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全腕关节置换术患者的磨损颗粒与骨质溶解

Wear particles and osteolysis in patients with total wrist arthroplasty.

作者信息

Boeckstyns Michel E H, Toxvaerd Anders, Bansal Manjula, Vadstrup Lars Soelberg

机构信息

Clinic of Hand Surgery, Gentofte Hospital, University of Copenhagen, Denmark, NY; Department of Pathology, Herlev Hospital, University of Copenhagen, Denmark, NY; Department of Pathology, Hospital for Special Surgery, New York, NY.

Clinic of Hand Surgery, Gentofte Hospital, University of Copenhagen, Denmark, NY; Department of Pathology, Herlev Hospital, University of Copenhagen, Denmark, NY; Department of Pathology, Hospital for Special Surgery, New York, NY.

出版信息

J Hand Surg Am. 2014 Dec;39(12):2396-404. doi: 10.1016/j.jhsa.2014.07.046. Epub 2014 Sep 13.

Abstract

PURPOSE

To determine whether the amount of polyethylene debris in the interphase tissue between prosthesis and bone in patients with total wrist arthroplasty correlated with the degree of periprosthetic osteolysis (PPO); and to investigate the occurrence of metal particles in the periprosthetic tissue, the level of chrome and cobalt ions in the blood, and the possible role of infectious or rheumatoid activity in the development of PPO.

METHODS

Biopsies were taken from the implant-bone interphase in 13 consecutive patients with total wrist arthroplasty and with at least 3 years' follow-up. Serial annual radiographs were performed prospectively for the evaluation of PPO. We collected blood samples for white blood cell count, C-reactive protein, and metallic ion level.

RESULTS

A radiolucent zone of greater than 2 mm was observed juxta-articular to the radial component in 4 patients and at the carpal component in 3. The magnitude of the radiolucent zone tended to level out over time. We observed subsidence of the implant in 3 patients on the carpal side and in none on the radial side. The amount of polyethylene and metallic debris was generally small and did not correlate with the width of the radiolucent zone. The blood levels of chrome and cobalt ions were normal. There was no evidence of infectious or rheumatoid activity.

CONCLUSIONS

Polyethylene wear has been accepted as a major cause of osteolysis in total hip arthroplasty, and metallic debris has also been cited to be an underlying cause. However, our hypothesis that polyethylene debris correlated with the degree of PPO could not be confirmed. Also, metallic debris and infectious or rheumatoid activity did not correlate with PPO.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic I.

摘要

目的

确定全腕关节置换患者假体与骨之间的界面组织中聚乙烯碎屑的量是否与假体周围骨溶解(PPO)的程度相关;并研究假体周围组织中金属颗粒的出现情况、血液中铬和钴离子的水平,以及感染或类风湿活动在PPO发生发展中可能的作用。

方法

对13例连续接受全腕关节置换且至少随访3年的患者,从植入物 - 骨界面取活检组织。前瞻性地进行系列年度X线片检查以评估PPO。我们采集血样进行白细胞计数、C反应蛋白和金属离子水平检测。

结果

4例患者在桡骨组件关节旁、3例患者在腕骨组件处观察到大于2 mm的透亮区。随着时间推移,透亮区的大小趋于稳定。我们观察到3例患者腕侧植入物下沉,桡侧无下沉。聚乙烯和金属碎屑的量一般较少,且与透亮区宽度无关。血液中铬和钴离子水平正常。没有感染或类风湿活动的证据。

结论

聚乙烯磨损已被公认为全髋关节置换中骨溶解的主要原因,金属碎屑也被认为是潜在原因。然而,我们关于聚乙烯碎屑与PPO程度相关的假设未得到证实。此外,金属碎屑以及感染或类风湿活动与PPO均无关。

研究类型/证据水平:预后性研究I级

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