Metzner G, Lindner B, Neumann D, Dorn U
Universitätsklinik für Orthopädie, Paracelsus Medizinische Privatuniversität Salzburg, Osterreich.
Z Orthop Unfall. 2010 Mar;148(2):174-9. doi: 10.1055/s-0029-1240860. Epub 2010 Feb 22.
This retrospective study investigates the incidence of anterior intertrochanteric ossifications (AIO), especially in comparison with heterotopic ossifications classified according to Brooker. A classification system of AIO regarding short-term results (< 1 year after surgery) was introduced in 2003: AIO occurred solely in 13 % of all cases (ossifications according to Brooker grade 0) and would have been "overlooked" without a lateral X-ray. The incidence of AIO combined with ossifications according to Brooker > 0 was 48.8 % of all cases. Our study reports long-term results, furthermore correlations between ossifications and clinical outcome, rated by the Harris hip score (HHS) and range of motion (ROM), are evaluated.
149 cementless total hip arthroplasties (Hofer-Imhof threaded cup, straight stem), implanted into 140 patients from November 1991 to December 1994 underwent complete clinical and radiological follow-up from December 2005 to October 2006. The average age of the 81 female and 59 male patients at the time of implantation was 64 years. Without exception, a conventional, transgluteal approach (Bauer) was performed. All patients received indomethacin prophylaxis for 8 consecutive days after surgery. Current X-rays (a.-p. and lateral view) were evaluated in comparison with the former X-rays.
AIO were found in 77 cases (51.7 %), heterotopic ossifications corresponding to Brooker in 93 cases (62.4 %), a combination of AIO and Brooker in 58 cases (38.9 %) and solitary AIO in 19 cases (12.8 %). HHS and ROM were not significantly altered by ossifications.
Our long-term findings compare with the short-term results (indicating lack of new bone formation [heterotopic ossification] after more than one year after surgery, as previously described in the literature concerning ossifications according to Brooker) and verify the incidence rate of solitary AIO. Despite a minor correlation with clinical outcome, AIO could be considered as a possible indicator for predilection of heterotopic bone formation, especially if revision arthroplasty or THA of the contralateral side is needed.
本回顾性研究调查转子间前部骨化（AIO）的发生率，特别是与根据布鲁克分类的异位骨化相比较。2003年引入了一种关于短期结果（术后<1年）的AIO分类系统：AIO仅发生在所有病例的13%中（布鲁克0级骨化），若无侧位X线片则可能“被忽视”。AIO合并布鲁克>0级骨化的发生率为所有病例的48.8%。我们的研究报告了长期结果，此外，还评估了骨化与临床结果之间的相关性，临床结果通过Harris髋关节评分（HHS）和活动范围（ROM）进行评定。
1991年11月至1994年12月为140例患者植入的149例非骨水泥型全髋关节置换术（霍费尔 - 因霍夫螺纹髋臼杯，直柄），于2005年12月至2006年10月接受了完整的临床和放射学随访。81例女性和59例男性患者植入时的平均年龄为64岁。无一例外，均采用传统的经臀入路（鲍尔）。所有患者术后连续8天接受吲哚美辛预防治疗。将当前的X线片（前后位和侧位片）与之前的X线片进行对比评估。
发现77例（51.7%）存在AIO，93例（62.4%）存在符合布鲁克分类的异位骨化，58例（38.9%）存在AIO与布鲁克骨化的组合，19例（12.8%）存在孤立性AIO。骨化未显著改变HHS和ROM。
我们的长期研究结果与短期结果相符（表明术后一年多后无新骨形成[异位骨化]，如先前关于布鲁克骨化的文献所述），并证实了孤立性AIO的发生率。尽管与临床结果存在轻微相关性，但AIO可被视为异位骨形成倾向的一个可能指标，特别是在需要进行翻修关节成形术或对侧全髋关节置换术时。
