Alberghina Flavia, McManus Robin, Keogh Cillian, Turner Henry, Moore David, Noël Jacques, Kennedy Jim, Kiely Patrick
Department of Orthopaedics, Children's Health Ireland (CHI) at Crumlin, Crumlin, Dublin, Ireland.
J Pediatr Orthop. 2024 Jan 1;44(1):43-48. doi: 10.1097/BPO.0000000000002526. Epub 2023 Oct 2.
Magnetically controlled growing rods (MCGR) aim to control curve progression while limiting surgical burden in children with early-onset scoliosis. Systemic and local distribution of metal debris has been documented in children with spinal implants. The aim of the study was to assess serum metal ion levels and local metal debris-related changes at the conclusion of MCGR treatment.
Between February 2019 and September 2022, all patients who had a conversion to definitive fusion at the completion of MCGR treatment in our institution were invited to participate in this study. Consenting patients had serum metal ion levels drawn (titanium, cobalt, and chromium) and histologic analyses of peri-implant tissue samples.
We enrolled 24 children who underwent definitive fusion post-MCGR treatment for early-onset scoliosis. The average age at definitive fusion was 13.3 years (range: 11 to 17 y). The average length of MCGR treatment was 4.8 years (range: 1.5 to 6.8 y). At the end of the MCGR treatment, 23 (96%) patients had elevated serum metal ion levels. Mean serum titanium levels were 165.4 nmol/L (range: 30 to 390 nmol/L), mean serum cobalt levels were 4.6 nmol/L (range: 1.2 to 14 nmol/L), and mean serum chromium levels were 14 nmol/L (range: 2.4 to 30 nmol/L). Peri-implant soft tissue histologic analysis demonstrated local metal debris and foreign body reactions in all patients.
At the completion of MCGR treatment, the majority of patients demonstrate elevated serum metal ion levels and local metal debris-related peri-implant soft tissue changes. Although there is no current literature to suggest these findings are harmful, further research as to the clinical significance is required.
Level IV.
磁控生长棒（MCGR）旨在控制早发性脊柱侧弯患儿的侧弯进展，同时减轻手术负担。脊柱植入物患儿体内已记录到金属碎屑的全身和局部分布情况。本研究的目的是在MCGR治疗结束时评估血清金属离子水平及局部与金属碎屑相关的变化。
2019年2月至2022年9月期间，我院所有在MCGR治疗结束后转为确定性融合手术的患者均受邀参加本研究。同意参与的患者进行了血清金属离子水平检测（钛、钴和铬）以及植入物周围组织样本的组织学分析。
我们纳入了24例接受MCGR治疗后因早发性脊柱侧弯接受确定性融合手术的儿童。确定性融合手术时的平均年龄为13.3岁（范围：11至17岁）。MCGR治疗的平均时长为4.8年（范围：1.5至6.8年）。在MCGR治疗结束时，23例（96%）患者的血清金属离子水平升高。血清钛平均水平为165.4纳摩尔/升（范围：30至390纳摩尔/升），血清钴平均水平为4.6纳摩尔/升（范围：1.2至14纳摩尔/升），血清铬平均水平为14纳摩尔/升（范围：2.4至30纳摩尔/升）。植入物周围软组织组织学分析显示，所有患者均存在局部金属碎屑和异物反应。
在MCGR治疗结束时，大多数患者血清金属离子水平升高，且植入物周围软组织出现与局部金属碎屑相关的变化。尽管目前尚无文献表明这些发现有害，但仍需进一步研究其临床意义。
四级。
