Harvie P, Giele H, Fang C, Ansorge O, Ostlere S, Gibbons M, Whitwell D
Oxford Tumour and Joint Reconstruction Service, Nuffield Orthopaedic Centre, Oxford, UK.
Hip Int. 2008 Oct-Dec;18(4):313-20. doi: 10.1177/112070000801800408.
Concerns now exist about the long-term biological effects of exposure to orthopaedic metal alloys, particularly serum cobalt and chromium ions derived from metal-on-metal wear debris in these patients. A pseudotumour mass complicating metal-on-metal resurfacing arthroplasty has been recognized by orthopaedic oncologists and specialist hip units. Pseudotumours may also present with a major nerve palsy. Two cases of femoral neuropathy due to pseudotumour masses caused by metal-on-metal resurfacing arthroplasty are presented. Preoperative neurophysiological studies showed severe and irreversible pathological changes to nerve function with neurohistopathological evidence of complete nerve destruction with a previously unreported pathological appearance. This may represent a previously unrecognized pathological process, possibly 'toxic' in nature, resulting from metal-on-metal wear debris. Prolonged follow-up and detailed clinical assessment of patients after hip resurfacing arthroplasty is advocated with planned and expeditious revision of any patient in whom evidence of femoral neuropathy develops.
目前人们对接触骨科金属合金的长期生物学效应存在担忧，尤其是这些患者体内金属对金属磨损碎屑产生的血清钴和铬离子。骨科肿瘤学家和专业髋关节治疗单位已认识到金属对金属表面置换关节成形术出现的假瘤肿块。假瘤也可能伴有严重的神经麻痹。本文介绍了两例因金属对金属表面置换关节成形术导致的假瘤肿块引起的股神经病变。术前神经生理学研究显示神经功能出现严重且不可逆的病理变化，神经组织病理学证据表明神经完全破坏，其病理表现此前未见报道。这可能代表一种此前未被认识的病理过程，本质上可能具有“毒性”，由金属对金属磨损碎屑引起。提倡对髋关节表面置换关节成形术后的患者进行长期随访和详细的临床评估，对于出现股神经病变证据的任何患者，应计划并尽快进行翻修手术。
