臺灣博碩士論文加值系統

近年來接受全人工關節置換的病患越來越多，但是目前最嚴重的問題就是在手術後數年之間，發生人工關節鬆脫的併發症，鬆動的原因很多，但是就臨床的研究報告指出，當病患在進行修復手術的時候，同時會發現附近的組織含有人工關節材料的顆粒碎屑，其中不乏超高分子量聚乙烯微粒、細微的金屬顆粒，以及肉眼所看不到的合金金屬離子。一般相信，這些經過磨耗以及腐蝕之後的產物，對於周圍的生理組織必定有不良的影響，應該也是造成人工關節鬆脫原因之一。
本實驗從免疫的觀點出發，以人類的白血球為實驗的對象 ，並且以臨床上已經使用來測量我們人體體液與血液中金屬離子濃度時，所使用的金屬離子標準溶液。而實驗一共使用七種金屬離子，包括鈷、鉻、鉬、鎳、欽、鋁、釩等離子，以及沒有離子的控制組。選擇的離子濃度有0.1ppm，1ppm，10ppm三種，刺激細胞的時間共計一小時、三小時、一天、三天、七天等五種。評估項目是目前一般認為是蝕骨物質的IL-1β、IL-6、TNF-α等三種物質，以及細胞計數。
實驗的結果顯示：鈷離子對於白血球的毒性最大，不管是刺激血球中的嗜中性球分泌TNF-α，或者單核球/巨噬細胞所分泌的TL-1β以及IL-6，皆可看出較高的濃度值，允其是TNF-α的濃度，鈷離子刺激組相對於沒有離子刺激的控制組，皆有明顯的統計差異 (P＜0.05)。另外，就TNF-α的分泌而言，鉬、鈦、釩等三種離子，對於白血球的毒性較低，而且有意義。
其次，從金屬離子的濃度而言，高濃度的金屬離子立刻刺激白血球分泌蝕骨物質，即10ppm所刺激分泌物質的濃度一開始大多高於其它兩個濃度，但是在幾天之後中低濃度的影響漸漸明顯，而趕上高濃度所造成的影響，甚至0.1ppm的金屬離子刺激白血球分泌蝕骨物質高於其它兩種濃度，且有明顯之差異。
最後從刺激的時間比較，大體來說，不管何種金屬離子，娜一種濃度，其刺激白血球分泌蝕骨物質是越來越高的，值得一提的是，高濃度(10ppm)的金屬離子雖然一開始明顯刺激蝕骨物質的分泌，但是到了第十天有濃度降低的現象，其餘中低金屬離子濃度的影響，是隨著時間延長而增大。

Recently, there has been more and more people receiving the operation of total joint replacement(TJR). But the most serious problem of this surgery now is complication of prothesis loosening. It is not fully understood. According to clinical reports, doctors found various foreign particles in adjacent tissue when proceeding revision operations. These particles include UHMWPE debris, metal wear debris and metal ions. It is believed that these particles produced by wearing or corrosion have adverse effects on the surrounding tissue. This maybe the reasons causing prothesis loosening.
From the immunological conception, human leukocytes were cultured with metal ions of various concentrations. The metal ions that we were concerning include cobalt, chromium, molybdenum, nickel, titanium, aluminum, and vanadium ions. The ion concentrations selected were O.1ppm, 1.Oppm, 1Oppm. The effects of ions types and ion concentrations were evaluated by the count of cell numbers and the concentrations of bone resorption substances, IL-1β, IL-6, and TNF-α after 1 hour, 3 hours, 1 day, 3 days and 7 days stimulation.
The results showed that the cobalt ion was the most toxic substance to leukocytes. The cobalt ion stimulated cells secreting more TNF- a. (released by neutrophils), IL-I 13 and IL-6 (released by monocytes/macrophages) than the controlled ones. The concentration of TNF- a. secreted by the cobalt stimulated cells was significantly higher than that secreted by the unstimulated controlled group (p<0. 05). Interestingly, when cells were stimulated molybdenum, titanium and vanadium ions, the secretions of TNF-o;, IL-I /3 and IL-6 were significantly lower than those of the controlled groups.
In addition, although high concentration (lOppm) metal ions stimulated leukocytes to release bone resorption substances rapidly in the first few hours, the concentrations from cells stimulated by low concentration (O.1ppm) metal ions gradually exceeded those stimulated by 1.0 and lOppm metal ions.
To consider the stimulation period, no matter what kind of metal ions stimulated cells, the concentration of bone resorption substances increased to a highest value and then fell down. The higher the metal concentration was, the faster the responses appeared.