采用金属对金属锥形耳轴连接的模块化髋关节半置换术系列病例:它们是金属颗粒释放的来源吗?

IF 4.9 1区 医学 Q1 ORTHOPEDICS
Neil Chotai, Rajiv Kaila, Hannah Wilson, Rajib Pradhan, Vipin Asopa, George Grammatopoulos, A J Andrade
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引用次数: 0

摘要

目的:髋关节置换术是治疗囊内移位型股骨颈骨折的常用方法。模块化半关节置换术有独立的髋关节、颈部和头部组成部分,这给外科医生提供了更多的组合,以尝试准确地重建患者原始的髋关节几何形状。尽管经常使用,但在这种特殊情况下对金属对金属碎片磨损的敏感性知之甚少。方法:这项单中心、为期两年的前瞻性队列研究旨在描述金属碎片(ARMD)在未胶结CORAIL假体和Cathcart模块头髋关节置换术中的体内磨损和相关不良反应。患者平均年龄为80.5岁(62 ~ 96岁),平均随访时间为2.2年(1.0 ~ 4.6年)。总的来说,54例患者进行了临床、放射学和血清金属离子(铬(Cr)和钴(Co))评估。在随访中,放射学证据对髋臼糜烂进行分级(0到3:正常到突出)。根据现行药品和保健产品监管机构的指导方针,如果金属离子水平≥7 ppb,则被认为是高水平。结果:ppb最终Cr和Co水平为0.26 (IQR为1.33;95% CI 0.67 ~ 5.16)和0.68 (IQR 2.52;95% CI分别为1.25 ~ 3.30)。平均一年牛津髋关节评分为35 (SD 10)。27例(50%)患者髋臼糜烂。所有8例(14.8%)高金属离子水平患者均伴有髋臼糜烂,其中4例(50%)有ARMD病变。高金属离子水平患者与低金属离子水平患者具有相似的头大小、相同的锥度、相似的OHS和相似的骨折前活动能力。结论:与接受全髋关节置换术的患者相比,模块化髋关节置换术患者尽管活动量较少,但仍可能容易发生金属病和ARMD。髋臼侵蚀与金属离子水平升高的风险增加2.5倍有关,但因果关系尚未确定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A case series of modular hip hemiarthroplasties employing a metal-on-metal taper-trunnion junction : are they a source of metal particle release?

Aims: Hip hemiarthroplasty is a common procedure in the treatment of intracapsular displaced femoral neck fractures. Modular hemiarthroplasties have a separate stem, neck, and head component which gives the surgeon more combinations to try and accurately recreate the patient's original hip geometry. Despite regular use, little is known regarding susceptibility to metal-on-metal debris wear in this specific situation.

Methods: This single-centre, two-year prospective cohort study aimed to characterize in vivo wear and associated adverse reaction to metal debris (ARMD) in an uncemented CORAIL stem and Cathcart modular head hip hemiarthroplasty. The mean patient age was 80.5 years (62 to 96) and mean follow-up 2.2 years (1.0 to 4.6). Overall, 54 patients had a clinical, radiological, and serum metal ion (chromium (Cr) and cobalt (Co)) assessment. At follow-up radiological evidence of acetabular erosion was graded (0 to 3: normal to protrusio). Metal ion levels were considered high if ≥ 7 ppb as per current Medicines and Healthcare products Regulatory Agency guidelines.

Results: Final Cr and Co levels in ppb were 0.26 (IQR 1.33; 95% CI 0.67 to 5.16) and 0.68 (IQR 2.52; 95% CI 1.25 to 3.30), respectively. The mean one-year Oxford Hip Score was 35 (SD 10). Acetabular erosion was detected in 27 patients (50%). All eight patients (14.8%) with high metal ion levels had associated acetabular erosion, of which four (50%) had an ARMD lesion. Patients with high metal ion levels had a similar head size with the same taper size, similar OHS, and similar pre-fracture mobility to those with low metal ion levels.

Conclusion: Modular hip hemiarthroplasty patients may be susceptible to metallosis and ARMD despite being less active individuals than those who receive a total hip arthroplasty. Acetabular erosion was associated with a 2.5-times increased risk of raised metal ion levels but cause and effect have not been established.

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来源期刊
Bone & Joint Journal
Bone & Joint Journal ORTHOPEDICS-SURGERY
CiteScore
9.40
自引率
10.90%
发文量
318
期刊介绍: We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.
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