采用生长友好型器械治疗的早发性脊柱侧弯儿童血清钛水平升高。
Elevated Serum Titanium Levels in Children With Early Onset Scoliosis Treated With Growth-friendly Instrumentation.
作者信息
Li Ying, Graham Chelsea K, Robbins Christopher, Caird Michelle S, Farley Frances A
机构信息
Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI.
出版信息
J Pediatr Orthop. 2020 Jul;40(6):e420-e423. doi: 10.1097/BPO.0000000000001463.
BACKGROUND
A previous study showed significantly higher serum titanium levels in patients with early-onset scoliosis (EOS) treated with traditional growing rods (TGR) and magnetically controlled growing rods (MCGR) compared with controls. Children with vertical expandable prosthetic titanium rib (VEPTR) were not assessed. The purpose of this study was to compare serum titanium levels in EOS patients treated with TGR, MCGR, and VEPTR. We hypothesized that EOS patients treated with all forms of growth-friendly instrumentation (GFI) have elevated serum titanium levels.
METHODS
This was a prospective cross-sectional case series. Serum titanium levels were collected from patients with GFI who were enrolled in an EOS database. Blood samples were collected at a clinic visit or lengthening/exchange procedure between April and December 2018. The normal range for serum titanium is 0 to 1 ng/mL. Analyses were conducted using analysis of variance and Bonferroni post hoc test.
RESULTS
A total of 23 patients (2 TGR, 8 MCGR, 13 VEPTR) were analyzed. There was a significant difference in age at the time of blood sample collection (12.5 vs. 9.8 vs. 7.5 y, P=0.015) and serum titanium level (1.5 vs. 4.5 vs. 7.6 ng/mL, P=0.021) between TGR, MCGR, and VEPTR, respectively. All of the MCGR and VEPTR patients had a serum titanium level ≥2 ng/mL. Binary comparisons showed that VEPTR had a significantly higher serum titanium level than TGR (P=0.046). There was no difference in serum titanium level when MCGR was compared with TGR and VEPTR. Time from implant insertion to blood sample collection, number of rods currently implanted, total number of rods implanted throughout treatment, and number of lengthenings per patient was similar between the groups.
CONCLUSIONS
Elevated serum titanium levels may be present in EOS patients treated with all forms of GFI. Although our TGR patients had indwelling implants for the longest period of time, they had the lowest serum titanium level. Repetitive chest wall motion during respiration may lead to continued wear and metal ion release with VEPTR.
LEVEL OF EVIDENCE
Level II-therapeutic.
背景
先前的一项研究表明，与对照组相比，接受传统生长棒（TGR）和磁控生长棒（MCGR）治疗的早发性脊柱侧弯（EOS）患者血清钛水平显著更高。垂直可扩张人工钛肋骨（VEPTR）治疗的儿童未纳入评估。本研究的目的是比较接受TGR、MCGR和VEPTR治疗的EOS患者的血清钛水平。我们假设接受所有形式生长友好型器械（GFI）治疗的EOS患者血清钛水平会升高。
方法
这是一项前瞻性横断面病例系列研究。从纳入EOS数据库的接受GFI治疗的患者中收集血清钛水平。在2018年4月至12月的门诊就诊或延长/更换手术时采集血样。血清钛的正常范围是0至1 ng/mL。采用方差分析和Bonferroni事后检验进行分析。
结果
共分析了23例患者（2例TGR、8例MCGR、13例VEPTR）。TGR、MCGR和VEPTR组在采集血样时的年龄（12.5岁对9.8岁对7.5岁，P = 0.015）和血清钛水平（1.5 ng/mL对4.5 ng/mL对7.6 ng/mL，P = 0.021）存在显著差异。所有MCGR和VEPTR患者的血清钛水平≥2 ng/mL。二元比较显示，VEPTR的血清钛水平显著高于TGR（P = 0.046）。MCGR与TGR和VEPTR比较时，血清钛水平无差异。各组从植入物植入到采集血样的时间、当前植入的棒数量、整个治疗过程中植入的棒总数以及每位患者的延长次数相似。
结论
接受所有形式GFI治疗的EOS患者可能存在血清钛水平升高。尽管我们的TGR患者植入物留置时间最长，但他们的血清钛水平最低。呼吸过程中胸壁的反复运动可能导致VEPTR持续磨损和金属离子释放。
证据水平
二级治疗性。
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