人工全膝關節周圍組織之臨床磨耗殘屑研究

人工膝關節在活動時，脛骨-股骨關節界面受到數倍於體重的負載；在正常功能下，其受作用力均勻分佈在脛骨－股骨之間的聚乙烯的墊片上，然而，原有來自於筋－肌肉與韌帶系統對人工股骨遠端與脛骨的穩定作用則降低。因長期承受壓應力作用，近表層聚乙烯逐漸產生應變量的累積而形成局部硬化層，剪應力再對此硬化層作用導致分層化或受到界面第三顆粒對此層磨損侵蝕，破裂成片狀殘屑或次微米級顆粒。從植入約10年的臨床病人取出鬆脫的人工膝關節周圍軟組織之磨耗殘屑發現，殘屑的表面型態有呈扁平片狀，平均尺寸大小約300μm，或呈堆積聚集，平均尺寸大小約為15μm，其中亦可發現次微米顆粒分散其中。臨床磨耗殘屑的主要物種為聚乙烯片斷、金屬元素或兩者聚集的混合物，且其元素的組成與人工膝關節組件所使用的材質有關。觀察經染色後的磨耗殘屑及其周圍軟組織生理切片，發現若此病例的磨耗殘屑中，金屬元素含量較多且其軟組織間存在黑色物質的聚集，經X光光電子能譜儀分析，推論此磨損物質為含有高比例Ti的氧化物。

關鍵字

人工膝關節；磨耗殘屑；型態；成份

並列摘要

During the motion of total knee joint (TKJ), the tibiofemoral interface bears loading several times larger than its body weight. In normal functions, the applied forces are uniformly distributed on the polyethylene (PE) cushion at the tibiofemoral cavity. Nevertheless, joint stability resulting from the support of surrounding tissues such as tendonous muscles and ligamentous systems, is incapable to withstand as normal. Owing to long term compression on the polyethylene part, the repeatedly loaded surface may accumulate strains and eventually generate a stress-localized layer, which tends to be delaminated by shearing forces or disintegrated by the abrasion of third particles. The wear pieces mostly exhibit as flake-like or sub-micron particles. Wear debris taken from peri-prosthetic tissues of ten-year implanted TKJs contains compressed and flake-like species of ca. 300μm in dimension and accumulated pile-up species of ca. 15μm. Particles in sub-micron can be found dispersively. The main constituents of those tissue-detached particles are composed of polyethylene segments, metallic elements and their mixtures. The composition of wear debris is highly correlated with the materials of TKJ components. Using X-ray Photoelectron Spectroscopy, the black-like accumulates in the dyed peri-prosthetic tissues are identified as the substances with rich of titanium oxides.

並列關鍵字

Total knee prosthesis ； Wear debris ； Morphology ； Composition

國際替代計量

人工全膝關節周圍組織之臨床磨耗殘屑研究

全文下載

主題瀏覽