本文選題：人工髖關(guān)節(jié)表面置換術(shù)　切入點(diǎn)：金屬離子　出處：《中國(guó)修復(fù)重建外科雜志》2017年04期 　論文類型：期刊論文

【摘要】：目的應(yīng)用電感耦合等離子體質(zhì)譜儀檢測(cè)人工髖關(guān)節(jié)表面置換術(shù)(resurfacing arthroplasty of the hip,RSAH)后不同時(shí)間患者血清鈷、鉻以及鉬離子濃度,探討其影響因素。方法選擇2005年6月-2014年11月行RSAH且術(shù)后歷次隨訪關(guān)節(jié)功能良好(Harris評(píng)分85分)的47例(55髖)患者作為研究對(duì)象。其中男25例,女22例;年齡18~64歲,平均49.7歲。髖臼發(fā)育不良(developmental dysplasia of the hip,DDH)18例(22髖),非DDH 29例(33髖)。術(shù)后隨訪時(shí)間6個(gè)月~5年,平均3.2年。應(yīng)用電感耦合等離子體質(zhì)譜儀測(cè)定血清鈷、鉻以及鉬離子濃度,以6名正常自愿者血清金屬離子濃度作為正常參照值進(jìn)行比較。綜合金屬離子濃度測(cè)量結(jié)果分析,選擇患者并根據(jù)髖臼假體位置以及股骨頭假體直徑分組比較,分析其與金屬離子濃度的關(guān)系。對(duì)金屬離子濃度與患者年齡、體質(zhì)量指數(shù)、手術(shù)前后Harris評(píng)分以及股骨假體頸干角、柄干角進(jìn)行相關(guān)分析。結(jié)果與正常參照值比較,置換術(shù)后患者鈷離子濃度于術(shù)后1年時(shí)達(dá)峰值(P0.05),之后緩慢下降,至術(shù)后4年時(shí)再次升高,術(shù)后5年時(shí)濃度接近術(shù)后2年水平;鉻離子濃度于術(shù)后9個(gè)月達(dá)峰值(P0.05),之后逐漸下降,至術(shù)后5年時(shí)接近正常水平;鉬離子濃度總體呈逐漸上升趨勢(shì),術(shù)后5年濃度最高(P0.05)。根據(jù)金屬離子濃度測(cè)量結(jié)果綜合分析,取術(shù)后隨訪9個(gè)月及1年的29例(35髖)患者進(jìn)行分組分析。與髖臼假體外展角40°及45°組相比,40~45°組DDH及非DDH患者鈷、鉻離子濃度降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);鉬離子濃度差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。與髖臼假體前傾角15°及20°組相比,15~20°組患者鈷、鉻、鉬離子濃度均顯著降低(P0.05)。股骨頭直徑≥48 mm組鈷、鉻、鉬離子濃度均低于48 mm組,但組間僅鈷離子濃度差異有統(tǒng)計(jì)學(xué)意義(P0.05)。相關(guān)分析示,鈷離子濃度與術(shù)后Harris評(píng)分成負(fù)相關(guān)(r=-0.486,P=0.041)。結(jié)論 RSAH術(shù)后1年血清鈷離子濃度明顯高于正常水平,術(shù)后9個(gè)月鉻離子明顯升高,術(shù)后鉬離子濃度呈持續(xù)上升趨勢(shì);各金屬離子濃度與髖臼假體位置有密切關(guān)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 擄and 45 擄, the cobalt and chromium ion concentrations in DDH and non-#en1# patients were lower than those in 40 擄and 45 擄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 擄and 20 擄acetabular prosthetic anteversion, the concentrations of cobalt, chromium and molybdenum ions were significantly decreased in 15 擄and 20 擄groups. The diameter of femoral head was 鈮，

本文編號(hào)：1565464