人工髋关节表面置换术后血清金属离子浓度测定及影响因素分析

发布时间：2018-03-04 11:31

  本文选题：人工髋关节表面置换术　切入点：金属离子　出处：《中国修复重建外科杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的应用电感耦合等离子体质谱仪检测人工髋关节表面置换术(resurfacing arthroplasty of the hip,RSAH)后不同时间患者血清钴、铬以及钼离子浓度,探讨其影响因素。方法选择2005年6月-2014年11月行RSAH且术后历次随访关节功能良好(Harris评分85分)的47例(55髋)患者作为研究对象。其中男25例,女22例;年龄18~64岁,平均49.7岁。髋臼发育不良(developmental dysplasia of the hip,DDH)18例(22髋),非DDH 29例(33髋)。术后随访时间6个月~5年,平均3.2年。应用电感耦合等离子体质谱仪测定血清钴、铬以及钼离子浓度,以6名正常自愿者血清金属离子浓度作为正常参照值进行比较。综合金属离子浓度测量结果分析,选择患者并根据髋臼假体位置以及股骨头假体直径分组比较,分析其与金属离子浓度的关系。对金属离子浓度与患者年龄、体质量指数、手术前后Harris评分以及股骨假体颈干角、柄干角进行相关分析。结果与正常参照值比较,置换术后患者钴离子浓度于术后1年时达峰值(P0.05),之后缓慢下降,至术后4年时再次升高,术后5年时浓度接近术后2年水平;铬离子浓度于术后9个月达峰值(P0.05),之后逐渐下降,至术后5年时接近正常水平;钼离子浓度总体呈逐渐上升趋势,术后5年浓度最高(P0.05)。根据金属离子浓度测量结果综合分析,取术后随访9个月及1年的29例(35髋)患者进行分组分析。与髋臼假体外展角40°及45°组相比,40~45°组DDH及非DDH患者钴、铬离子浓度降低,差异均有统计学意义(P0.05);钼离子浓度差异无统计学意义(P0.05)。与髋臼假体前倾角15°及20°组相比,15~20°组患者钴、铬、钼离子浓度均显著降低(P0.05)。股骨头直径≥48 mm组钴、铬、钼离子浓度均低于48 mm组,但组间仅钴离子浓度差异有统计学意义(P0.05)。相关分析示,钴离子浓度与术后Harris评分成负相关(r=-0.486,P=0.041)。结论 RSAH术后1年血清钴离子浓度明显高于正常水平,术后9个月铬离子明显升高,术后钼离子浓度呈持续上升趋势;各金属离子浓度与髋臼假体位置有密切关系。
[Abstract]:Objective to detect the concentrations of cobalt, chromium and molybdenum ions in serum of patients with artificial hip surface replacement arthroplasty of the hip RSAH at different time points by inductively coupled plasma mass spectrometer (ICP-MS). Methods 47 patients (55 hips) who underwent RSAH from June 2005 to November 2014 were selected as subjects, including 25 males and 22 females, aged 1864 years. The average age was 49.7 years. There were 18 cases with developmental dysplasia of the dysphore and 22 hips with DDH. The follow-up time was 6 months to 5 years, with an average of 3.2 years. The concentrations of cobalt, chromium and molybdenum in serum were determined by inductively coupled plasma mass spectrometry (ICP-MS). The serum metal ion concentrations of 6 normal volunteers were compared with the normal reference values. The patients were selected and compared according to the position of the acetabular prosthesis and the diameter of the femoral head prosthesis. The relationship between metal ion concentration and the age of patients, body mass index, Harris score before and after operation, shaft angle of femoral prosthesis neck and shaft angle of pedicle were analyzed. The results were compared with the normal reference value. After replacement, the concentration of cobalt ion reached the peak value at 1 year after operation, then decreased slowly, then increased again at 4 years after operation, and reached the level of 2 years after operation, and the concentration of chromium ion reached the peak value at 9 months after operation, and then decreased gradually. By 5 years after operation, the concentration of molybdenum ion was gradually increasing, and the highest concentration of molybdenum ion was found in 5 years after operation (P 0.05). The results were analyzed synthetically according to the results of metal ion concentration measurement. 29 patients with 35 hips were followed up for 9 months and 1 year after operation. Compared with the acetabular prosthetic abduction angle of 40 掳and 45 掳, the cobalt and chromium ion concentrations in DDH and non-#en1# patients were lower than those in 40 掳and 45 掳acetabular prosthesis groups. The differences were statistically significant (P 0.05), but there was no significant difference in molybdenum ion concentration (P 0.05). Compared with 15 掳and 20 掳acetabular prosthetic anteversion, the concentrations of cobalt, chromium and molybdenum ions were significantly decreased in 15 掳and 20 掳groups. The diameter of femoral head was 鈮，

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