Case C P, Langkamer V G, Howell R T, Webb J, Standen G, Palmer M, Kemp A, Learmonth I D
Department of Histopathology, University of Bristol, United Kingdom.
Clin Orthop Relat Res. 1996 Aug(329 Suppl):S269-79. doi: 10.1097/00003086-199608001-00024.
Previous epidemiologic studies have suggested that there may be a risk of malignancy, especially lymphoma and leukemia, after joint replacement, but the followup has been relatively short. This is a preliminary study to see if there is any biologic basis for such a risk. Blood and bone marrow samples from 71 patients at revision arthroplasty of a loose or worn prosthesis and 30 control patients at primary arthroplasty were analyzed with cytogenetic techniques and molecular biology. There was a higher chromosomal aberration rate in cells adjacent to the prosthesis at revision surgery compared with iliac crest marrow from the same patients or with femoral bone marrow at primary arthroplasty. Clonal expansion of lymphocytes without a serum paraprotein was seen in 2 of 21 patients at revision arthroplasty performed more than 10 years after primary arthroplasty. The results of this preliminary study suggest that future epidemiologic studies should concentrate on patients with longer postoperative intervals to see if there is any risk that would be pertinent to a young patient at primary arthroplasty.
以往的流行病学研究表明，关节置换术后可能存在恶性肿瘤风险，尤其是淋巴瘤和白血病，但随访时间相对较短。这是一项初步研究，旨在探究这种风险是否存在生物学基础。采用细胞遗传学技术和分子生物学方法，对71例因假体松动或磨损而进行翻修置换术的患者以及30例初次置换术的对照患者的血液和骨髓样本进行了分析。与同一患者的髂嵴骨髓或初次置换术时的股骨骨髓相比，翻修手术时假体周围细胞的染色体畸变率更高。在初次置换术后10年以上进行翻修置换术的21例患者中，有2例出现了无血清副蛋白的淋巴细胞克隆性扩增。这项初步研究结果表明，未来的流行病学研究应关注术后间隔时间更长的患者，以确定是否存在与初次置换术时的年轻患者相关的风险。
