人工全髋关节翻修术患者血清钴铬离子浓度与局部组织病理变化的关系

目的探讨人工全髋翻修术患者外周血血清钴铬离子水平与假体周围组织无菌性淋巴细胞为主型血管炎相关病变(ALVAL)的关系。方法纳入2015年1月至2018年9月在北京积水潭医院行人工髋关节翻修术且除髋关节假体外不携带其他含钴铬材料的内植物,术前血清钴、铬离子浓度高于梅奥诊所参考标准的患者17例。男9例,女8例。其中右侧髋关节10例,左侧7例。术中取假体周围组织行病理检查,按Campbell-ALVAL评分系统评分,通过SPSS软件分析金属离子水平与ALVAL评分之间的相关性。结果 17例患者体质量指数(BMI)(23. 8±3. 2) kg/m2。摩擦界面为金属-金属(MOM) 5例,金属-聚乙烯(MOP) 12例。病理Campbell-ALVAL评分4分1例,5分1例,6分6例,7分7例,8分1例,9分1例,MOP组和MOM组术前金属离子水平与ALVAL评分之间均无相关性(r分别为0. 09﹑0. 26,P> 0. 05);而钴和铬离子浓度之间存在相关关系(r=0. 836,P <0. 001)。结论 ALVAL的诊断仍以镜下病理检查为诊断依据,人工髋关节翻修术前的血清钴铬离子升高可以提示ALVAL的存在,钴和铬离子浓度之间存在相关关系,但其钴和铬离子浓度高低与ALVAL均无相关。这表明金属离子水平并不是ALVAL的独立作用机制,也不适合单独作为ALVAL的预测指标及翻修手术适应证选择。

Correlation between serum cobalt chromium ion concentration and local histopathological ALVAL score of patients after revision total hip arthroplasty

Objective To investigate the correlation between serum cobalt-chromium metal ion levels in peripheral blood and the severity of ALVAL around the prosthesis of patients after revision total hip arthroplasty.Methods Seventeen patients after revision hip arthroplasty with preoperative serum cobalt and chromium concentrations elevated above the Mayo Clinic reference standard were included from January2015to September2018at Beijing Jishuitan Hospital.All cases of BMI was(23.8±3.2)kg/m^2.Among them,9males and8females.The bearing surfaces were5metal-on-metal(MOM)and12metal-on-polyethylene(MOP),respectively.There was no other cobalt,chrome,molybdenum based implants.Intra-operatively,sample tissue around the prosthesis were taken and sent for pathological examination.ALVAL scores were given according to the Campbell-ALVAL scoring system.Correlation between metal ion levels and ALVAL scores were analyzed by SPSS software.Results Among the17cases,with the Campell-ALVAL score was4in one case,5in one case,6in6cases,7in7cases,8in one case,and9in one case.There was no correlation between metal ion levels and ALVAL score both MOP and MOM(r=0.09,0.26,P>0.05).There was a correlation between serum cobalt and chromium metal ion levels(r=0.836,P<0.001).Conclusion The diagnosis of ALVAL is still based on pathological examination under the microscope.There is no significant correlation between ALVAL score and serum metal ion levels.This suggests that metal ion levels are not an independent mechanism of ALVAL,and not suitable as a predictor of ALVAL and as an indication for revision surgery alone.