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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 700 -706. doi: 10.3877/cma.j.issn.1674-134X.2021.06.008

综述

金属超敏反应在全膝关节置换术中的研究进展
余鹏1, 孙长鲛2,†(), 蔡谞2   
  1. 1. 430081　武汉科技大学医院
    2. 102218　清华大学附属北京清华长庚医院骨科，清华大学临床医学院
  • 收稿日期:2020-10-27 出版日期:2021-12-01
  • 通信作者: 孙长鲛

Research progress of metal hypersensitivity in total knee arthroplasty

Peng Yu1, Changjiao Sun2,†(), Xu Cai2   

  1. 1. Department of Orthopedic, Wuhan University of Science and Technology Hospital, Wuhan 430081, China
    2. Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
  • Received:2020-10-27 Published:2021-12-01
  • Corresponding author: Changjiao Sun
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余鹏, 孙长鲛, 蔡谞. 金属超敏反应在全膝关节置换术中的研究进展[J]. 中华关节外科杂志(电子版), 2021, 15(06): 700-706.

Peng Yu, Changjiao Sun, Xu Cai. Research progress of metal hypersensitivity in total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(06): 700-706.

全膝关节置换术临床效果良好，但仍有20%的患者对临床结果不满意。这些患者虽然存在疼痛但膝关节假体功能良好。在排除了其他潜在原因后，要考虑到可能与金属超敏反应(MHS)有关。MHS实际是对假体植入物金属(通常是镍和钴铬合金)的Ⅳ型超敏反应。通常表现为假体周围关节疼痛和肿胀以及皮肤出现湿疹性皮炎。虽然MHS是膝关节置换术后罕见的并发症，但该反应在一般人群的发生率约为15%，并且在最近几十年中，随着膝关节置换术的增加，金属超敏反应的现象也在增加。.这篇综述的目的是对现有文献进行回顾分析，以便更好地了解MHS的病理生理，临床表现，诊断标准，检测方法，治疗方法和防过敏性假体。

关键词: 关节成形术，置换，膝, 超敏反应, 斑贴试验

Total knee arthroplasty is a common procedure, with extremely good clinical results. Despite this success, it produces 20% unsatisfactory results. These patients complained pain in otherwise well implanted and aligned prostheses. Metal hypersensitivity (MHS) is a rare complication of total joint arthroplasty that has been linked to prosthetic device failure when other potential causes have been ruled out. It has been described as a type IV hypersensitivity reaction to the metals comprising prosthetic implants, often nickel and cobalt-chromium. Patients suffering from this condition have reported periprosthetic joint pain and swelling as well as cutaneous, eczematous dermatitis. Although MHS is rare, hypersensitivity to metals in the general population has an incidence of about 15%, and in rising also for the higher number of joint replacements in the last decades. The purpose of this review was to conduct an analysis of existing literature in order to get a better understanding of the pathophysiology, clinical syndromes diagnosis, detection method, management of MHS and "hypersensitivity-friendly" implants

Key words: Arthroplasty, replacement, knee, Hypersensitivity, Patch tests
图1 TKA(全膝关节置换)术后金属超敏反应治疗流程
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