金属对金属全髋关节置换与全膝关节置换术后早期钴铬钼离子的释出

Comparison of Cobalt Chrome Molybdenum release after metal on metal replacement between THA and TKA

目的研究金属对金属全髋关节置换与全膝关节置换术后早期患者体内钴、铬、钼离子的释出情况。方法选择2007年5月至2008年3月实施的金属对金属全髋关节置换10例，全膝关节置换8例。假体选择采取随机原则。分别于术前和术后第2、6、12、24周采集静脉全血，应用双聚焦电感耦合等离子体质谱法测量钴、铬、钼离子在血浆样品中的浓度。结果（1）金属对金属全髋关节置换及全膝关节置换术后患者血浆中钴、铬离子水平增高，于术后2周开始至6周增高明显，6周时离子浓度达到峰值，6周后离子浓度逐渐下降，12周下降至2周水平，24周离子下降趋势逐渐减慢。（2）金属对金属全髋关节置换术后6、12、24周钴、铬离子浓度低于全膝关节置换术患者。（3）使用锻造工艺假体患者术后血浆钴、铬离子浓度低于使用铸造工艺假体患者。（4）两组患者随访半年内钼离子浓度与术前比较差异均无统计掣意义。结论钴铬钼合金金属对金属全髋关节及全膝关节置换术后血浆钴、铬离子浓度均高于术前，离子浓度增高趋势相似。

Objective To explore and compare the level of Cobalt chromium and Molybdenum in the patients after metal on metal replacement between THA and TKA in 6 months after operation. Methods From May 2007 to March 2008, metal on metal replacement of 10 THA and 8 TKA were included in this study. Blood samples were collected before operation, 2 weeks, 6 weeks, 12 weeks and 24 weeks after operation in each patient. The concentration of Chromium （Cr）, Cobalt （Co） and Molybdenum （Mo） ions in the plasma were measured by Double-focusing Inductively Coupled Plasma Mass Spectrometry （ICP-MS）. Resuits 1） The level of Cobalt, Chromium ion after metal on metal hip and knee replacement were significantly higher than normal. They increased sharply 2 weeks after operation, and reached the peak 6 weeks after operation, then decreased gradually to the level of 2 weeks when it was 12 weeks after operation, and after that they decreased slowly until 24 weeks after operation. 2） The concentration of Cobalt, Chromium ion in hip replacement group was lower than that of in knee replacement group. 3） The concentration of Cobalt and Chromium ion in patients using forging products were lower than those using casting products. 4） No significant changes were found in the concentration of Molybdenum ion in 6 months follow-up in two groups. Conclusion The concentration of Cobalt, Chromium ion increases after metal on metal replacement in THA and TKA. The concentration of Cobalt, Chromium ion in hip replacement group was lower than that of knee replacement group in 6 months after operation.