全膝关节表面置换术后金属过敏的研究现状  

Current research statuse of metal hypersensitivity after total knee arthroplasty

作　　者：张笑[1] 彭慧明[1] 边焱焱[1] 翁习生[1] ZHANG Xiao;PENG Huiming;BIAN Yanyan;WENG Xisheng(Department of Orthopaedics,Peking Union Medical College Hospital,CAMS ＆ PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院骨科,北京100730

出　　处：《中华骨与关节外科杂志》2018年第7期546-550,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：骨科医生使用金属假体实施人工髋、膝关节置换术的历史已经超过40年。全髋关节置换术(total hip arthroplasy,THA)及全膝关节表面置换术(total knee arthroplasty,TKA)是治疗终末期髋膝疾病极为有效的方法,但术后在部分患者中会出现不明原因的皮肤红斑、湿疹、关节疼痛、活动度受限的症状,甚至需要再次手术。20年前,Merritt针对这种表现提出了假体金属过敏的解释,但到目前为止,假体金属过敏的话题仍具有争议。主要原因是其发病率低,临床表现不特异,缺乏较特异的实验室检查,且难以与其他TKA术后并发症相鉴别。因此,TKA术后金属过敏的诊断仍需在除外其他诊断以后做出。斑贴试验虽是诊断Ⅳ型超敏反应的金标准,但目前共识并不推荐术前常规筛查。在治疗上,局部激素治疗皮炎反应被认为是有效的[1],但若出现严重滑膜炎、关节功能障碍时,保守治疗往往没有效果,最终需要使用不含过敏原的假体或涂层假体进行翻修手术,通常会得到疼痛缓解、活动度提升的结果。Metallic components have been used in hip or knee arthroplasty for over 40 years.Total hip arthroplasty（THA）and total knee arthroplasty（TKA） are the common surgeries that reduce the critical pain and improve the quality of the life in patients who suffer from the joint disorders.Several reports of persistent localized or systemic skin reactions such as dermatitis after TKA have appeared in the dermatology literature.Metal hypersensitivity is a potential complication of TKA.It occurs rarely and unpredictably,but can result in severe joint dysfunction and implant failure.The diagnosis of the metal hypersensitivity is difficult,because of the clinic syndromes are not specific,and the lack of robust clinical validation of the utility of cutaneous and in vitro testing.The diagnosis of the metal hypersensitivity after TKA should be considered after eliminating other causes of pain and swelling,such as low-grade infection.The pathophysiology of this implant-related hypersensitivity is generally a type Ⅳ allergic reaction.The patching test is the golden standard of the type Ⅳ allergic reaction,but the value of the patching test for predicting metal hypersensitivity before TKA is not confirmed.If metal hypersensitivity is suspected and nonsurgical measures have failed,as the last choice,revision to components fabricated of titanium alloy or zirconium coating can be successful in relieving symptoms.

关 键 词：全膝关节表面置换术 金属过敏 Ⅳ型超敏反应 皮炎 滑膜炎 斑贴试验 

分 类 号：R687.4[医药卫生—骨科学]