人工全髋关节翻修术患者血清钴铬离子浓度与局部组织病理变化的关系
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摘要
目的探讨人工全髋翻修术患者外周血血清钴铬离子水平与假体周围组织无菌性淋巴细胞为主型血管炎相关病变(ALVAL)的关系。方法纳入2015年1月至2018年9月在北京积水潭医院行人工髋关节翻修术且除髋关节假体外不携带其他含钴铬材料的内植物,术前血清钴、铬离子浓度高于梅奥诊所参考标准的患者17例。男9例,女8例。其中右侧髋关节10例,左侧7例。术中取假体周围组织行病理检查,按Campbell-ALVAL评分系统评分,通过SPSS软件分析金属离子水平与ALVAL评分之间的相关性。结果 17例患者体质量指数(BMI)(23. 8±3. 2) kg/m2。摩擦界面为金属-金属(MOM) 5例,金属-聚乙烯(MOP) 12例。病理Campbell-ALVAL评分4分1例,5分1例,6分6例,7分7例,8分1例,9分1例,MOP组和MOM组术前金属离子水平与ALVAL评分之间均无相关性(r分别为0. 09﹑0. 26,P> 0. 05);而钴和铬离子浓度之间存在相关关系(r=0. 836,P <0. 001)。结论 ALVAL的诊断仍以镜下病理检查为诊断依据,人工髋关节翻修术前的血清钴铬离子升高可以提示ALVAL的存在,钴和铬离子浓度之间存在相关关系,但其钴和铬离子浓度高低与ALVAL均无相关。这表明金属离子水平并不是ALVAL的独立作用机制,也不适合单独作为ALVAL的预测指标及翻修手术适应证选择。
Objective To investigate the correlation between serum cobalt-chromium metal ion levels in peripheral blood and the severity of ALVAL around the prosthesis of patients after revision total hip arthroplasty.Methods Seventeen patients after revision hip arthroplasty with preoperative serum cobalt and chromium concentrations elevated above the Mayo Clinic reference standard were included from January 2015 to September2018 at Beijing Jishuitan Hospital. All cases of BMI was( 23. 8 ± 3. 2) kg/m2. Among them,9 males and8 females. The bearing surfaces were 5 metal-on-metal( MOM) and 12 metal-on-polyethylene( MOP),respectively. There was no other cobalt,chrome,molybdenum based implants. Intra-operatively,sample tissue around the prosthesis were taken and sent for pathological examination. ALVAL scores were given according to the Campbell-ALVAL scoring system. Correlation between metal ion levels and ALVAL scores were analyzed by SPSS software. Results Among the 17 cases,with the Campell-ALVAL score was 4 in one case,5 in one case,6 in 6 cases,7 in 7 cases,8 in one case,and 9 in one case. There was no correlation between metal ion levels and ALVAL score both MOP and MOM( r = 0. 09,0. 26,P > 0. 05). There was a correlation between serum cobalt and chromium metal ion levels( r = 0. 836,P < 0. 001). Conclusion The diagnosis of ALVAL is still based on pathological examination under the microscope. There is no significant correlation between ALVAL score and serum metal ion levels. This suggests that metal ion levels are not an independent mechanism of ALVAL,and not suitable as a predictor of ALVAL and as an indication for revision surgery alone.
Objective To investigate the correlation between serum cobalt-chromium metal ion levels in peripheral blood and the severity of ALVAL around the prosthesis of patients after revision total hip arthroplasty.Methods Seventeen patients after revision hip arthroplasty with preoperative serum cobalt and chromium concentrations elevated above the Mayo Clinic reference standard were included from January 2015 to September2018 at Beijing Jishuitan Hospital. All cases of BMI was( 23. 8 ± 3. 2) kg/m2. Among them,9 males and8 females. The bearing surfaces were 5 metal-on-metal( MOM) and 12 metal-on-polyethylene( MOP),respectively. There was no other cobalt,chrome,molybdenum based implants. Intra-operatively,sample tissue around the prosthesis were taken and sent for pathological examination. ALVAL scores were given according to the Campbell-ALVAL scoring system. Correlation between metal ion levels and ALVAL scores were analyzed by SPSS software. Results Among the 17 cases,with the Campell-ALVAL score was 4 in one case,5 in one case,6 in 6 cases,7 in 7 cases,8 in one case,and 9 in one case. There was no correlation between metal ion levels and ALVAL score both MOP and MOM( r = 0. 09,0. 26,P > 0. 05). There was a correlation between serum cobalt and chromium metal ion levels( r = 0. 836,P < 0. 001). Conclusion The diagnosis of ALVAL is still based on pathological examination under the microscope. There is no significant correlation between ALVAL score and serum metal ion levels. This suggests that metal ion levels are not an independent mechanism of ALVAL,and not suitable as a predictor of ALVAL and as an indication for revision surgery alone.
引文
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[13]Almousa SA,Greidanus NV,Masri BA,et al.The natural history of inflammatory pseudotumors in asymptomatic patients after metal-onmetal hip arthroplasty[J].Clin Orthop Relat Res,2013,471(12):3814-3821.DOI:10.1007/s11999-013-2944-4.
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[16]Magone K,Luckenbill D,Goswami T.Metal ions as inflammatory initiators of osteolysis[J].Arch Orthop Trauma Surg,2015,135(5):683-695.DOI:10.1007/s00402-015-2196-8.
[17]Hallab NJ,Cunningham BW,Jacobs JJ.Spinal implant debrisinduced osteolysis[J].Spine(Phila Pa 1976),2003,28(20):S125-138.PMID:14560184.
[18]Yan Y,Neville A,Dowson D.Understanding the role of corrosion in the degradation of metal-on-metal implants[J].Proc Inst Mech Eng H,2006,220(2):173-181.DOI:10.1243/095441105X63246.
[19]Macdonald SJ.Can a safe level for metal ions in patients with metalon-metal total hip arthroplasties be determined?[J].JArthroplasty,2004,19(8 Suppl 3):71-77.PMID:15578557.
[20]Craig P,Bancroft G,Burton A,et al.Raised levels of metal ions in the blood in patients who have undergone uncemented metal-onpolyethylene Trident-Accolade total hip replacement[J].Bone Joint J,2014,96-B(1):43-47.DOI:10.1302/0301-620X.96B1.30923.
[21]Kwon YM,Macauliffe J,Arauz PG,et al.Sensitivity and specificity of metal ion level in predicting adverse local tissue reactions due to head-neck taper corrosion in primary metal-on-polyethylene total hip arthroplasty[J].J Arthroplasty,2018,33(9):3025-3029.DOI:10.1016/j.arth.2018.04.007.
[22]Savarino L,Granchi D,Ciapetti G,et al.Ion release in patients with metal-on-metal hip bearings in total joint replacement:a comparison with metal-on-polyethylene bearings[J].J Biomed Mater Res,2002,63(5):467-474.DOI:10.1002/jbm.10299.
[23]Plummer DR,Yi PH,Jacobs JJ,et al.Aseptic lymphocytic-dominated vasculitis-associated lesions scores do not correlate with metal ion levels or unreadable synovial fluid white blood cell counts[J].JArthroplasty,2017,32(4):1340-1343.DOI:10.1016/j.arth.2016.11.020.3
[24]Molloy DO,Munir S,Jack CM,et al.Fretting and corrosion in modular-neck total hip arthroplasty femoral stems[J].J Bone Joint Surg Am,2014,96(6):488-493.DOI:10.2106/JBJS.L.01625.
[25]Mc Grory BJ,Payson AM,Mac Kenzie JA.Elevated intra-articular cobalt and chromium levels in mechanically assisted crevice corrosion in metal-on-polyethylene total hip arthroplasty[J].J Arthroplasty,2017,32(5):1654-1658.DOI:10.1016/j.arth.2016.11.056.
[26]Campbell PA,Kung MS,Hsu AR,et al.Do retrieval analysis and blood metal measurements contribute to our understanding of adverse local tissue reactions?[J].Clin Orthop Relat Res,2014,472(12):3718-3727.DOI:10.1007/s11999-014-3893-2.
[27]Liow MHL,Urish KL,Preffer FI,et al.Metal ion levels are not correlated with histopathology of adverse local tissue reactions in taper corrosion of total hip arthroplasty[J].J Arthroplasty,2016,31(8):1797-1802.DOI:10.1016/j.arth.2016.01.041.
[28]Mcalister IP,Abdel MP.Elevated serum titanium level as a marker for failure in a titanium modular fluted tapered stem[J].Orthopedics,2016,39(4):e768-770.DOI:10.3928/01477447-20160503-02.
[29]Savarino L,Tigani D,Greco M,et al.The potential role of metal ion release as a marker of loosening in patients with total knee replacement:a cohort study[J].J Bone Joint Surg Br,2010,92(5):634-638.DOI:10.1302/0301-620X.92B5.23452.
[2]Mcgrory BJ,Mackenzie J,Babikian G.A high prevalence of corrosion at the head-neck taper with contemporary Zimmer noncemented femoral hip components[J].J Arthroplasty,2015,30(7):1265-1268.DOI:10.1016/j.arth.2015.02.019.
[3]Cooper HJ,Della Valle CJ,Berger RA,et al.Corrosion at the headneck taper as a cause for adverse local tissue reactions after total hip arthroplasty[J].J Bone Joint Surg Am,2012,94(18):1655-1661.DOI:10.2106/JBJS.K.01352.
[4]Campbell P,Ebramzadeh E,Nelson S,et al.Histological features of pseudotumor-like tissues from metal-on-metal hips[J].Clin Orthop Relat Res,2010,468(9):2321-2327.DOI:10.1007/s11999-010-1372-y.
[5]Cadosch D,Chan E,Gautschi OP,et al.Metal is not inert:role of metal ions released by biocorrosion in aseptic loosening:current concepts[J].J Biomed Mater Res A,2009,91(4):1252-1262.DOI:10.1002/jbm.a.32625.
[6]Plummer DR,Berger RA,Paprosky WG,et al.Diagnosis and management of adverse local tissue reactions secondary to corrosion at the head-neck junction in patients with metal on polyethylene bearings[J].J Arthroplasty,2016,31(1):264.DOI:10.1016/j.arth.2015.07.039.
[7]Polyzois I,Nikolopoulos D,Michos I,et al.Local and systemic toxicity of nanoscale debris particles in total hip arthroplasty[J].JAppl Toxicol,2012,32(4):255-269.DOI:10.1002/jat.2729.
[8]Kwon YM,Ostlere SJ,Mclardy-Smith P,et al."Asymptomatic"pseudotumors after metal-on-metal hip resurfacing arthroplasty:prevalence and metal ion study[J].J Arthroplasty,2011,26(4):511-518.DOI:10.1016/j.arth.2010.05.030.
[9]Mayo Clinic Mayo medical laboratories[EB/OL].(2015-01-01)[2018-10-25]http://www.mayo medical laboratories.com/index.html.
[10]Parvizi J,Zmistowski B,Berbari EF,et al.New definition for periprosthetic joint infection:from the workgroup of the musculoskeletal infection society[J].Clin Orthop Relat Res,2011,26(8):1136-1138.DOI:10.1016/j.arth.2011.09.026.
[11]王耐芬,王小燕,欧阳荔,等.DRCⅡ型ICP-MS分析技术及其应用[J].现代仪器与医疗,2004,10(1):37-39.DOI:10.3969/j.issn.1672-7916.2004.01.010.
[12]Ebramzadeh E,Campbell PA,Takamura KM,et al.Failure modes of433 metal-on-metal hip implants:how,why,and wear[J].Orthop Clin North Am,2011,42(2):241-250.DOI:10.1016/j.ocl.2011.01.001.
[13]Almousa SA,Greidanus NV,Masri BA,et al.The natural history of inflammatory pseudotumors in asymptomatic patients after metal-onmetal hip arthroplasty[J].Clin Orthop Relat Res,2013,471(12):3814-3821.DOI:10.1007/s11999-013-2944-4.
[14]Bolland BJ,Culliford DJ,Langton DJ,et al.High failure rates with a large-diameter hybrid metal-on-metal total hip replacement:clinical,radiological and retrieval analysis.[J].J Bone Joint Surg Br,2011,93(5):608-615.DOI:10.1302/0301-620X.93B5.26309.
[15]Kwon YM,Glyn-Jones S,Simpson DJ,et al.Analysis of wear of retrieved metal-on-metal hip resurfacing implants revised due to pseudotumours[J].J Bone Joint Surg Br,2010,92(3):356-361.DOI:10.1302/0301-620X.92B3.23281.
[16]Magone K,Luckenbill D,Goswami T.Metal ions as inflammatory initiators of osteolysis[J].Arch Orthop Trauma Surg,2015,135(5):683-695.DOI:10.1007/s00402-015-2196-8.
[17]Hallab NJ,Cunningham BW,Jacobs JJ.Spinal implant debrisinduced osteolysis[J].Spine(Phila Pa 1976),2003,28(20):S125-138.PMID:14560184.
[18]Yan Y,Neville A,Dowson D.Understanding the role of corrosion in the degradation of metal-on-metal implants[J].Proc Inst Mech Eng H,2006,220(2):173-181.DOI:10.1243/095441105X63246.
[19]Macdonald SJ.Can a safe level for metal ions in patients with metalon-metal total hip arthroplasties be determined?[J].JArthroplasty,2004,19(8 Suppl 3):71-77.PMID:15578557.
[20]Craig P,Bancroft G,Burton A,et al.Raised levels of metal ions in the blood in patients who have undergone uncemented metal-onpolyethylene Trident-Accolade total hip replacement[J].Bone Joint J,2014,96-B(1):43-47.DOI:10.1302/0301-620X.96B1.30923.
[21]Kwon YM,Macauliffe J,Arauz PG,et al.Sensitivity and specificity of metal ion level in predicting adverse local tissue reactions due to head-neck taper corrosion in primary metal-on-polyethylene total hip arthroplasty[J].J Arthroplasty,2018,33(9):3025-3029.DOI:10.1016/j.arth.2018.04.007.
[22]Savarino L,Granchi D,Ciapetti G,et al.Ion release in patients with metal-on-metal hip bearings in total joint replacement:a comparison with metal-on-polyethylene bearings[J].J Biomed Mater Res,2002,63(5):467-474.DOI:10.1002/jbm.10299.
[23]Plummer DR,Yi PH,Jacobs JJ,et al.Aseptic lymphocytic-dominated vasculitis-associated lesions scores do not correlate with metal ion levels or unreadable synovial fluid white blood cell counts[J].JArthroplasty,2017,32(4):1340-1343.DOI:10.1016/j.arth.2016.11.020.3
[24]Molloy DO,Munir S,Jack CM,et al.Fretting and corrosion in modular-neck total hip arthroplasty femoral stems[J].J Bone Joint Surg Am,2014,96(6):488-493.DOI:10.2106/JBJS.L.01625.
[25]Mc Grory BJ,Payson AM,Mac Kenzie JA.Elevated intra-articular cobalt and chromium levels in mechanically assisted crevice corrosion in metal-on-polyethylene total hip arthroplasty[J].J Arthroplasty,2017,32(5):1654-1658.DOI:10.1016/j.arth.2016.11.056.
[26]Campbell PA,Kung MS,Hsu AR,et al.Do retrieval analysis and blood metal measurements contribute to our understanding of adverse local tissue reactions?[J].Clin Orthop Relat Res,2014,472(12):3718-3727.DOI:10.1007/s11999-014-3893-2.
[27]Liow MHL,Urish KL,Preffer FI,et al.Metal ion levels are not correlated with histopathology of adverse local tissue reactions in taper corrosion of total hip arthroplasty[J].J Arthroplasty,2016,31(8):1797-1802.DOI:10.1016/j.arth.2016.01.041.
[28]Mcalister IP,Abdel MP.Elevated serum titanium level as a marker for failure in a titanium modular fluted tapered stem[J].Orthopedics,2016,39(4):e768-770.DOI:10.3928/01477447-20160503-02.
[29]Savarino L,Tigani D,Greco M,et al.The potential role of metal ion release as a marker of loosening in patients with total knee replacement:a cohort study[J].J Bone Joint Surg Br,2010,92(5):634-638.DOI:10.1302/0301-620X.92B5.23452.