Barrack Robert L, Brumfield Christopher S, Rorabeck Cecil H, Cleland Diana, Myers Leann
Department of Orthopaedic Surgery, Tulane University Health Sciences Center, New Orleans, LA 70112, USA.
Clin Orthop Relat Res. 2002 Nov(404):208-13. doi: 10.1097/00003086-200211000-00034.
A consecutive series of revision total knee arthroplasties done at two centers was evaluated for the presence of heterotopic ossification on radiographs taken before and after revision using the classification system of Harwin et al. Knee Society scores were obtained preoperatively and at annual intervals postoperatively. The patients' demographics and clinical scores were correlated with the incidence and grade of heterotopic ossification. Minimum 2-year followup was obtained in 135 of 151 patients who had revision total knee arthroplasty during this period (89%). The incidence of heterotopic ossification before revision surgery was 23%, which increased to 56% at most recent followup (mean, 30 months; range, 24-48 months). The only risk factor identified for the development of heterotopic ossification was the presence of infection (76%), which was significantly higher than the 47% incidence of heterotopic ossification in patients who did not have an infection. The average postoperative Knee Society score was lower in patients with heterotopic ossification compared with patients without heterotopic ossification (129 points versus 148 points). Patients with heterotopic ossification had significantly lower functional scores particularly on stair climbing but did not have a significantly decreased range of motion. Parameters not associated with subsequent development of heterotopic ossification included gender (males), patient size (body mass index), surgical time, operative approach, or number of prior knee procedures.
对在两个中心进行的一系列连续的全膝关节置换翻修手术进行评估，使用Harwin等人的分类系统，根据翻修前后拍摄的X线片判断是否存在异位骨化。术前及术后每年获取膝关节协会评分。将患者的人口统计学数据和临床评分与异位骨化的发生率及分级进行关联分析。在此期间接受全膝关节置换翻修手术的151例患者中，135例（89%）获得了至少2年的随访。翻修手术前异位骨化的发生率为23%，在最近一次随访时（平均30个月；范围24 - 48个月）升至56%。确定的异位骨化发生的唯一危险因素是存在感染（76%），这显著高于无感染患者47%的异位骨化发生率。与无异位骨化的患者相比，有异位骨化的患者术后膝关节协会平均评分更低（129分对1分）。有异位骨化的患者功能评分显著更低，尤其是在爬楼梯方面，但活动范围没有显著减小。与随后异位骨化发生无关的因素包括性别（男性）、患者体型（体重指数）、手术时间、手术入路或既往膝关节手术次数。
