Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, British Columbia, V5Z 4E3, Canada.
Clin Orthop Relat Res. 2013 Dec;471(12):3814-21. doi: 10.1007/s11999-013-2944-4.
Although pseudotumors have been reported in 32% of asymptomatic metal-on-metal hips, the natural history of asymptomatic pseudotumors is unknown.
QUESTIONS/PURPOSES: The purpose of this study was to assess changes over time in asymptomatic pseudotumors and the effect of revision on pseudotumor mass.
Followup ultrasound was performed a mean of 25.8 months (range, 21-31 months) after the detection of 15 pseudotumors and five isolated fluid collections in a cohort of 20 asymptomatic patients (13 metal-on-metal, three metal-on-polyethylene, and four hip resurfacings) [42]. Changes in pseudotumors and fluid collections size and nature, and serum ion levels were determined.
Among the 15 nonrevised patients, pseudotumors increased in size in six (four solid and two cystic) of 10 patients, three of which had clinically important increases (13-148 cm(3); 28-74 cm(3); 47-104 cm(3)). Three pseudotumors (one solid and two cystic) disappeared completely (the largest measured 31 cm(3)). One solid pseudotumor decreased in size (24 to 18 cm(3)). In five revised patients, pseudotumors completely disappeared in four patients. The fifth patient had two masses that decreased from 437 cm(3) to 262 cm(3) and 43 cm(3) to 25 cm(3). All revision patients had a reduction of chromium (40.42 μ/L to 2.69 μ/L) and cobalt ions (54.19 μ/L to 0.64 μ/L). Of five isolated fluid collections, four completely disappeared (two metal-on-metal and two metal-on-polyethylene) and one (metal-on-metal) increased from 26 cm(3) to 136 cm(3).
Our observations suggest pseudotumors frequently increase in size in asymptomatic patients with occasional remission of small masses. Revision resulted in remission of pseudotumors.
虽然在 32%的无症状金属对金属髋关节中已经报告了假性肿瘤，但无症状假性肿瘤的自然病史尚不清楚。
问题/目的：本研究的目的是评估无症状假性肿瘤随时间的变化以及翻修对假性肿瘤质量的影响。
在 20 名无症状患者（13 例金属对金属、3 例金属对聚乙烯和 4 例髋关节表面置换）的队列中，在检测到 15 例假性肿瘤和 5 例孤立性积液后，平均随访超声 25.8 个月（范围，21-31 个月）[42]。确定假性肿瘤和积液大小和性质的变化以及血清离子水平。
在 15 例未行翻修的患者中，10 例患者中有 6 例（4 例实性和 2 例囊性）的假性肿瘤增大，其中 3 例有临床重要的增大（13-148cm3；28-74cm3；47-104cm3）。3 例假性肿瘤（1 例实性和 2 例囊性）完全消失（最大测量值为 31cm3）。1 例实性假性肿瘤体积减小（24 至 18cm3）。在 5 例翻修患者中，4 例患者的假性肿瘤完全消失。第五例患者有两个肿块，从 437cm3 减小到 262cm3 和 43cm3 减小到 25cm3。所有翻修患者的铬离子（40.42μ/L 至 2.69μ/L）和钴离子（54.19μ/L 至 0.64μ/L）均减少。在 5 例孤立性积液中，4 例完全消失（2 例金属对金属和 2 例金属对聚乙烯），1 例（金属对金属）从 26cm3 增加到 136cm3。
我们的观察结果表明，无症状患者的假性肿瘤常增大，偶有小肿块缓解。翻修导致假性肿瘤缓解。
