Dujardin F, Février V, Lecorvaisier C, Joly P
Clinique Chirurgicale Orthopédique et Traumatologique, CHU de Rouen.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(6):473-84.
Dermatitis due to metallic implants in orthopaedic surgery are uncommon complications and are difficult to diagnose.
A literature review found descriptions of 54 cases. All types of implants, even small in size such as screws or loops, made of stainless steel or chromium-cobalt alloys have been incriminated. There was no case related to titanium alloy.
The clinical aspects were very different; all the forms of dermatitis are possible. The most frequent were eczemas (44 per cent), bullous dermatitis (11 per cent) and inflammatory forms (13 per cent).
These dermatitis result either from immuno-allergic mechanisms or from cell-toxicity. There are two main diagnostic difficulties. 1--To confirm the responsibility of the implant in the dermatitis because the cutaneous lesions appears often generalized or localized in an area distant from the implant and because their emergence may be very belated, sometime after several years. 2--To distinguish some of these dermatitis and especially inflammatory forms, from sepsis. There is no current means to state positively this diagnosis without removing the implant. The microscopic tissues analysis surrounding the implant and the cutaneous patch-tests using fillings of the implant itself are the only methods which appear able to confirm the diagnosis. There are no reliable means to detect risk subjects, the emergence of a dermatitis seems to be unpredictable. The specificity and the sensibility of the usual patch-tests are insufficient.
The main means to prevent dermatitis is to reduce the production of metallic particles due to wear, fritting and corrosion. Management is based on removing of the incriminated implant. Treatment using drugs, including local applications or general dispensing of steroids, have generally a low efficiency.
骨科手术中金属植入物引起的皮炎是罕见的并发症，且难以诊断。
文献综述发现了54例病例描述。所有类型的植入物，即使尺寸很小，如螺钉或环，由不锈钢或铬钴合金制成，都被认为有嫌疑。没有与钛合金相关的病例。
临床症状差异很大；各种形式的皮炎都有可能出现。最常见的是湿疹（44%）、大疱性皮炎（11%）和炎症形式（13%）。
这些皮炎要么由免疫过敏机制引起，要么由细胞毒性引起。主要有两个诊断难点。1. 确认植入物与皮炎的因果关系，因为皮肤病变常常表现为全身性或局限于远离植入物的区域，而且其出现可能非常延迟，有时是在数年之后。2. 将其中一些皮炎，尤其是炎症形式，与败血症区分开来。在不移除植入物的情况下，目前没有确定诊断的方法。植入物周围的微观组织分析以及使用植入物本身填充物进行的皮肤斑贴试验是似乎能够确诊的唯一方法。没有可靠的手段来检测风险对象，皮炎的出现似乎不可预测。常规斑贴试验的特异性和敏感性不足。
预防皮炎的主要方法是减少因磨损、烧结和腐蚀产生的金属颗粒。处理方法是移除有嫌疑的植入物。使用药物治疗，包括局部应用或全身使用类固醇，通常效果不佳。
