CAJ | 학술논문

目的：关节置换术后假体松动一直是关节外科的难题。文中通过探讨肿瘤坏死因子样弱凋亡诱导因子（ tumor necrosis factor like weak inducer of apoptosis ， TWEAK）在松动假体周围界膜中的表达及其临床意义，进一步了解假体松动的发生机制。方法收集7例髋关节翻修的界膜组织标本为界膜组，同时收集7例因股骨颈骨折行关节置换的髋关节滑膜组织标本为骨折滑膜组，7例因骨性关节炎行关节置换的髋关节滑膜组织标本为关节炎滑膜组。通过形态学观察并采用逆转录PCR（ reverse transcription-PCR， RT-PCR）和Western blot检测TWEAK mRNA及TWEAK蛋白在标本中的表达。结果界膜组HE染色可见细胞增生明显并伴有局灶性大量炎性细胞浸润，免疫组化染色见大量TWEAK染色阳性细胞。 RT-PCR检测TWEAK mRNA的表达：骨折滑膜组为0．216±0．016，关节炎滑膜组为0．318±0．021，界膜组为0．437±0．008；Western blot检测TWEAK蛋白的表达：骨折滑膜组为0．298±0．014，关节炎滑膜组为0．537±0．033，界膜组为0．715±0．062；TWEAK mRNA和TWEAK蛋白表达，组间两两比较差异均有统计学意义（P＜0．05）。结论 TWEAK可能是炎性骨溶解的启动因素之一，进一步探索TWEAK在骨溶解中的作用机制，对临床防治人工关节无菌性松动具有重要意义。
목적：관절치환술후가체송동일직시관절외과적난제。문중통과탐토종류배사인자양약조망유도인자（ tumor necrosis factor like weak inducer of apoptosis ， TWEAK）재송동가체주위계막중적표체급기림상의의，진일보료해가체송동적발생궤제。방법수집7례관관절번수적계막조직표본위계막조，동시수집7례인고골경골절행관절치환적관관절활막조직표본위골절활막조，7례인골성관절염행관절치환적관관절활막조직표본위관절염활막조。통과형태학관찰병채용역전록PCR（ reverse transcription-PCR， RT-PCR）화Western blot검측TWEAK mRNA급TWEAK단백재표본중적표체。결과계막조HE염색가견세포증생명현병반유국조성대량염성세포침윤，면역조화염색견대량TWEAK염색양성세포。 RT-PCR검측TWEAK mRNA적표체：골절활막조위0．216±0．016，관절염활막조위0．318±0．021，계막조위0．437±0．008；Western blot검측TWEAK단백적표체：골절활막조위0．298±0．014，관절염활막조위0．537±0．033，계막조위0．715±0．062；TWEAK mRNA화TWEAK단백표체，조간량량비교차이균유통계학의의（P＜0．05）。결론 TWEAK가능시염성골용해적계동인소지일，진일보탐색TWEAK재골용해중적작용궤제，대림상방치인공관절무균성송동구유중요의의。
Objective Prosthesis loosening is a problem of joint surgery .We studied the expressions and clinical signifi-cance of TWEAK in patients with aseptic loosening of prostheses , and tried to make clear the mechanism of prosthesis loosening . Methods Periprosthetic interface membranes (7 aseptic loosening of prostheses ) were obtained as experimental group and synovial tissues were obtained (7 osteoarthritis patients and 7 fracture subjects) as control groups.Tissue sections were stained for general mor-phological characterization .TWEAK mRNA expression in tissues were examined by RT-PCR.TWEAK protein expression were exam-ined by Western blot . Results HE staining showed that a large number of inflammatory cells infiltrated in periprosthetic interface membranes .Immunohistochemical staining also showed that the positive cells markedly increased .The expression levels of TWEAK mRNA was 0.216 ±0.016 in the fracture synovial tissues group , 0.318 ±0.021 in osteoarthritis synovial tissues group , and 0.437 ± 0.008 in periprosthetic interface membranes group;The expression levels of TWEAK protein was 0.298 ±0.014 in the fracture synovi-al tissues group, 0.537 ±0.033 in osteoarthritis synovial tissues group, and 0.715 ±0.062 in periprosthetic interface membranes group(P<0.05). Conclusion TWEAK may be the trigger of in-flammatory osteolysis .It plays an important role in the pathogenesis of aseptic loosening .