全髋置换假体松动局部组织表现与CXCL16的表达△

Histological characteristics and CXCL16 expression in tissue around loosened prosthesis of total hip arthroplasty

摘要:

[目的] 探讨全髋关节置换术后无菌性松动与局部组织表现和 CXCL16 的表达水平相关性。[方法] 2017 年 6 月— 2023 年 6 月 44 例无菌性假体松动行翻修的患者为翻修组，44 例同期于本院行初次全髋关节置换术的患者为初次组。术中取关节滑膜组织行组织学评分和 CXCL16 检测，比较不同临床状态的组织学检测指标，并分析它们之间的相关性。[结果] 翻修组假体界膜组织中有较多多核巨细胞浸润，翻修组的组织学评分显著高于初次组 [(5.9±1.8) vs (0.6±0.8), P＜0.001]。免疫组化染色结果显示，翻修组 CXCL16 的蛋白表达阳性率显著高于初次组 （86.4% vs 6.8%, P＜0.001）。44 例翻修患者按临床特征分层比较表明，不同假体类型之间组织学评分的差异有统计学意义 （P＜0.05）；不同假体类型、假体生存期之间 CXCL16 表达水平的差异有统计学意义 （P＜0.05）。相关性分析结果显示，组织学评分与假体生存期存在显著正相关 （r=0.383, P=0.010），CXCL16 表达分级与假体生存期（r=0.350, P=0.020）呈显著正相关，与翻修前 Harris 评分（r=-0.345, P=0.022）呈显著负相关。[结论]全髋置换术后无菌性松动患者假体界膜组织中 CXCL16 的表达水平显著高于初次组，该因子有可能参与了无菌性松动的发病过程。

Abstract:

[Objective] To investigate the correlation between clinical characteristics and local histologic manifestations and CXCL16 level around aseptic loosening prosthesis of total hip arthroplasty (THA). [Methods] From June 2017 to June 2023, 44 patients who underwent revision THA for aseptic loosening were included in the revision group, while 44 patients who underwent primary total hip arthroplasty in our hospital during the same period were included in the primary group. Histological score and CXCL16 detection were performed in the synovium harvested during the operation, and histological assay parameters were compared based on different clinical states, and the correlation between them was analyzed. [Results] There was more infiltration of nuclear giant cells in the prosthetic boundary membrane in the revision group, and the revision group got significantly higher histological score than the primary group [(5.9±1.8) vs (0.6±0.8), P＜0.001]. Immunohistochemical staining showed that CXCL16 level in the revision group was significantly higher than that in the primary group (χ² = 55.942, P＜0.001). As results of stratified comparison in the 44 revision patients based on clinical characteristics, there was significant differences in histological scores among different prosthesis types (P＜0.05). In addition, there were significant differences in CXCL16 levels among different prosthesis types and prosthesis survival time (P＜0.05). As for correlation analysis, the histological score was significantly positively correlated with implant survival period (r=0.383, P=0.010). Futhermore, the CXCL16 expression grade was significantly positively correlated to the implant survival period (r=0.350, P=0.020), whereas significantly negative correlation with Harris score before revision (r=-0.345, P=0.022). [Conclusion] The expression of CXCL16 in the prosthetic boundary membrane tissue harvested from revision THA for aseptic loosening was significantly higher than that in the primary THA, which might be involved in the pathogenesis of aseptic loosening.