金属超敏反应在人工全关节置换术中的研究进展

RESEARCH PROGRESS OF METAL HYPERSENSITIVITY IN ARTIFICIAL TOTAL JOINT ARTHROPLASTY

金属超敏反应(MHS)是全关节置换术的一种较为罕见的并发症,是导致假体失效的众多原因之一。目前MHS已被认为是机体对植入假体所含金属(通常为镍和钴-铬)的IV型超敏反应,病人往往出现较为典型的关节疼痛、肿胀以及湿疹样皮肤改变。迄今为止对MHS尚无明确的诊断标准,但皮肤斑贴试验与淋巴细胞转化实验已被证明具有一定的特异性。目前对MHS的治疗方案主要包括类固醇激素和假体翻修手术,其中翻修手术通常需要以低敏金属植入物取代原有植入物,但往往也要根据病人的具体症状来决定使用何种植入物。本文主要对MHS在人工全关节置换中的研究进展做一综述,旨在更好地了解MHS的病理生理学,临床表现,诊断及治疗方案。

Metal hypersensitivity(MHS)is a rare complication of total joint arthroplasty and is one of the many causes of prosthesis failure.At present,MHS has been considered as a type IV hypersensitivity reaction of the metal contained in the implant(usually nickel and cobalt-chromium).Patients often have typical joint pain,swelling and eczema-like skin changes.There are no clear diagnostic criteria for MHS so far,but skin patch testing and lymphocyte transformation testing have proven to be specific.The treatment plan for MHS mainly includes steroid hormone and prosthetic revision surgery.The revision surgery usually needs to replace the original implant with a low-sensitivity metal implant,but it is often decided to use the plant according to the specific symptoms of the patient.This article is mainly to review the research progress of MHS in artificial total joint replacement,in order to better understand the pathophysiology,clinical manifestations,diagnosis and treatment of MHS.