Miki Hidenobu, Sugano Nobuhiko, Yamamura Mitsuyoshi, Nakamura Nobuo, Nishii Takashi, Yoshikawa Hideki
Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Osaka, Japan.
Arch Orthop Trauma Surg. 2006 Apr;126(3):192-6. doi: 10.1007/s00402-006-0112-y. Epub 2006 Feb 24.
We reported a rare revision case necessitated by massive metallosis of a metal head due to a fragmented ceramic screw which had been extraarticularily used in the primary THA here and reviewed previous literature about metallosis of metal heads associated with ceramic materials. The ceramic screw had been used for the fixation of a bone graft and reattachment of the greater trochanter in the primary THA. Scanning electron microscope analysis revealed large alumina ceramic particles embedded on the bearing surface of the polyethylene. It has previously been pointed out that metallosis of an inner head occurred in bipolar case due to a fracture of the ceramic screws in contact with a proximally migrated outer head. However, this case showed that if a ceramic screw fragmented even though it was used outside of the hip joint, the fragments could migrate into bearing surface and cause serious metallosis of the metal head. Thus, we recommend that surgeons should pay special attention to the radiographic signs of ceramic failure or metallosis such as a change of the metal head contour, if an aseptic loosening or severe osteolysis is observed in a THA in which ceramic materials were used near the hip joint. And, when a surgical revision is planned, the surgeon should be prepared to exchange with a new ceramic head.
我们报告了一例罕见的翻修病例，该病例是由于在初次全髋关节置换术（THA）中外侧使用的陶瓷螺钉破碎导致金属股骨头出现大量金属沉着病而必须进行翻修，并回顾了先前关于与陶瓷材料相关的金属股骨头金属沉着病的文献。该陶瓷螺钉在初次THA中用于固定骨移植和重新附着大转子。扫描电子显微镜分析显示，聚乙烯的承重表面嵌入了大量氧化铝陶瓷颗粒。此前曾指出，在双极病例中，由于与近端移位的外侧股骨头接触的陶瓷螺钉断裂，内侧股骨头会发生金属沉着病。然而，该病例表明，如果陶瓷螺钉即使在髋关节外使用时破碎，碎片也可能迁移到承重表面并导致金属股骨头严重的金属沉着病。因此，我们建议，如果在髋关节附近使用陶瓷材料的THA中观察到无菌性松动或严重骨溶解，外科医生应特别注意陶瓷失效或金属沉着病的影像学征象，如金属股骨头轮廓的变化。并且，当计划进行手术翻修时，外科医生应准备好更换新的陶瓷股骨头。
