人工全髋关节翻修术患者血清金属离子浓度与假体周围组织病理学改变的相关性分析  

The correlation analysis of serum metal ion concentration and metal particles with histopathological features in patients with revision total hip arthroplasty

作　　者：宫丽华[1] 陈曦[2] 顾建明[2] 邵宏翊[2] 周一新[2] 丁宜[1] Gong Lihua;Chen Xi;Gu Jianming;Shao Hongyi;Zhou Yixin;Ding Yi(Department of Pathology,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院病理科,100035 [2]北京积水潭医院矫形骨科,100035

出　　处：《骨科临床与研究杂志》2020年第3期176-182,共7页Journal Of Clinical Orthopedics And Research

基　　金：国家食品药品监督管理总局“十三五”医疗器械重点监测工作项目;北京积水潭医院FRCS人才培训基金。

摘　　要：目的分析人工全髋关节翻修术患者血清金属钴、铬、钛离子浓度与假体周围组织中坏死、组织细胞增生及淋巴细胞聚集的相关性。方法纳入2015年1月至2018年9月北京积水潭医院矫形骨科人工全髋关节翻修术患者18例。男、女各9例;平均年龄59岁(43~73岁);右髋11例,左髋7例。其中6例假体为金属对金属界面,12例假体为金属对聚乙烯界面。对所有患者进行术前血清钴、铬、钛离子浓度检测并采集术中假体周围组织标本。对假体周围组织的坏死、组织细胞增生及金属颗粒数量进行半定量分析,同时应用牛津无菌性淋巴细胞为主型血管炎相关病变(Oxford-ALVAL)评分系统对血管周淋巴细胞聚集进行分级。采用Spearman秩相关分析及Kendall's tau-b等级相关分析方法对血清钴、铬、钛离子浓度与假体周围组织中金属颗粒数量、坏死程度、组织细胞增生及淋巴细胞分布的相关性进行分析。结果血清中金属离子浓度铬(6.53±11.95)μg/L,钴(4.94±5.27)μg/L,钛(119.41±40.51)μg/L。假体周围组织坏死1级、2级各1例,3级3例,4级13例;组织细胞增生0级1例,1级2例,2级7例,3级7例,4级1例;淋巴细胞聚集0级1例,1级11例,2级5例,3级1例;金属颗粒数量0级1例,1级2例,2级5例,3级4例,4级6例。假体周围组织中的金属颗粒数量与血清铬、钴、钛离子浓度相关(P=0.042、0.038、0.004),与组织细胞增生和淋巴细胞聚集相关(P=0.004、0.002)。结论人工髋关节假体周围组织中金属颗粒可能导致组织细胞增生,其致敏性可能引起血管周淋巴细胞聚集。Objective To evaluate the correlation of serum metal ion levels and metal particles with histopathological features in patients with revised total hip arthroplasty(THA).Methods Eighteen cases of total revised THA in Department of Orthopedic Surgery of Beijing Jishuitan Hospital between January 2015 and September 2018 were collected.There were 9 males and 9 females.Patients'age ranged from 43 to 73 years(mean 59 years).All cases included 6 metal-on-metal(MOM)and 12 metal-on-polyethylene(MOP)THA.The preoperative serum metal ion concentrations were detected.Under the optical microscope,the metal particles appeared small black granules.The semi-quantitative analysis of tissue necrosis,macrophage cell,metal particles and lymphocyte were conducted.Correlation between serum metal ion levels and histopathological features were analyzed.Results The serum concentrations of metal ion showed:Cr:(6.53±11.95)μg/L;Co:(4.94±5.27)μg/L;Ti:(119.41±40.51)μg/L.The grades of tissue necrosis included grade one(n=2),grade 2(n=1),grade 3(n=3),grade 4(n=13).The grades of macrophage cells included grade 0(n=1),grade one(n=2),grade 2(n=7),grade 3(n=7),grade 4(n=1).The grades of metal particles included grade 0(n=1),grade one(n=2),grade 2(n=5),grade 3(n=4),grade 4(n=6).The grades of lymphocytes proliferation included grade 0(n=1),grade one(n=11),grade 2(n=5),grade 3(n=1).The metal particles in the tissue were correlated to serum metal ion levels,macrophage cells and lymphocytes proliferation.Conclusion The serum metal ion may result the metal particles deposited in the tissue and induce proliferation of macrophage cells and lymphocytes.

关 键 词：关节成形术 置换 髋 金属 离子 血清 坏死 细胞增殖 淋巴细胞 组织分布 

分 类 号：R73[医药卫生—肿瘤]