肿瘤型假体周围界膜的研究及临床意义

发布时间：2018-04-17 03:20

本文选题：肿瘤型假体 + 界膜　；参考：《辽宁医学院》2012年硕士论文

【摘要】：目的通过对松动的肿瘤型假体周围界膜的微观结构研究，分析肿瘤型假体周围界膜形态学及组织学表现与假体周围组织反应的关系。初步分析人工肿瘤型假体松动的原因，探讨其中的规律，为肿瘤型人工假体设计和材料的选择提供理论基础。方法通过对10例肿瘤型关节假体翻修术中获取的假体周围界膜组织进行组织学切片及电镜标本制备，将组织学切片作HE及CD68免疫组织化学染色,在普通光镜下观察界膜组织学构成、磨损颗粒分布及其聚集部位的组织学特征并应用修订的Mirra’ s组织学评分标准进行半定量评分，计算CD68阳性细胞数。使用扫描电镜观察假体周围界膜组织的表面微观结构，并行能量色散X射线光谱分析（EDX），记录界膜表层金属离子峰值及含量比例。采用SPSS17.0软件包进行统计分析，对资料进行Kendall’s tau b检验，将CD68阳性细胞率、组织学表现及界膜表面Ti峰值含量进行相关性分析。结果所有本组10例假体周围界膜的组织学表现以慢性异物肉芽组织样炎性反应改变为特征，界膜主要由单核和多核组织细胞、纤维基质以及慢性炎性细胞组成。其内可见大量黑色金属磨损颗粒的聚集，被巨噬细胞所吞噬或包围，淋巴细胞散在分布，其中CD68阳性细胞占24.5%±5%(x|-±s)。假体周围界膜组织定量病理学评分与CD68阳性细胞率呈正相关（r_s=0.677，，P0.01），金属磨损颗粒数量与病理学评分呈正相关（r_s=0.673，P0.01）。扫描电镜观察中见到界膜表面大量的粗细不等的胶原纤维组织，直径约为1μm~5μm，少量直径从1μm~60μm大小不一异物颗粒。能量色散X射线光谱分析（EDX）结果显示10例中均可见高低不等的Ti峰，金属Ti离子含量比率平均为4.627%，最大比率为5.93%，最低比率为0.15%。同时在4例中可见Fe峰存在；8例中可见Al峰存在；2例可见较低的Co峰和Cr峰存在；6例可见Si峰的存在。假体周围界膜组织定量病理学评分与界膜表面Ti金属含量比率呈正相关（r_s=0.629，P0.01），界膜表面Ti金属含量比率与CD68阳性细胞率呈正相关（r_s=0.778，P0.01）。在不具有聚乙烯包裹的钛合金假体周围界膜组织中,其CD68阳性细胞率、组织学评分和Ti金属离子含量比率均较高,假体周围发生的慢性炎性组织学反应更明显。结论肿瘤型人工假体因其在较大的骨缺损情况下使用，与骨及周围组织的接触范围广泛，伴随着假体微动，大量假体磨损微粒出现和释放。肿瘤型假体与周围组织的接触范围广泛，由此产生较多的界膜组织填充，局部慢性炎性细胞因子的激活和释放导致骨溶解而出现假体松动。在肿瘤型假体周围界膜中，假体周围界膜组织的慢性炎性反应与界膜表面Ti金属含量比率和CD68阳性细胞数均呈显著的正相关，证实了假体周围界膜中金属磨损颗粒与周围组织慢性炎症有着密切的联系。在不具有高分子聚乙烯包裹的钛合金假体周围界膜组织中,其CD68阳性细胞率、组织学评分和Ti金属离子含量比率均较高,假体周围慢性异物炎性反应更明显。可见如果能通过选择合适的肿瘤型假体材料和设计控制磨损颗粒的产生和释放从而减少炎性介质的激活生成，减少周围炎症反应的程度，就可从生物学角度降低肿瘤型人工假体置换术后无菌性松动的发生率。
[Abstract]:objective
By studying the microstructure of tumor type prosthesis loose around the film industry, analysis of the relationship between tumor prosthesis interface membrane around the morphological and histological findings and periprosthetic tissue reaction. A preliminary analysis of the reasons of artificial tumor prosthesis loosening, explore the law, to provide theoretical basis for tumor prosthesis design and material selection.
Method
By histological section and electron microscope specimens were prepared for 10 cases of tumor type prosthesis for joint prosthesis arthroplasty in the limiting membrane surrounding tissue, the histological sections HE and CD68 immunohistochemical staining, observe the periprosthetic tissue under light microscope, composition, distribution and accumulation of wear particles and histological features the application of the revised Mirra s standard for evaluation of semi quantitative histological score, calculated the number of CD68 positive cells. The surface microstructure observation of periprostheticinterface membranes using scanning electron microscopy, energy dispersive X-ray spectroscopy analysis of parallel X (EDX), and record the peak film surface of metal ions and content ratio. Analyzed by SPSS17.0 software package Kendall, s tau B "for inspection, will be the ratio of CD68 positive cells, histological features and the correlation analysis of Ti membrane surface peak content.
Result
All of this group of 10 cases of periprosthetic interface membranes histology to change inflammatory granulation tissue samples for chronic foreign body characteristics, limiting membrane is mainly composed of a single core and multi-core fiber matrix composed of tissue cells, and chronic inflammatory cell aggregation. Note the amount of black metal wear particles inside, swallowed or surrounded by macrophages, lymphocytes scattered among CD68 positive cells accounted for 24.5% + 5% (x|- + s). Scores of CD68 positive cells was positively correlated with the rate of periprostheticinterface membranes (r_s=0.677, P0.01) quantitative pathological evaluation, was positively related to the amount of wear particles and metal (r_s=0.673, P0.01). The pathological see collagen fiber thickness a large number of different film surface scanning electron microscope, the diameter of about 1 mu m~5 mu m, a small diameter from 1 mu m~60 mu m sizes of foreign particles. Analysis of energy dispersive X ray spectroscopy (EDX) results showed that 10 cases were seen or not The Ti peak, Ti metal ion content ratio is 4.627% on average, the maximum ratio of 5.93%, the lowest ratio of 0.15%. at the same time in 4 cases seen in the Fe peak; there showed a Al peak in 8 cases; Co and Cr peaks in 2 cases lower; 6 cases showed a Si peak around the prosthesis existence. Periprosthetic tissue quantitative pathology score and membrane surface Ti ratio was positively related metal content (r_s=0.629, P0.01), the surface of Ti film metal content ratio and the ratio of CD68 positive cells was positively correlated (r_s=0.778, P0.01). The titanium prosthesis with polyethylene wrapped around the periprosthetic tissue, the ratio of CD68 positive cells. The histological score ratio and Ti content of metal ions were higher in tissues of chronic inflammatory reaction occurred around the prosthesis is more obvious.
conclusion
Tumor type prosthesis because of its use in the condition of larger bone defects, and bone contact area and surrounding tissues widely, with a large number of prosthesis fretting, prosthesis wear particles and release. The contact range of tumor type prosthesis and the surrounding tissues extensively, periprosthetic tissue resulting in more filling, local chronic inflammatory cytokines the activation and release of lead to osteolysis and loosing of prosthesis. The tumor type periprosthetic interface membranes, was significantly correlated to the number of Ti on the surface of chronic inflammatory reaction and membrane bound metal content ratio and the CD68 positive cells of periprostheticinterface membranes were confirmed, periprosthetic interface membranes of metal wear particles and surrounding tissue of chronic inflammation is closely linked. The titanium prosthesis with polyethylene film wrapped around the world organization, the percentage of CD68 positive cells, histological score ratio and Ti content of metal ions Are all high, periprosthetic chronic foreign body inflammatory reaction is more obvious. If visible by selecting tumor prosthesis materials and design appropriate control of wear particles so as to reduce the production and release of inflammatory mediators in the activation of generation, reduce the degree of inflammation around, can reduce the incidence rate from the biological perspective of aseptic loosening of artificial tumor after prosthetic replacement.

【学位授予单位】：辽宁医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R318.1

【参考文献】