.无菌性松动(aseptic loosening,AL)是导致手术失败和后续翻修手术的关键因素,充分了解AL的发生机制对制定有效的治疗方案十分必要.目前认为AL的主要发生机制是由于磨损颗粒激活一系列炎症细胞产生促炎细胞因子,导致机体的动态骨平衡被打破,从而引发AL.本文分析总结目前AL的研究现状,将其主要分为生物学因素(磨损颗粒、趋化因子、自噬等)和机械性因素(下肢力线、骨水泥与种植体设计、应力遮挡)两大类,阐述其发生机制及影响因素,以期为AL的治疗和预防提供理论依据.
Abstract
Total joint arthroplasty(TJA)is the most common and effective treatment for end-stage joint disease,but it is often associat-ed with a series of complications.Aseptic loosening(AL)is a key factor leading to surgical failure and subsequent revision surgery,therefore,a full understanding of the mechanism of AL is necessary for the development of an effective treatment program.Currently,it is believed that the main mechanism of AL is the activation of a series of inflammatory cells by wear debris to produce pro-inflammatory cytokines,which leads to the disruption of the dynamic bone balance of the organism,thus triggering AL.In this article,we summarize the current research sta-tus of AL,which is mainly classified into two categories:biological factors(wear debris,chemokines,autophagy,etc.)and mechanical factors(lower limb force lines,cement and implant design,and stress shielding),and elaborates on the mechanisms of its occurrence and influencing factors,with a view to providing theoretical basis for the treatment and prevention of AL.
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