结核分枝杆菌与四种人工关节介面粘附特点对比研究

发布时间：2018-04-28 13:52

本文选题：关节结核 + 结核分枝杆菌　；参考：《河北北方学院》2013年硕士论文

【摘要】：髋关节结核(Tuberculosis of the hip)是一种常见的关节结核。其发病率仅次于脊柱结核,约占全身骨关节的15%,在下肢关节中发病率居第一位。发病人群年纪多半集中在20-40岁的青年,如果诊断不及时,变为晚期髋关节结核,主要病理表现为骨质缺损,软骨破坏、关节间狭窄而造成下肢运动障碍,严重地影响着人们的生活质量。目前国内主要采用手术治疗,通过一期病灶清除,二期人工全髋关节置换或关节融合术。但假体材料的选择是保障一期病灶清除人工关节置换术治疗活动期髋关节结核的重要条件。有研究表明,人工假体材料与结核分枝杆菌的粘附性明显较普通细菌差,脊柱结核病灶清除同时使用内固定是安全的,这也为我们可以在结核病灶内放置人工关节假体提供了依据。但是我们的前期研究显示结核分枝杆菌在不同的假体表面的粘附性还是有差异的,这样,选择合适的假体就显得非常重要,可以大大降低活动期髋结核人工全髋关节置换术后的复发率。因此本研究拟在前期研究的基础上,通过假体材料表面结核菌粘附力和围手术期治疗方法等研究,为活动期髋关节结核患者行一期人工全髋关节置换术的治疗提供临床依据。观察何种人工关节假体更为安全,希望能够为活动期髋关节结核患者的一期病灶清除并行人工全髋关节置换的假体选择提供基础依据。我们从细菌粘附的角度出发,通过对结核分枝杆菌与四种不同人工关节介面的实验研究,探讨结核分枝杆菌粘附特性,为关节结核患者一期关节置换选择假体提供理论依据。将表面多孔涂层、钛涂层、喷砂涂层和羟基磷灰石涂层实验材料每组各取40片,将每片实验材料在无菌条件下悬吊于M960培养基中,与结核分枝杆菌共同培养。每个M960培养基培养28天。用比浊法测定培养基菌液的OD (Optical Density)值：以期观察结核分枝杆菌在培养基中生长情况,并用扫描电镜观察结核分枝杆菌与四种介面的粘附情况。通过测得的OD(Optical Density)与菌液浓度的关系可以看出,四种材料对结核分枝杆菌生长无明显影响,差别无统计学意义(P0.05)。扫描电镜结果提示,结核分枝杆菌在多孔介面粘附量为(14.91±0.47)和钛涂层粘附量为(14.68±0.35)高于喷砂涂层粘附量为(6.48±0.50)和羟基磷灰石涂层介面粘附量为(6.23±0.26),差异有统计学意义(P0.05),结核分枝杆菌与多孔涂层和钛涂层粘附明显多于喷砂涂层和羟基磷灰石涂层,在为关节结核患者做人工关节置换时,选择羟基磷灰石涂层和喷砂涂层比多孔涂层和钛涂层更有优势。
[Abstract]:Hip tuberculosis of the is a common joint tuberculosis. Its incidence is second only to spinal tuberculosis, accounting for about 15% of the whole body bone and joints, the first incidence of lower extremity joints. Most of the patients are young people aged 20-40 years. If the diagnosis is not timely, they will become advanced hip tuberculosis. The main pathological manifestations are bone defect, cartilage destruction, and interarticular stenosis, resulting in lower limb motor disorders. Seriously affect people's quality of life. At present, the main domestic surgical treatment, through one-stage debridement, two-stage total hip replacement or arthrodesis. However, the selection of prosthetic materials is an important condition for the treatment of active hip tuberculosis by primary debridement of artificial joint replacement. Studies have shown that the adhesiveness of artificial prosthesis materials to Mycobacterium tuberculosis is significantly worse than that of common bacteria, and it is safe to use internal fixation for the removal of spinal tuberculosis foci. This also provides the basis for the placement of artificial joint prostheses in tuberculosis foci. But our previous studies have shown that the adhesion of Mycobacterium tuberculosis to different prosthesis surfaces is still different, so it is very important to choose the right prosthesis. It can greatly reduce the recurrence rate after total hip arthroplasty. Therefore, based on the previous studies, this study aims to provide clinical evidence for the treatment of active hip tuberculosis patients with total hip arthroplasty through the study of the adhesion of tuberculous bacteria on the surface of prosthetic materials and perioperative treatment. The purpose of this study is to observe which artificial joint prosthesis is more safe and to provide the basis for the selection of prosthesis in patients with active tuberculosis of hip joint after primary debridement and total hip replacement. From the point of view of bacterial adhesion, we studied the adhesion characteristics of Mycobacterium tuberculosis with four different artificial joint interfaces in order to provide a theoretical basis for the selection of prosthesis for joint replacement in patients with joint tuberculosis. The porous coating, titanium coating, sandblasting coating and hydroxyapatite coating were taken from each group of experimental materials. Each material was suspended in M960 medium under aseptic condition and cultured with Mycobacterium tuberculosis. Each M960 medium was cultured for 28 days. The OD optical Density of the culture medium was measured by turbidimetry. The growth of Mycobacterium tuberculosis in the medium was observed and the adhesion of mycobacterium tuberculosis to the four interfaces was observed by scanning electron microscope. The relationship between the concentration of OD(Optical density and the concentration of mycobacterium tuberculosis showed that the four materials had no significant effect on the growth of Mycobacterium tuberculosis, but the difference was not statistically significant (P 0.05). The results of scanning electron microscopy indicate that, The adhesion of mycobacterium tuberculosis to porous interface was 14.91 卤0.47) and that of titanium coating was 14.68 卤0.35), which was higher than that of sandblasting coating (6.48 卤0.50) and hydroxyapatite coating (6.23 卤0.26). The difference was statistically significant (P 0.05). The adhesion between the coating and the titanium coating was much more than that of the sand blasting coating and hydroxyapatite coating. Hydroxyapatite coating and sand blasting coating are better than porous coating and titanium coating in arthroplasty for patients with joint tuberculosis.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R529.2

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