Granchi D, Cenni E, Giunti A, Baldini N
Rizzoli Orthopaedic Institute, Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine, Via di Barbiano 1/10, 40136 Bologna, Italy.
J Bone Joint Surg Br. 2012 Aug;94(8):1126-34. doi: 10.1302/0301-620X.94B8.28135.
We report a systematic review and meta-analysis of the peer-reviewed literature focusing on metal sensitivity testing in patients undergoing total joint replacement (TJR). Our purpose was to assess the risk of developing metal hypersensitivity post-operatively and its relationship with outcome and to investigate the advantages of performing hypersensitivity testing. We undertook a comprehensive search of the citations quoted in PubMed and EMBASE: 22 articles (comprising 3634 patients) met the inclusion criteria. The frequency of positive tests increased after TJR, especially in patients with implant failure or a metal-on-metal coupling. The probability of developing a metal allergy was higher post-operatively (odds ratio (OR) 1.52 (95% confidence interval (CI) 1.06 to 2.31)), and the risk was further increased when failed implants were compared with stable TJRs (OR 2.76 (95% CI 1.14 to 6.70)). Hypersensitivity testing was not able to discriminate between stable and failed TJRs, as its predictive value was not statistically proven. However, it is generally thought that hypersensitivity testing should be performed in patients with a history of metal allergy and in failed TJRs, especially with metal-on-metal implants and when the cause of the loosening is doubtful.
我们报告了一项针对全关节置换术（TJR）患者金属敏感性测试的同行评审文献的系统评价和荟萃分析。我们的目的是评估术后发生金属超敏反应的风险及其与预后的关系，并研究进行超敏反应测试的优势。我们对PubMed和EMBASE中引用的文献进行了全面检索：22篇文章（共3634例患者）符合纳入标准。TJR术后阳性测试的频率增加，尤其是在植入物失败或金属对金属耦合的患者中。术后发生金属过敏的可能性更高（优势比（OR）1.52（95%置信区间（CI）1.06至2.31）），与稳定的TJR相比，失败的植入物发生金属过敏的风险进一步增加（OR 2.76（95%95%CI 1.14至6.70））。超敏反应测试无法区分稳定和失败的TJR，因为其预测价值未得到统计学验证。然而，一般认为，有金属过敏史的患者以及失败的TJR患者，尤其是金属对金属植入物患者以及松动原因存疑时，应进行超敏反应测试。
