金属对金属髋关节假体置换术后的炎性假瘤

金属对金属髋关节假体置换因其低磨损、高稳定性及灵活性等优势受到髋部疾病患者尤其是年轻患者的青睐。但近年来越来越多的报道指出,部分患者在金属对金属髋关节假体置换术后于假体周围软组织出现金属碎屑不良反应(Adverse reactions to metal debris,ARMD),这一不良反应会诱发炎性假瘤的形成,最终导致较高的术后翻修率。这引发了医生和患者的广泛关注和担忧。因炎性假瘤导致的髋关节翻修术面临骨及周围软组织大量缺损、原有假体难以移除及翻修假体固定困难等巨大的失败风险,使金属对金属髋关节假体的应用受到了限制,临床医生的选择也更加谨慎。通过最新研究文献就金属对金属髋关节假体置换术后炎性假瘤形成的危险因素、诊断及治疗进行综述。髋关节假体周围炎性假瘤形成的危险因素主要包括金属离子浓度升高、假体植入位置及患者自身因素三个方面。其诊断主要依靠体格检查、影像学检查、实验室检查、关节镜检查及组织学检查等方法。针对临床有症状和无症状患者其治疗策略也不相同。通过对以上内容的详尽分析、评价及总结,旨在为临床髋关节置换假体的选择提供指导,同时为进一步探究ARMD引发炎性假瘤的机制奠定基础。

The inflammatory pseudotumor formed after metal-on-metal hip arthroplasty

Due to its advantages of low wear,high stability and flexibility,the new generation metal-on-metal hip prosthesis is favored by many patients with hip diseases,especially young patients.However,in recent years,several studies have indicated that adverse reactions to metal debris(ARMD)caused the formation of inflammatory pseudotumor,which ultimately led to a higher revision rate after metal-on-metal hip arthroplasty.This aroused the widespread concern from doctors and patients.Moreover,revision surgery for metal-on-metal hip arthroplasty in the setting of inflammatory pseudotumor is faced with a great risk of failure because of the large defects of bone and surrounding soft tissue and difficulty in removing the original prosthesis and the fixing of the modified prosthesis.Therefore,the use of such products is restricted with caution in their choice.We summarized the recent developments in the research in the risk factors,diagnosis and treatment of inflammatory pseudotumor after metal-on-metal hip arthroplasty.The risk factors for the formation of inflammatory pseudotumor around the hip prosthesis mainly include the increase of metal ion concentration,the position of prosthesis implantation and the patient's own factors.The diagnosis mainly depends on physical examination,imaging examination,laboratory examination,arthroscopy and histological examination.The treatment strategies for clinical symptomatic and asymptomatic patients are also varies.Through the detailed analysis,evaluation and summary of the above contents,we may provide guidance for the selection of hip prosthesis,and lay the foundation for further exploration of the mechanism of inflammatory pseudotumor caused by ARMD.