Department of Orthopaedic Surgery, Women's and Children's Hospital, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia.
Spine (Phila Pa 1976). 2010 Apr 20;35(9):975-82. doi: 10.1097/BRS.0b013e3181d7a197.
Prospective cohort study.
To determine the predictors of serum chromium levels after stainless steel posterior spinal instrumentation for adolescent idiopathic scoliosis.
Abnormally elevated serum chromium levels have been detected in patients with adolescent idiopathic scoliosis after stainless steel instrumentation. To date, the relationship among serum chromium levels, time of implantation, and implant characteristics (including surface area, rod length, numbers of hooks, screws, and cross connectors) has not been studied.
Thirty patients with adolescent idiopathic scoliosis undergoing posterior instrumented spinal arthrodesis using stainless steel implants between 1998 and 2002 were prospectively studied. Serum chromium levels were measured between October 2006 and June 2007. Postoperative radiographs were used to measure rod lengths, number of hooks, screws, cross-connectors, and cables. The surface area of each component and the total surface area for each patient were calculated. Possible associations between serum chromium levels, time of implantation, and implant characteristics were investigated.
Implant exposure, whether expressed in the form of total metal implant surface area, rod length, or number of metal interfaces, was found to be positively associated with serum chromium levels. Specifically, chromium levels increased by a multiplicative factor of 1.0060 for every additional square centimeter of total metal implant surface area (P = 0.02). In addition, the chromium level was found to decrease by a multiplicative factor of 0.7766 for every additional year since surgery (P = 0.02).
After adjusting for the number of years since surgery, metal implant exposure is positively associated with elevated serum chromium levels in adolescent idiopathic scoliosis patients with stainless steel posterior spinal implants. This is the first study to identify statistically significant positive associations between specific spinal implant characteristics (other than corrosion identified by radiographs) and serum chromium levels.
前瞻性队列研究。
确定青少年特发性脊柱侧凸后路不锈钢脊柱内固定术后血清铬水平的预测因素。
在接受不锈钢器械治疗的青少年特发性脊柱侧凸患者中，检测到血清铬水平异常升高。迄今为止，血清铬水平与植入时间以及植入物特征（包括表面积、杆长、钩、螺钉和交叉连接器的数量）之间的关系尚未得到研究。
对 1998 年至 2002 年间接受后路器械脊柱融合术的 30 例青少年特发性脊柱侧凸患者进行前瞻性研究。2006 年 10 月至 2007 年 6 月期间测量血清铬水平。术后 X 线片用于测量杆长、钩、螺钉、交叉连接器和电缆的数量。计算每个组件的表面积和每个患者的总表面积。研究了血清铬水平、植入时间和植入物特征之间的可能关联。
暴露的植入物，无论是以总金属植入物表面积、杆长还是金属界面数量的形式表示，都与血清铬水平呈正相关。具体来说，每增加一平方厘米的总金属植入物表面积，铬水平就会增加 1.0060 倍（P=0.02）。此外，还发现铬水平每增加一年手术时间，就会降低 0.7766 倍（P=0.02）。
在调整手术时间后，金属植入物的暴露与不锈钢后路脊柱植入的青少年特发性脊柱侧凸患者血清铬水平升高呈正相关。这是第一项确定特定脊柱植入物特征（除 X 线片确定的腐蚀外）与血清铬水平之间具有统计学显著正相关的研究。
