Mills William J, Tejwani Nirmal
Department of Orthopaedics, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
J Orthop Trauma. 2003 May;17(5):338-45. doi: 10.1097/00005131-200305000-00004.
To determine the relationship of multiple variables, including the Injury Severity Score (ISS), closed head injury (CHI), and timing and type of surgery to formation of motion-limiting heterotopic ossification (HO) following knee dislocation.
Longitudinal observational study.
University level 1 trauma center.
PATIENTS/PARTICIPANTS: Thirty-five consecutive patients with 36 knee dislocations (OTA fracture and dislocation classification 40-D) admitted over a 26-month period.
Admission ISS, Glasgow Coma scale (GCS) scores, CHI, timing (> or < 3 weeks from injury) and type (open or arthroscopic) of surgery, number of cruciate ligaments reconstructed, medial surgical procedure, and eventual presence or absence of motion-limiting HO.
A classification system for HO was developed ranging from none (type 0) to ankylosing (type IV) HO. Twenty-nine patients with type 0-III HO recovered an average range of motion of 126 degrees at an average of 14 months (group A). Six patients formed ankylosing type IV HO (group B). The ISS in group A ranged from 9 to 26. ISS in group B ranged from 26 to 50 (P < 0.001). Regarding the formation of type IV HO, the sensitivity of an ISS >/=26 was 100%, the specificity was 97%, and the positive predictive value was 86%. Patients in group B had a greater incidence of documented CHI (P < 0.025). Timing and type of surgery, number of ligaments reconstructed, and whether or not the patient had a medial surgical procedure had no statistical influence on degree of HO formation.
An ISS of 26 seems to be a discrete boundary above which patients with knee dislocation are at extremely high risk for type IV HO formation if undergoing surgical reconstruction and below which patients are likely spared this complication. The presence of a CHI is a significant factor in type IV HO formation, although harder to quantify. None of the remaining independent variables studied were significantly related to ankylosing type IV HO formation.
确定多个变量之间的关系，包括损伤严重度评分（ISS）、闭合性颅脑损伤（CHI）、手术时机和类型与膝关节脱位后运动受限性异位骨化（HO）形成之间的关系。
纵向观察性研究。
大学一级创伤中心。
患者/参与者：在26个月期间收治的35例连续患者，共36例膝关节脱位（OTA骨折和脱位分类40 - D）。
入院时的ISS、格拉斯哥昏迷量表（GCS）评分、CHI、手术时机（受伤后>或<3周）和类型（开放或关节镜）、重建的交叉韧带数量、内侧手术操作以及最终是否存在运动受限性HO。
制定了一个HO分类系统，范围从无（0型）到强直性（IV型）HO。29例0 - III型HO患者平均在14个月时恢复了126度的平均活动范围（A组）。6例患者形成强直性IV型HO（B组）。A组的ISS范围为9至26。B组的ISS范围为26至50（P < 0.001）。关于IV型HO的形成，ISS≥26的敏感性为100%，特异性为97%，阳性预测值为86%。B组记录到的CHI发生率更高（P < 0.025）。手术时机和类型、重建的韧带数量以及患者是否进行了内侧手术操作对HO形成程度无统计学影响。
ISS为26似乎是一个离散界限，高于此界限的膝关节脱位患者如果接受手术重建，发生IV型HO形成的风险极高，低于此界限的患者可能不会出现这种并发症。CHI的存在是IV型HO形成的一个重要因素，尽管更难量化。研究的其余独立变量均与强直性IV型HO形成无显著相关性。
Zotero 插件