Histological features of pseudotumor-like tissues from metal-on-metal hips.
Histological features of pseudotumor-like tissues from metal-on-metal hips.
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DOI：
10.1007/s11999-010-1372-y
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发表时间：
2010-09
影响因子：
4.2
通讯作者：
Amstutz, Harlan C.
中科院分区：
文献类型：
--
作者：
Campbell, Pat;Ebramzadeh, Edward;Nelson, Scott;Takamura, Karren;De Smet, Koen;Amstutz, Harlan C.
假肿瘤样假体周围组织周围金属对金属（M-M）髋关节置换术可引起疼痛并导致翻修手术。这些反应的原因尚不清楚，但可能是由于过度磨损，或金属过敏或其他未知原因。组织特征可以帮助区分高磨损反应和疑似金属过敏反应。因此，我们检查了来自M-M髋关节的假肿瘤样组织的滑膜内膜完整性、炎症细胞浸润、组织组织、坏死和金属磨损颗粒，这些组织被修正为疑似高磨损相关和疑似金属超敏性原因。研究了32例有假肿瘤样反应的改良髋关节置换术的组织样本。通过检查滑膜内膜完整性、炎症细胞浸润和组织组织，采用10分组织学评分对无菌淋巴细胞血管炎相关病变（ALVAL）的程度进行分级。对淋巴细胞、巨噬细胞、浆细胞、巨细胞、坏死细胞和金属磨损颗粒进行半定量评价。采用三坐标测量机测量种植体磨损。根据临床、放射学和检索结果将病例分为怀疑有高磨损和怀疑有金属超敏反应。采用Mann-Whitney检验比较两组患者的组织学特征。疑似高磨损患者的组织与因疼痛和疑似金属过敏而修改的髋部组织相比，ALVAL评分较低，淋巴细胞较少，但巨噬细胞和金属颗粒较多。最高的ALVAL评分发生在因疼痛和疑似金属过敏而进行修订的患者中。该组的部件磨损较低。假性肿瘤样反应可由高磨损引起，但也可能发生在低磨损种植体周围，可能是由于金属超敏反应。组织学特征包括滑膜完整性、炎症细胞浸润、组织组织和金属颗粒可以帮助区分这些病因。髋关节疼痛伴假体周围肿块可能是由高度磨损引起的，但如果可以排除这种情况，则应考虑金属过敏。
Pseudotumor-like periprosthetic tissue reactions around metal-on-metal (M-M) hip replacements can cause pain and lead to revision surgery. The cause of these reactions is not well understood but could be due to excessive wear, or metal hypersensitivity or an as-yet unknown cause. The tissue features may help distinguish reactions to high wear from those with suspected metal hypersensitivity. We therefore examined the synovial lining integrity, inflammatory cell infiltrates, tissue organization, necrosis and metal wear particles of pseudotumor-like tissues from M-M hips revised for suspected high wear related and suspected metal hypersensitivity causes. Tissue samples from 32 revised hip replacements with pseudotumor-like reactions were studied. A 10-point histological score was used to rank the degree of aseptic lymphocytic vasculitis-associated lesions (ALVAL) by examination of synovial lining integrity, inflammatory cell infiltrates, and tissue organization. Lymphocytes, macrophages, plasma cells, giant cells, necrosis and metal wear particles were semiquantitatively rated. Implant wear was measured with a coordinate measuring machine. The cases were divided into those suspected of having high wear and those suspected of having metal hypersensitivity based on clinical, radiographic and retrieval findings. The Mann-Whitney test was used to compare the histological features in these two groups. The tissues from patients revised for suspected high wear had a lower ALVAL score, fewer lymphocytes, but more macrophages and metal particles than those tissues from hips revised for pain and suspected metal hypersensitivity. The highest ALVAL scores occurred in patients who were revised for pain and suspected metal hypersensitivity. Component wear was lower in that group. Pseudotumor-like reactions can be caused by high wear, but may also occur around implants with low wear, likely because of a metal hypersensitivity reaction. Histologic features including synovial integrity, inflammatory cell infiltrates, tissue organization, and metal particles may help differentiate these causes. Painful hips with periprosthetic masses may be caused by high wear, but if this can be ruled out, metal hypersensitivity should be considered.
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影响因子：
3.5
作者：
Khan, Munir;Kuiper, Jan-Herman;Richardson, James B.
通讯作者：
Richardson, James B.
DOI：
10.1302/0301-620x.91b8.21701
发表时间：
2009-08-01
影响因子：
--
作者：
Ollivere, B.;Darrah, C.;Porteous, M. J.
通讯作者：
Porteous, M. J.
DOI：
10.1302/0301-620x.90b7.20213
发表时间：
2008-07-01
影响因子：
--
作者：
Pandit, H.;Glyn-Jones, S.;Murray, D. W.
通讯作者：
Murray, D. W.
DOI：
10.1302/0301-620x.91b6.21682
发表时间：
2009-06-01
影响因子：
--
作者：
Hart, A. J.;Sabah, S.;Skinner, J. A.
通讯作者：
Skinner, J. A.
DOI：
10.1302/0301-620x.75b2.8444946
发表时间：
1993-03-01
影响因子：
--
作者：
KABO, JM;GEBHARD, JS;AMSTUTZ, HC
通讯作者：
AMSTUTZ, HC