Department of Reconstructive Orthopaedics, Karolinska University Hospital, 171 76, Solna, Sweden.
Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Eur Spine J. 2022 Nov;31(11):3036-3041. doi: 10.1007/s00586-022-07341-5. Epub 2022 Sep 14.
The aim of this study is to evaluate the levels of chromium (Cr), cobalt (Co), and titanium (Ti) after instrumented fusion for scoliosis.
Serum samples were collected at median 2.24 (range 0.1-38.8) years after fusion surgery for scoliosis in 91 individuals, of which 71 had been treated with steel implants and 20 with titanium implants. 91 sex and age-matched non-surgically treated individuals with scoliosis were used as controls. Levels of Cr, Co, and Ti were measured.
In the 91 surgically treated individuals median levels of Cr were 0.54 µg/l vs 0 µg/l in the 91 controls, p < 0.001. Corresponding results for Co were 0.29 µg/l vs. 0.24 µg/l, p = 0.19, and for Ti were 0 µg/l vs. 0 µg/l, p < 0.001. In the individuals with steel implants and their corresponding controls median Cr levels were 0.63 µg/l vs. 0.00 µg/l, p < 0.001 and Co levels 0.27 µg/l vs. 0.23 µg/l, p = 0.36. No Ti was detected. In the individuals with titanium implants, median Cr levels were 0 µg/l vs. 0 µg/l in their corresponding controls, p = 0.38. Corresponding results for Co was 0.39 µg/l vs. 0.31 µg/l, p = 0.27 and for Ti 4.31 µg/l vs. 0 µg/l, p < 0.001. In the individuals with steel implants a negative correlation between implant time in situ and levels of Cr was found ([Formula: see text] = - 0.52, p < 0.001) but not with Co ([Formula: see text] = - 0.14, p = 0.23). Ti was not detected. In the individuals with titanium implants, there was no correlation between implant time in situ and levels of Cr ([Formula: see text] = 0.36, p = 0.12), Co ([Formula: see text] = - 0.12, p = 0.60) or Ti ([Formula: see text] = 0.22, p = 0.35).
The use of stainless steel and titanium implants in spinal fusion surgery is associated with elevated metal ion concentrations several years after surgery.
本研究旨在评估脊柱侧凸后路融合术后铬（Cr）、钴（Co）和钛（Ti）的水平。
在脊柱侧凸后路融合术后中位数 2.24 年（范围 0.1-38.8 年）收集了 91 名个体的血清样本，其中 71 名接受了钢植入物治疗，20 名接受了钛植入物治疗。91 名性别和年龄匹配的未接受手术治疗的脊柱侧凸患者作为对照。测量 Cr、Co 和 Ti 的水平。
在 91 名接受手术治疗的个体中，Cr 的中位数水平为 0.54μg/l，而 91 名对照者的 Cr 中位数水平为 0μg/l，p<0.001。相应的 Co 中位数水平分别为 0.29μg/l 和 0.24μg/l，p=0.19，Ti 中位数水平分别为 0μg/l 和 0μg/l，p<0.001。在接受钢植入物治疗的个体及其相应对照者中，Cr 中位数水平分别为 0.63μg/l 和 0.00μg/l，p<0.001，Co 中位数水平分别为 0.27μg/l 和 0.23μg/l，p=0.36。未检测到 Ti。在接受钛植入物治疗的个体中，Cr 的中位数水平为 0μg/l，与相应对照者的 0μg/l 相比，p=0.38。Co 的中位数水平分别为 0.39μg/l 和 0.31μg/l，p=0.27，Ti 的中位数水平分别为 4.31μg/l 和 0μg/l，p<0.001。在接受钢植入物治疗的个体中，植入物原位时间与 Cr 水平之间存在负相关关系（[Formula: see text]=-0.52，p<0.001），但与 Co 无关（[Formula: see text]=-0.14，p=0.23）。未检测到 Ti。在接受钛植入物治疗的个体中，植入物原位时间与 Cr（[Formula: see text]=0.36，p=0.12）、Co（[Formula: see text]=-0.12，p=0.60）或 Ti（[Formula: see text]=0.22，p=0.35）水平之间均无相关性。
后路脊柱融合术中使用不锈钢和钛植入物与术后数年金属离子浓度升高有关。
