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):967-74. doi: 10.1097/BRS.0b013e3181d53724.
Case-control study.
To determine whether serum metal ion levels and erythrocyte chromium levels in adolescents with stainless steel spinal instrumentation are elevated when compared with 2 control groups.
Instrumented spinal arthrodesis is a common procedure to correct scoliosis. The long-term consequences of retained implants are unclear. Possible toxic effects related to raised metal ion levels have been reported in the literature.
Thirty patients who underwent posterior spinal arthrodesis with stainless steel instrumentation for scoliosis (group 1) were included. Minimum postoperative duration was 3 years. Serum chromium, molybdenum, iron, and ferritin levels were measured. Participants with elevated above normal serum chromium levels (n = 11) also underwent erythrocyte chromium analysis. Comparisons were made with 2 control groups; 10 individuals with scoliosis with no spinal surgery (group 2) and 10 volunteers without scoliosis (group 3). All control group participants underwent serum and erythrocyte analysis.
Elevated above normal serum chromium levels were demonstrated in 11 of 30 (37%) group 1 participants. Elevated serum chromium levels were demonstrated in 0 of 10 participants (0%) in group 2 and 1 of 10 (10%) in group 3. There was a statistically significant elevation in serum chromium levels between group 1 and group 2 participants (P = 0.001). There was no significant association between groups 1, 2, and 3 for serum molybdenum, iron, and ferritin levels. Erythrocyte chromium measurements were considered within the normal range for all participants tested (n = 31).
Raised serum chromium levels were detected in 37% of patients following instrumented spinal arthrodesis for correction of scoliosis. This new finding has relatively unknown health implications but potential mutagenic, teratogenic and carcinogenic sequelae. This is especially concerning with most scoliosis patients being adolescent females with their reproductive years ahead.
病例对照研究。
与 2 个对照组相比，确定青少年使用不锈钢脊柱器械后血清金属离子水平和红细胞铬水平是否升高。
脊柱融合术是一种常见的治疗脊柱侧凸的方法。植入物残留的长期后果尚不清楚。文献中报道了与升高的金属离子水平相关的可能毒性作用。
30 名接受不锈钢脊柱器械治疗脊柱侧凸的患者（组 1）纳入研究。术后时间至少 3 年。测量血清铬、钼、铁和铁蛋白水平。11 名血清铬水平升高的患者（n=11）还进行了红细胞铬分析。与 2 个对照组进行比较；10 名无脊柱手术的脊柱侧凸患者（组 2）和 10 名无脊柱侧凸的志愿者（组 3）。所有对照组参与者均进行了血清和红细胞分析。
组 1 中 30 名患者中有 11 名（37%）血清铬水平升高。组 2 中 10 名患者（0%）和组 3 中 10 名患者（10%）中未发现血清铬水平升高。组 1 与组 2 患者之间的血清铬水平存在统计学显著升高（P=0.001）。组 1、2 和 3 之间的血清钼、铁和铁蛋白水平无显著相关性。所有接受测试的患者（n=31）的红细胞铬测量值均在正常范围内。
在接受脊柱融合术矫正脊柱侧凸的患者中，37%的患者检测到血清铬水平升高。这一新发现对健康的影响相对未知，但具有潜在的诱变、致畸和致癌作用。这尤其是因为大多数脊柱侧凸患者是青少年女性，她们还有生育的未来。
