Newcastle University, StephensonBuilding, Claremont Road, Newcastleupon Tyne NE1 7RU, UK.
Bone Joint Res. 2013 May 16;2(5):84-95. doi: 10.1302/2046-3758.25.2000148. Print 2013.
The aims of this piece of work were to: 1) record the background concentrations of blood chromium (Cr) and cobalt (Co) concentrations in a large group of subjects; 2) to compare blood/serum Cr and Co concentrations with retrieved metal-on-metal (MoM) hip resurfacings; 3) to examine the distribution of Co and Cr in the serum and whole blood of patients with MoM hip arthroplasties; and 4) to further understand the partitioning of metal ions between the serum and whole blood fractions.
A total of 3042 blood samples donated to the local transfusion centre were analysed to record Co and Cr concentrations. Also, 91 hip resurfacing devices from patients who had given pre-revision blood/serum samples for metal ion analysis underwent volumetric wear assessment using a coordinate measuring machine. Linear regression analysis was carried out and receiver operating characteristic curves were constructed to assess the reliability of metal ions to identify abnormally wearing implants. The relationship between serum and whole blood concentrations of Cr and Co in 1048 patients was analysed using Bland-Altman charts. This relationship was further investigated in an in vitro study during which human blood was spiked with trivalent and hexavalent Cr, the serum then separated and the fractions analysed.
Only one patient in the transfusion group was found to have a blood Co > 2 µg/l. Blood/Serum Cr and Co concentrations were reliable indicators of abnormal wear. Blood Co appeared to be the most useful clinical test, with a concentration of 4.5 µg/l showing sensitivity and specificity for the detection of abnormal wear of 94% and 95%, respectively. Generated metal ions tended to fill the serum compartment preferentially in vivo and this was replicated in the in vitro study when blood was spiked with trivalent Cr and bivalent Co.
Blood/serum metal ion concentrations are reliable indicators of abnormal wear processes. Important differences exist however between elements and the blood fraction under study. Future guidelines must take these differences into account.
本研究旨在：1）记录大量人群的血液铬（Cr）和钴（Co）浓度的背景浓度；2）比较血液/血清 Cr 和 Co 浓度与检索到的金属对金属（MoM）髋关节表面置换物；3）检查 MoM 髋关节置换术患者血清和全血中 Co 和 Cr 的分布；4）进一步了解金属离子在血清和全血部分之间的分配。
对当地输血中心捐赠的 3042 份血液样本进行分析，以记录 Co 和 Cr 浓度。同时，对 91 个髋关节表面置换装置进行了体积磨损评估，这些装置来自曾提供金属离子分析预修订血液/血清样本的患者，使用坐标测量机进行了评估。进行线性回归分析，并构建接收者操作特征曲线，以评估金属离子识别异常磨损植入物的可靠性。使用 Bland-Altman 图表分析了 1048 例患者血清和全血中 Cr 和 Co 浓度之间的关系。在体外研究中进一步研究了这种关系，在该研究中，用人血添加三价和六价 Cr，然后分离血清并分析各部分。
仅在输血组中发现一名患者血液 Co > 2 µg/l。血液/血清 Cr 和 Co 浓度是异常磨损的可靠指标。血液 Co 似乎是最有用的临床检测，浓度为 4.5 µg/l 时，对异常磨损的检测具有 94%和 95%的灵敏度和特异性。体内生成的金属离子倾向于优先填充血清室，在体外研究中，当血液中添加三价 Cr 和二价 Co 时，这一点得到了复制。
血液/血清金属离子浓度是异常磨损过程的可靠指标。然而，元素和正在研究的血液部分之间存在重要差异。未来的指南必须考虑到这些差异。
