THR后金屬離子病的危害和防治

1、異位骨化異位骨化間隙明顯間隙明顯SEM : metal particles and PE particle股骨柄周圍黑色壞死組織股骨柄周圍黑色壞死組織 Coen N，Kadhim MA，Wright EG，et a1Particulate debris from a titanium metal prosthesis induces genomics instability in primary human fibroblast cellsJBr J Cancer,2003，88(4)：548552 Mekala Gunaratnam 1, M. Helen Grant Cr (VI) inh

2、ibits DNA, RNA and protein syntheses in hepatocytes: Involvement of glutathione reductase,reduced glutathione and DT-diaphorase Toxicology in Vitro 22 (2008) 879886誘發(fā)了基因突變誘發(fā)了基因突變導致染色體損傷導致染色體損傷干擾了干擾了DNA轉(zhuǎn)錄轉(zhuǎn)錄復制復制滑膜細胞滑膜細胞 促進破促進破骨細胞骨細胞分化成分化成熟熟 Niki Y,Matsumoto H,Suda Y,et al.Mental ions induce bone-resor

3、bing cytokine production through the redox pathway in synoviocytes and bone marrow macrophage.Biomaterials,2003; 24(8):1447-1457 抑制成骨抑制成骨細胞分化細胞分化 Cyrille Fleurya,b, Alain Petita, Fackson Mwalea, John Antonioua,c,David J. Zukora, Maryam Tabrizianb,c,d,e, Olga L. Huka,c, Effect of cobalt and chromium

4、ions on human MG-63 osteoblasts in vitro: Morphology, cytotoxicity, and oxidative stress Biomaterials 27 (2006) 33513360預防措施預防措施金屬微觀金屬微觀結(jié)構改變結(jié)構改變金屬表面金屬表面涂層技術涂層技術防止脫位防止脫位內(nèi)襯破裂內(nèi)襯破裂假體因素假體因素個體因素個體因素不銹鋼不銹鋼鈦合金鈦合金Co-Cr-Mo合金合金C N B等元素等元素表面注入表面注入高硬度高硬度 耐腐蝕耐腐蝕 低磨損低磨損在在37水水的潤滑下，的潤滑下，加壓加壓2200N，TiN+聚乙烯配對可作聚乙烯配對可作為

5、一種終生結(jié)合。為一種終生結(jié)合。SEM CaSiO 結(jié)合強度結(jié)合強度切除異位骨化切除異位骨化金屬離子金屬離子組織壞死組織壞死切除肉芽組織切除肉芽組織Jun-Dong Chang, MD, PhD, Sang-Soo Lee, MD, PhD, Mina Hur, MD, PhD,Eun-Min Seo, MD, Yung-Khee Chung, MD, PhD, and Chang-Ju Lee, MD, PhDRevision Total Hip Arthroplasty in Hip Joints With Metallosis A Single-Center Experience With

6、 31 CasesJ The Journal of Arthroplasty, Vol. 20 No. 5 2005Bubble signcloud sign extreme metallosis Macroscopic metal fragments 3 year post OPrevision影像學（影像學（CT.MRI. EDX X-Ray)臨床癥狀臨床癥狀（Pain swell disorder)輔助檢查（輔助檢查（ESR CRP 金屬離子濃度)聚四氟乙烯髖臼聚四氟乙烯髖臼與不銹鋼股骨頭與不銹鋼股骨頭1958年英國年英國Charnley高密度聚乙高密度聚乙烯髖臼烯髖臼1962年英國年英國Charnley鈦合金鈦合金 鈷鉻鈷鉻鉬合金假體鉬合金假體Distribution of Chromium and Cobalt Ions in Various Blood Fractions After Resurfacing Hip Arthr