金属-金属界面髋关节置换后的血清金属离子水平测定及分析  

Detection and analysis of serum metal ions concentration level after metal-to-metal hip arthroplasty

作　　者：崔鹏[1] 姜文学[2] 范猛[2] 万彦林 

机构地区：[1]天津市天津医院骨科,天津市300211 [2]天津市第一中心医院骨科,天津市300192

出　　处：《中国组织工程研究》2016年第53期7909-7916,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:金属-金属髋关节假体适合活动量较大年轻患者,但界面之间摩擦会导致金属碎屑释放金属离子入血,准确的测定及分析有助于指导临床操作。目的:采用电感耦合等离子体质谱仪测定髋关节表面置换及金属-金属全髋置换患者不同时间血清钴(Co)、铬(Cr)、钼(Mo)离子水平并对比探讨其影响因素。方法:纳入髋关节表面置换患者共32例40髋,金属-金属全髋置换患者12例14髋,将6例正常人血清金属离子水平均值作为正常参考值,所有患者置换后均通过X射线及CT测量假体位置,应用电感耦合等离子体质谱仪(ICP-MS)可较准确测定髋关节置换后患者的血清金属离子水平。结果与结论:表面置换假体Co离子水平置换后1年到达顶峰,较正常值高7.7倍;Cr离子水平置换后9个月到达顶峰,为正常值7.5倍;Mo离子水平总体为上升趋势,置换后5年为正常7.8倍(P<0.05)。全髋置换后5年Co、Cr离子水平分别为正常值10.6倍和9.8倍。应用电感耦合等离子体质谱仪可较准确测定髋关节置换后患者的血清金属离子水平,表面置换血清Co金属离子置换后1年到达峰值,Cr离子置换后9个月到达峰值,置换后5年趋于平稳。置换后5年全髋置换离子水平略高于表面置换。结果证实,金属-金属界面假体髋关节置换后金属离子水平较正常明显升高,且存在较明显的上升与趋于平稳的趋势,浓度高低与髋臼假体位置有密切关系,并受置换后关节功能影响明显。BACKGROUND： Metal-metal hip prosthesis is suitable for young patients with a large amount of activity, but the friction between the interface will lead to metal debris, and release metal ions into blood. Accurate determination and analysis will help to direct clinical operation.OBJECTIVE： To determine serum cobalt（Co）, chromium（Cr）, and molybdenum（Mo） ion levels at various time points in patients resurfacing arthroplasty of the hip（RSAH） and metal-metal total hip arthroplasty（M-MTHR） by inductively coupled plasma mass spectrometry（ICP-MS）, and analyze the influential factors. METHODS： We included 32 patients undergoing RSAH（40 hips） and 12 patients undergoing M-M THR（14 hips）. Average metal ion value of six normal people was considered as normal reference value. Prosthesis position was measured by using X-ray and CT after replacement. ICP-MS could accurately determine serum metal ion levels in patients after hip arthroplasty. RESULTS AND CONCLUSION： The concentrations of serum Co ion reached the peak at 1 year after operation, which was 7.7-fold relative to normal people. Cr ion reached its peak at 9 months after operation, which was 7.5-fold relative to normal people. Mo ion concentration kept the increased trend, reached 7.8-fold 5 years after replacement relative to normal people（P〈0.05）. Five years after total hip arthroplasty, Co and Cr ions concentrations were 10.6-fold and 9.8-fold relative to normal people, respectively. ICP-MS could precisely measure serum metal ion levels after hip arthroplasty. Serum Co ions reached a peak at 1 year, and Cr ions reached a peak at 9 months, and stabilized after 5 years. Above ion levels were slightly higher than that of RSAH. These findings concluded that metal ion concentrations rose obviously compared to the normal level after metal-metal hip prosthesis, and had an obvious trend of increasing and stability. The concentrations had close relationship with the acetabulum prosthesis position, and affected by the joint function

关 键 词：组织工程 髋关节 髋臼 骨科植入物 人工假体 表面置换 全髋置换 金属-金属界面 金属离子 髋臼前倾角 髋臼外展角 Harris评分 电感耦合等离子体质谱仪 

分 类 号：R318[医药卫生—生物医学工程]