Smith James, Lee David, Bali Kamal, Railton Pam, Kinniburgh David, Faris Peter, Marshall Deborah, Burkart Brian, Powell James
Orthopaedic Trauma and Lower Extremity Reconstruction, University of Calgary, #0444 3134 Hospital Drive NW Calgary AB T2N 5A1, Canada.
J Orthop Surg Res. 2014 Jan 28;9:3. doi: 10.1186/1749-799X-9-3.
The purpose of the study was twofold: first, to determine whether there is a statistically significant difference in the metal ion levels among three different large-head metal-on-metal (MOM) total hip systems. The second objective was to assess whether position of the implanted prostheses, patient demographics or factors such as activity levels influence overall blood metal ion levels and whether there is a difference in the functional outcomes between the systems.
In a cross-sectional cohort study, three different metal-on-metal total hip systems were assessed: two monoblock heads, the Durom socket (Zimmer, Warsaw, IN, USA) and the Birmingham socket (Smith and Nephew, Memphis, TN, USA), and one modular metal-on-metal total hip system (Pinnacle, Depuy Orthopedics, Warsaw, IN, USA). Fifty-four patients were recruited, with a mean age of 59.7 years and a mean follow-up time of 41 months (12 to 60). Patients were evaluated clinically, radiologically and biochemically. Statistical analysis was performed on all collected data to assess any differences between the three groups in terms of overall blood metal ion levels and also to identify whether there was any other factor within the group demographics and outcomes that could influence the mean levels of Co and Cr.
Although the functional outcome scores were similar in all three groups, the blood metal ion levels in the larger monoblock large heads (Durom, Birmingham sockets) were significantly raised compared with those of the Pinnacle group. In addition, the metal ion levels were not found to have a statistically significant relationship to the anteversion or abduction angles as measured on the radiographs.
When considering a MOM THR, the use of a monoblock large-head system leads to higher elevations in whole blood metal ions and offers no advantage over a smaller head modular system.
本研究有两个目的：第一，确定三种不同的大头金属对金属（MOM）全髋关节系统之间的金属离子水平是否存在统计学上的显著差异。第二个目的是评估植入假体的位置、患者人口统计学特征或活动水平等因素是否会影响整体血液金属离子水平，以及这些系统之间的功能结果是否存在差异。
在一项横断面队列研究中，评估了三种不同的金属对金属全髋关节系统：两种一体式股骨头、杜罗姆髋臼杯（美国印第安纳州华沙市的齐默公司）和伯明翰髋臼杯（美国田纳西州孟菲斯市的施乐辉公司），以及一种模块化金属对金属全髋关节系统（美国印第安纳州华沙市的迪普伊骨科公司的innacle）。招募了54名患者，平均年龄为59.7岁，平均随访时间为41个月（12至60个月）。对患者进行了临床、放射学和生化评估。对所有收集的数据进行统计分析，以评估三组在整体血液金属离子水平方面的任何差异，并确定组内人口统计学特征和结果中是否存在任何其他因素可能影响钴和铬的平均水平。
尽管三组的功能结果评分相似，但较大的一体式大头（杜罗姆、伯明翰髋臼杯）的血液金属离子水平与innacle组相比显著升高。此外，未发现金属离子水平与X线片测量的前倾角或外展角有统计学上的显著关系。
在考虑金属对金属全髋关节置换术时，使用一体式大头系统会导致全血金属离子水平更高，且与较小头的模块化系统相比没有优势。
