PDF(Pubmed)
Abstract：
Metal-on-metal (MoM) bearing surfaces were historically used for young patients undergoing total hip arthroplasty (THA), and remain commonplace in modern hip resurfacing. A substantial number of female patients with MoM bearings subsequently gave birth following implantation of the bearings before a full understanding of metal ions exposure in these patients was established. In theory, it has been postulated that metal ions released from such implants may cross the placental barrier and cause harm to the fetus. In light of this potential risk, recommendations against the use of MoM components in women of child-bearing age have been advocated. The purpose of this systematic review was to evaluate: (I) the MoM bearing types and ion levels found; (II) the concentrations of metals in maternal circulation and the umbilical cord; and (III) the presence of abnormalities in the fetus or delivered child. A comprehensive literature review was conducted of studies published between January 1st, 1975 and April 1st, 2019 using specific keywords. We defined the inclusion criteria for qualifying studies for this review as follows: (I) studies that reported on the women who experienced pregnancy and who had a MoM hip implant; (II) studies that reported on maternal metal ions blood and umbilical cord levels; and (III) studies that reported on the occurrence of fetal complications. Data on cobalt and chromium ion levels in the maternal blood and umbilical cord blood, as well as the presence of adverse effects in the infant were collected. Age at parturition and time from MoM implant to parturition were also collected. A total of six studies were included in the final analysis that reported on a total of 21 females and 21 infants born. The mean age at parturition was 31 years (range, 24 to 41 years), and the mean time from MoM implantation to parturition was 47 months (range, 11 to 119 months). Maternal blood cobalt levels were found as a weighted average of 34.09 µg/L (0.425 to 138 µg/L), while umbilical cord blood cobalt levels were found to be 22.61 µg/L (0.52 to 51.11 µg/L). Cobalt levels were reduced by an average of 34% between maternal and umbilical cord blood. Maternal cord blood chromium levels were found as a weighted average of 18.18 µg/L (0.225 to 75 µg/L), while umbilical cord chromium levels were found to be 3.96 µg/L (0.14 to 11.96 µg/L). Chromium levels were reduced by an average of 78% between maternal and umbilical cord blood. No cobalt or chromium was detected in the umbilical cord blood of three patients. Out of the 21 infants born to women with MoM implants, 20 were born healthy with no adverse effects or complications. Only one complication was recorded in single infant that did not appear to be related to the maternal MoM implant. To date, there is a lack of consensus as to whether MoM hip arthroplasty implants are to be avoided in the child-bearing female population and whether they constitute a hazard to the fetus in utero. Both chromium and cobalt ions were markedly reduced in levels when transitioning from maternal to cord blood. In particular, chromium showed a greater reduction on average than cobalt (78% vs. 34%). Based on the current evidence, there appears to be no correlation between the presence of metal ions in umbilical cord blood and complications, as none of the infants experienced abnormalities uniquely attributable to the presence of metal ions.
摘要：
金属对金属（MoM）轴承表面历来用于接受全髋关节置换术（THA）的年轻患者，在现代髋关节表面重铺中仍然很常见。植入轴承后，大量患有MoM轴承的女性患者随后分娩，然后对这些患者的金属离子暴露有了充分的了解。理论上,据推测，从这种植入物释放的金属离子可能会穿过胎盘屏障并对胎儿造成伤害。鉴于这种潜在的风险，建议禁止在育龄妇女中使用MoM组件。这项系统评价的目的是评估：（I）发现的MoM类型和离子水平；（II）母体循环和脐带中金属的浓度；（III）胎儿或分娩的孩子是否存在异常。对1月1日之间发表的研究进行了全面的文献综述，1975年4月1日,2019年使用特定关键字。我们定义了本综述的合格研究的纳入标准如下：（I）报道了怀孕和MoM髋关节植入物的女性的研究；（II）报道了母体金属离子血液和脐带水平的研究；（III）报道了胎儿并发症发生的研究。母体血液和脐带血中钴和铬离子水平的数据，以及在婴儿中存在的不良反应被收集。还收集了分娩时的年龄和从MoM植入物到分娩的时间。最终分析中包含了总共6项研究，报告了21名女性和21名婴儿的出生。分娩时的平均年龄为31岁(范围，24至41岁），从MoM植入到分娩的平均时间为47个月(范围，11至119个月）。母体血液中钴含量的加权平均值为34.09µg/L（0.425至138µg/L），而脐带血钴含量为22.61µg/L（0.52至51.11µg/L）。母体和脐带血之间的钴水平平均降低了34％。母体脐带血铬含量的加权平均值为18.18µg/L（0.225至75µg/L），而脐带铬含量为3.96µg/L（0.14至11.96µg/L）。母体和脐带血之间的铬水平平均降低了78％。3例患者的脐带血中未检测到钴或铬。在有MoM植入物的女性所生的21名婴儿中，20人出生健康，无不良反应或并发症。在单个婴儿中仅记录了一种并发症，该并发症似乎与母体MoM植入物无关。迄今为止,对于生育女性人群中是否应避免使用MoM髋关节置换术植入物以及它们是否对子宫内胎儿构成危害,目前尚无共识.从母体血过渡到脐带血时，铬和钴离子的水平均显着降低。特别是,铬的平均还原率高于钴(78%vs.34%)。根据目前的证据,脐带血中金属离子的存在与并发症之间似乎没有相关性，因为没有一个婴儿经历异常，唯一归因于金属离子的存在。
