European Spine Journal ( IF 2.6 ) Pub Date : 2022-09-14 , DOI: 10.1007/s00586-022-07341-5 Daniel Fell 1 , Elias Diarbakerli 1, 2 , Paul Gerdhem 1, 2, 3, 4
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Purpose
The aim of this study is to evaluate the levels of chromium (Cr), cobalt (Co), and titanium (Ti) after instrumented fusion for scoliosis.
Methods
Serum samples were collected at median 2.24 (range 0.1–38.8) years after fusion surgery for scoliosis in 91 individuals, of which 71 had been treated with steel implants and 20 with titanium implants. 91 sex and age-matched non-surgically treated individuals with scoliosis were used as controls. Levels of Cr, Co, and Ti were measured.
Results
In the 91 surgically treated individuals median levels of Cr were 0.54 µg/l vs 0 µg/l in the 91 controls, p < 0.001. Corresponding results for Co were 0.29 µg/l vs. 0.24 µg/l, p = 0.19, and for Ti were 0 µg/l vs. 0 µg/l, p < 0.001.
In the individuals with steel implants and their corresponding controls median Cr levels were 0.63 µg/l vs. 0.00 µg/l, p < 0.001 and Co levels 0.27 µg/l vs. 0.23 µg/l, p = 0.36. No Ti was detected.
In the individuals with titanium implants, median Cr levels were 0 µg/l vs. 0 µg/l in their corresponding controls, p = 0.38. Corresponding results for Co was 0.39 µg/l vs. 0.31 µg/l, p = 0.27 and for Ti 4.31 µg/l vs. 0 µg/l, p < 0.001.
In the individuals with steel implants a negative correlation between implant time in situ and levels of Cr was found (\(\rho\) = − 0.52, p < 0.001) but not with Co (\(\rho\) = − 0.14, p = 0.23). Ti was not detected.
In the individuals with titanium implants, there was no correlation between implant time in situ and levels of Cr (\(\rho\) = 0.36, p = 0.12), Co (\(\rho\) = − 0.12, p = 0.60) or Ti (\(\rho\) = 0.22, p = 0.35).
Conclusion
The use of stainless steel and titanium implants in spinal fusion surgery is associated with elevated metal ion concentrations several years after surgery.
中文翻译：
脊柱畸形手术后血清金属离子水平：182 人的病例对照研究
目的
本研究的目的是评估脊柱侧凸器械融合术后铬 (Cr)、钴 (Co) 和钛 (Ti) 的水平。
方法
在 91 名个体的脊柱侧弯融合手术后中位 2.24（范围 0.1-38.8）年收集血清样本，其中 71 名接受了钢植入物治疗，20 名接受了钛植入物治疗。91 名性别和年龄匹配的非手术治疗的脊柱侧凸患者被用作对照。测量了 Cr、Co 和 Ti 的含量。
结果
在 91 名接受手术治疗的个体中，Cr 的中值水平为 0.54 微克/升，而 91 名对照组为 0 微克/升，p < 0.001。Co 的相应结果为 0.29 µg/l 与 0.24 µg/l，p = 0.19，Ti 的相应结果为 0 µg/l 与 0 µg/l，p < 0.001。
在有钢植入物的个体及其相应的对照中，Cr 水平中值分别为 0.63 µg/l 与 0.00 µg/l，p < 0.001，Co 水平为 0.27 µg/l 与 0.23 µg/l，p = 0.36。没有检测到 Ti。
在有钛植入物的个体中，Cr 水平中位数为 0 µg/l，而相应的对照组为 0 µg/l，p = 0.38。Co 的相应结果为 0.39 µg/l 与 0.31 µg/l，p = 0.27，Ti 的相应结果为 4.31 µg/l 与 0 µg/l，p < 0.001。
在使用钢植入物的个体中，原位植入时间与 Cr 水平呈负相关（\(\rho\) = − 0.52，p < 0.001），但与 Co 无关（\(\rho\) = − 0.14，p = 0.23）。未检测到 Ti。
在植入钛的个体中，原位植入时间与 Cr（\(\rho\) = 0.36，p = 0.12）、Co（\(\rho\) = − 0.12，p = 0.60 ）水平之间没有相关性) 或 Ti ( \(\rho\) = 0.22, p = 0.35)。
结论
在脊柱融合手术中使用不锈钢和钛植入物与术后数年金属离子浓度升高有关。
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