Patton Michael S, Lyon Thomas D B, Ashcroft George P
Department of Orthopaedic Surgery, University of Aberdeen, Aberdeen.
Acta Orthop. 2008 Dec;79(6):820-5. doi: 10.1080/17453670810016911.
It is being increasingly recognized that orthopedic implants are associated with adverse tissue responses, mediated by degradation products. Recent interest has been focused on the production of metal ions from hip arthroplasty. Few studies have reviewed fracture fixation devices and their metal ion production.
61 subjects were enlisted into the study, with 3 subgroups. 21 subjects had Russell-Taylor intramedullary tibial nails in situ for 26 (21-32) months (316LVm stainless steel), 20 subjects had TriGen intramedullary tibial nails in situ for 43 (35-51) months (Ti-6Al-4V titanium alloy), and the remaining 20 subjects did not have any implant in situ and served as controls. Blood samples were taken and serum chromium, molybdenum, titanium, aluminium, and vanadium concentrations were measured using inductively coupled plasma (ICP) techniques.
The 3 groups were matched for age, sex, and BMI. The subjects with Russell-Taylor nails had elevated levels of chromium (0.10 microg/L) with median concentrations 2.5 times higher than those of the control group. The subjects with TriGen nails had less significantly elevated levels of titanium (6.5 microg/L).
Stainless steel implants show significant differences from titanium implants in the dissemination of metal ions. Although the levels of chromium were elevated, the overall levels were modest when compared to published data regarding metal ion release and hip arthroplasty. Intramedullary nails are, however, often used in younger patients. If not removed, they may result in prolonged exposure to metal ions.
人们越来越认识到骨科植入物会引发由降解产物介导的不良组织反应。最近的研究兴趣集中在髋关节置换术中金属离子的产生。很少有研究对骨折固定装置及其金属离子产生情况进行综述。
61名受试者被纳入研究，分为3个亚组。21名受试者原位植入Russell-Taylor胫骨髓内钉26（21 - 32）个月（316LVm不锈钢），20名受试者原位植入TriGen胫骨髓内钉43（35 - 51）个月（Ti-6Al-4V钛合金），其余20名受试者原位未植入任何植入物作为对照。采集血样，使用电感耦合等离子体（ICP）技术测量血清中铬、钼、钛、铝和钒的浓度。
3组在年龄、性别和体重指数方面相匹配。植入Russell-Taylor钉的受试者铬水平升高（0.10微克/升），中位数浓度比对照组高2.5倍。植入TriGen钉的受试者钛水平升高幅度较小（6.5微克/升）。
不锈钢植入物与钛植入物在金属离子扩散方面存在显著差异。尽管铬水平升高，但与已发表的关于金属离子释放和髋关节置换术的数据相比，总体水平适中。然而，髓内钉常用于年轻患者。如果不取出，可能会导致长期接触金属离子。
