Cipriano Cara A, Issack Paul S, Beksac Burak, Della Valle Alejandro Gonzalez, Sculco Thomas P, Salvati Eduardo A
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Am J Orthop (Belle Mead NJ). 2008 Feb;37(2):E18-25.
Metal debris should not be generated in a well-fixed, well-functioning metal-on-polyethylene total hip arthroplasty. However, surgeons sometimes encounter periprosthetic metallosis during revision hip surgery. Insert wear, fracture, or dislodgment in modular components may lead to articulation of the prosthetic head with the metallic shell and subsequent metallosis. Metallosis may occur with loose acetabular components as a consequence of fretting of the screws and shell screw holes or shedding of the ingrowth surface of the component. The femoral component can also be a source of metallosis: Wear of a titanium femoral head, loosening of rough surface finish from the femoral stem, and stem fracture all may result in metallic particles being deposited in periarticular tissues. Specific clinical and radiographic findings can help in differentiating these forms of failure and in planning surgery. When metallic debris-induced bone loss is recognized early, surgical intervention may limit its progression.
在固定良好、功能正常的金属对聚乙烯全髋关节置换术中不应产生金属碎屑。然而，外科医生在髋关节翻修手术中有时会遇到假体周围金属沉着症。模块化组件的插入物磨损、断裂或移位可能导致假体头部与金属外壳发生摩擦，继而引发金属沉着症。髋臼组件松动时，由于螺钉与外壳螺孔之间的微动或组件长入表面的脱落，也可能发生金属沉着症。股骨组件也可能是金属沉着症的来源：钛合金股骨头的磨损、股骨柄粗糙表面涂层的松动以及股骨柄骨折都可能导致金属颗粒沉积在关节周围组织中。特定的临床和影像学表现有助于区分这些失败形式并制定手术方案。当早期识别出金属碎屑导致的骨质流失时，手术干预可能会限制其进展。
