战创伤复杂性骨折外固定治疗的研究课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Ten-year outcome of serum metal ion levels after primary total hip arthroplasty: a concise follow-up of a previous report,Levine BR, et al. Rush University Medical Center,J Bone Joint Surg Am.,2013 Mar 20;95(6):512-8.,Ten-year outcome of serum meta,战创伤复杂性骨折外固定治疗的研究课件,Background,Adverse local and systemic effects:,Local soft tissue reactions,Pseudotumor formation,Systemic effects,End-organ deposition,Serum metal levels are not unique to metal-on-metal bearings,All metallic components potentially resulting in the formation of chemically active metal degradation products,Implants became more durable and increase longevity, demographic change,Background Adverse local a,There is no accepted threshold to be toxic in patients,Original report: Observe 3 years follow-up,Present study: determine the serum metal concentrations with metal-on-polyethylene on 10 years follow-up,Background,There is no accepted thre,All prostheses were inserted from 1989 1993,No other metallic implants used,Study,：,55,（,primary unilateral THA,）；,Control,：,20,Methods,hybrid group: cobalt-alloy cemented femoral stem with titanium acetabular socket without cement,CoCr group: cobalt-chromium without cement,Titanium group: titanium-alloy without cement,Control group: no metal implant,All prostheses were inser,hybrid group: coblat-alloy femoral stem cemented,28-mm-diameter cobalt-alloy head,titanium acetabular non-cemented,titanium screw,(Zimmer),CoCr group: Duraloc, AML, Solution, Prodigy(Depuy),Titanium group: Harris-Galante porous-coated (Zimmer),Metal ion concentrations in patient serum were analyzed by high-resolution plasma mass spectrometry,hybrid group: coblat-allo,The concentration of cobalt in the serum:,hybrid group is 3.2 times higher than the baseline at 120 month, and significantly different than Ti.,Co,The concentration of cobalt in,The concentration of chromium in the serum:,hybrid group is 3.9 times higher than the baseline at 120 month, and 3.6 times higher in CoCr group than they were at baseline.,Cr,The concentration of chromium,The concentration of titanium in the serum:,Hybrid group is 8.9 times higher than the baseline at 120 month, and 9.2 times higher than at the baseline in CoCr group.,Ti,The concentration of titanium,There is limited information available regarding the long-term impact of metal-on-polyethylene THA, particularly for titanium.,Fretting corrosion at the femoral head-neck junction was likely source of increased chromium release than passive dissolution.,Conclusion,There is limited i,Elevated cobalt levels in all three implant groups as compared with the levels in the control group, while our previous findings of low cobalt concentrations. -Due to different analysis system,HR-SF-ICP-MS VS Atomic absorption spectrometry,(detection limit, 0.04ng/dl) (detection limit, 0.3ng/dl),Increase cobalt : Failed implant MOP,Poorly functioning primary THA,Fretting corrosion: taper size of the femoral stem,geometry, tolerances, assembly forces,surface finish, metallurgy,Elevated cobalt leve,Elevated cobalt levels in the hybrid group and titanium group is noteworthy at 36m to 120m.,Hybrid group: fretting corrosion of the femoral stem with cement,A more likely cause: different composition of head-neck junction,Galvanic corrosion is not a dominant mode of metal release,Elevated cobalt le,Previous: Cr in titanium group is higher than hybrid and CoCr group,Now: titanium and CoCr group were similar about Cr,hybrid group were increased,Suggest: MACC at the head-neck junction was a primary source,Fact: Co levels in the hybrid group were consistently elevated than Cr levels is consistent with report documenting disproportionate elevations in Co with adverse local tissue reactions due to MACC with MOP implants.,MACC: mechanically assisted crevice corrosion,Previous: Cr in titanium g,Previous: Ti in titanium group is 3.4 times to control group,Elevated only one with a loose prosthesis,Now: titanium group had a peak at 36 m,decrease until 108 m,Previous: Ti in titanium g,Only half of original patients from 3 years fellow were qualified and available for 10 years study,Major limitation of this study and represents attrition bias,Prevented further trends and differents,Limitation,Only half of original,Not randomized,Type of implant and the method of fixation surgeon,Literature regarding metal ion concentration is variability,How measurement are gathered, analyzed, reported,Ensure samples are drawn, processed, and analyzed,Make comparisons between studies difficult,Limitation,Not randomized Limitation,With identical technique within a single lab,Good expertise allow more subtle differences,Advantage,With identical technique,Biologic and clinical effects of increased metal concentration remain,UNCLEAR,Despite individual reports of severe local and systemic reaction,Not been well defined,Even in patients with well-functioning prostheses who have not experienced increase in serum metal concentrations, deposition and accumulation of metal ions can occur locally and in remote organ,Biologic and clinical eff,Contribute to the understanding of long-term changes in serum metal levels in patients after primary joint replacement and how these levels are influenced by component composition.,The toxicological risks associated with metal ions from joint prostheses represent an area of much-needed investigation, as the number of patients is estimated to increase rapidly over the next decade.,ALL IN ALL,Contribute to the underst,Poor Mid-Term Survival of the Low-Carbide Metal-on-Metal Zweymuller-Plus Total Hip Arthroplasty System: a concise follow-up, at a Minimum of ten years, of a previous report,Thomas Repantis, et al. Agios Andreas,J Bone Joint Surg Am.,2013 Mar 20;95(6):535.,Poor Mid-Term Survival of the,Cementless Zweymuller SL-Plus stem,Bicon-Plus threaded cup,1994-1999 10 years later,217 hips 203 hips,The revision rate was 18%,Main reason: aseptic loosening,Cementless Zweymuller SL-,Survival of the stem at 15 years was 77%,Survival of the cup at 15 years was 80%,Abandon,the use of low-carbide metal-on-metal components,Survival of the stem at 1,战创伤复杂性骨折外固定治疗的研究课件,战创伤复杂性骨折外固定治疗的研究课件,