本文選題：腫瘤型假體 + 界膜　； 參考：《遼寧醫(yī)學(xué)院》2012年碩士論文

【摘要】：目的 通過對(duì)松動(dòng)的腫瘤型假體周圍界膜的微觀結(jié)構(gòu)研究，分析腫瘤型假體周圍界膜形態(tài)學(xué)及組織學(xué)表現(xiàn)與假體周圍組織反應(yīng)的關(guān)系。初步分析人工腫瘤型假體松動(dòng)的原因，探討其中的規(guī)律，為腫瘤型人工假體設(shè)計(jì)和材料的選擇提供理論基礎(chǔ)。 方法 通過對(duì)10例腫瘤型關(guān)節(jié)假體翻修術(shù)中獲取的假體周圍界膜組織進(jìn)行組織學(xué)切片及電鏡標(biāo)本制備，將組織學(xué)切片作HE及CD68免疫組織化學(xué)染色,在普通光鏡下觀察界膜組織學(xué)構(gòu)成、磨損顆粒分布及其聚集部位的組織學(xué)特征并應(yīng)用修訂的Mirra’ s組織學(xué)評(píng)分標(biāo)準(zhǔn)進(jìn)行半定量評(píng)分，計(jì)算CD68陽性細(xì)胞數(shù)。使用掃描電鏡觀察假體周圍界膜組織的表面微觀結(jié)構(gòu)，并行能量色散X射線光譜分析（EDX），記錄界膜表層金屬離子峰值及含量比例。采用SPSS17.0軟件包進(jìn)行統(tǒng)計(jì)分析，對(duì)資料進(jìn)行Kendall’s tau b檢驗(yàn)，將CD68陽性細(xì)胞率、組織學(xué)表現(xiàn)及界膜表面Ti峰值含量進(jìn)行相關(guān)性分析。 結(jié)果 所有本組10例假體周圍界膜的組織學(xué)表現(xiàn)以慢性異物肉芽組織樣炎性反應(yīng)改變?yōu)樘卣�，界膜主要由單核和多核組織細(xì)胞、纖維基質(zhì)以及慢性炎性細(xì)胞組成。其內(nèi)可見大量黑色金屬磨損顆粒的聚集，被巨噬細(xì)胞所吞噬或包圍，淋巴細(xì)胞散在分布，其中CD68陽性細(xì)胞占24.5%±5%(x|-±s)。假體周圍界膜組織定量病理學(xué)評(píng)分與CD68陽性細(xì)胞率呈正相關(guān)（r_s=0.677，，P0.01），金屬磨損顆粒數(shù)量與病理學(xué)評(píng)分呈正相關(guān)（r_s=0.673，P0.01）。掃描電鏡觀察中見到界膜表面大量的粗細(xì)不等的膠原纖維組織，直徑約為1μm~5μm，少量直徑從1μm~60μm大小不一異物顆粒。能量色散X射線光譜分析（EDX）結(jié)果顯示10例中均可見高低不等的Ti峰，金屬Ti離子含量比率平均為4.627%，最大比率為5.93%，最低比率為0.15%。同時(shí)在4例中可見Fe峰存在；8例中可見Al峰存在；2例可見較低的Co峰和Cr峰存在；6例可見Si峰的存在。假體周圍界膜組織定量病理學(xué)評(píng)分與界膜表面Ti金屬含量比率呈正相關(guān)（r_s=0.629，P0.01），界膜表面Ti金屬含量比率與CD68陽性細(xì)胞率呈正相關(guān)（r_s=0.778，P0.01）。在不具有聚乙烯包裹的鈦合金假體周圍界膜組織中,其CD68陽性細(xì)胞率、組織學(xué)評(píng)分和Ti金屬離子含量比率均較高,假體周圍發(fā)生的慢性炎性組織學(xué)反應(yīng)更明顯。 結(jié)論 腫瘤型人工假體因其在較大的骨缺損情況下使用，與骨及周圍組織的接觸范圍廣泛，伴隨著假體微動(dòng)，大量假體磨損微粒出現(xiàn)和釋放。腫瘤型假體與周圍組織的接觸范圍廣泛，由此產(chǎn)生較多的界膜組織填充，局部慢性炎性細(xì)胞因子的激活和釋放導(dǎo)致骨溶解而出現(xiàn)假體松動(dòng)。在腫瘤型假體周圍界膜中，假體周圍界膜組織的慢性炎性反應(yīng)與界膜表面Ti金屬含量比率和CD68陽性細(xì)胞數(shù)均呈顯著的正相關(guān)，證實(shí)了假體周圍界膜中金屬磨損顆粒與周圍組織慢性炎癥有著密切的聯(lián)系。在不具有高分子聚乙烯包裹的鈦合金假體周圍界膜組織中,其CD68陽性細(xì)胞率、組織學(xué)評(píng)分和Ti金屬離子含量比率均較高,假體周圍慢性異物炎性反應(yīng)更明顯。可見如果能通過選擇合適的腫瘤型假體材料和設(shè)計(jì)控制磨損顆粒的產(chǎn)生和釋放從而減少炎性介質(zhì)的激活生成，減少周圍炎癥反應(yīng)的程度，就可從生物學(xué)角度降低腫瘤型人工假體置換術(shù)后無菌性松動(dòng)的發(fā)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.

【學(xué)位授予單位】：遼寧醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R318.1

【參考文獻(xiàn)】

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