Kim Young-Jo, Kassab Farid, Berven Sigurd H, Zurakowski David, Hresko M Timothy, Emans John B, Kasser James R
Children's Hospital-Boston, Department of Orthopaedic Surgery, 300 Longwood Avenue, Hunnewell 225, Boston MA 02115, USA.
Spine (Phila Pa 1976). 2005 Apr 15;30(8):923-6. doi: 10.1097/01.brs.0000158872.42802.be.
Cross-sectional study of 37 patients to measure serum levels of nickel and chromium after posterior spinal arthrodesis using stainless steel implants.
To investigate the relationship between factors such as age, gender, pain, time from surgery, length of arthrodesis, and level of arthrodesis to serum metal ion levels after instrumented spinal arthrodesis.
Measurable levels of metal ions in the serum can be detected after the use of stainless steel implants. There is some evidence to suggest that long-term exposure can potentially be toxic. Posterior spinal arthrodesis with stainless steel implants is a common procedure to treat spinal deformity in the adolescent population; however, the extent of metal ion exposure after posterior spinal arthrodesis is unknown.
Patients that underwent posterior instrumented spinal arthrodesis with more than 6 months follow-up were recruited for this study. Patients with altered neurologic function were excluded. Serum levels of nickel and chromium were measured using inductively coupled plasma mass spectrometry. Pain was assessed using the Oswestry questionnaire. Spine radiographs were used to look for evidence of pseudarthrosis. Forty-five patients were approached, and 37 agreed to the questionnaire and blood test. Ten patients were men and 27 were women. Mean age at surgery was 14 years with mean follow-up of 6 years. Statistical correlations between serum metal ion levels and age at surgery, time from surgery, gender, number of segments fused, spinal instrument interfaces, pain, and instrumentation type were assessed.
Abnormally high levels of nickel and chromium above normal levels (0.3 ng/mL for nickel, 0.15 ng/mL for chromium) could be detected in serum after posterior spinal arthrodesis using stainless steel implants. There was a significant inverse correlation between serum nickel (r = -0.61, P < 0.001) and chromium (r = -0.64, P < 0.001) levels and time from surgery. When patients were grouped based on lengths of time from surgery, 0 to 2 years (n = 7), 2 to 4 years (n = 11), and >4 years (n = 8), the mean +/- SD for nickel (ng/mL) was 3.8 +/- 2.6, 1.3 +/- 1.1, and 0.9 +/- 0.8, respectively. Analysis ofvariance revealed significant group differences (P =0.004). Similarly, the chromium levels were 2.7 +/- 2.7, 0.6 +/- 0.4, and 0.3 +/- 0.3, respectively (P = 0.018). Only time from surgery was a significant multivariate predictor of nickel and chromium serum levels. Pseudarthrosis was not seen in this cohort.
Elevated levels of nickel and chromium can be measured after posterior instrumented spinal arthrodesis. The levels diminish rapidly with time from surgery but still remained above normal levels 4 years after surgery. Long-term implication of this metal ion exposure is unknown and should be studied further.
对37例患者进行横断面研究，以测量使用不锈钢植入物进行后路脊柱融合术后镍和铬的血清水平。
探讨年龄、性别、疼痛、手术时间、融合长度和融合节段水平等因素与器械辅助脊柱融合术后血清金属离子水平之间的关系。
使用不锈钢植入物后，血清中可检测到可测量水平的金属离子。有证据表明长期接触可能具有潜在毒性。不锈钢植入物后路脊柱融合术是治疗青少年脊柱畸形的常见手术；然而，后路脊柱融合术后金属离子暴露的程度尚不清楚。
招募接受后路器械辅助脊柱融合术且随访超过6个月的患者进行本研究。排除神经功能改变的患者。使用电感耦合等离子体质谱法测量血清镍和铬水平。使用Oswestry问卷评估疼痛。脊柱X线片用于寻找假关节的证据。共联系了45例患者，37例同意填写问卷并接受血液检查。其中10例为男性，27例为女性。手术时的平均年龄为14岁，平均随访6年。评估血清金属离子水平与手术时年龄、手术时间、性别、融合节段数、脊柱器械接口、疼痛和器械类型之间的统计相关性。
使用不锈钢植入物进行后路脊柱融合术后，血清中可检测到镍和铬水平异常高于正常水平（镍为0.3 ng/mL，铬为0.15 ng/mL）。血清镍（r = -0.61，P < 0.001）和铬（r = -0.64，P < 0.001）水平与手术时间呈显著负相关。当根据手术时间分组时，0至2年（n = 7）、2至4年（n = 11）和>4年（n = 8），镍（ng/mL）的平均值±标准差分别为3.8±2.6、1.3±1.1和0.9±0.8。方差分析显示组间差异显著（P = 0.004）。同样，铬水平分别为2.7±2.7、0.6±0.4和0.3±0.3（P = 0.018）。只有手术时间是镍和铬血清水平的显著多变量预测因子。该队列中未发现假关节。
后路器械辅助脊柱融合术后可测量到镍和铬水平升高。这些水平随手术时间迅速下降，但术后4年仍高于正常水平。这种金属离子暴露的长期影响尚不清楚，应进一步研究。
