Akman Senol, Sönmez Mehmet Mesut, Ertürer Ramazan Erden, Seçkin Mustafa Faik, Kara Adnan, Oztürk Irfan
Department of Orthopedics and Traumatology, Şişli Etfal Training and Research Hospital, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2010;44(3):206-11. doi: 10.3944/AOTT.2010.2441.
Heterotopic ossification which may develop following elbow injuries or elbow surgery may result in complete loss of elbow functions. We evaluated the results of surgical treatment for ankylosis of the elbow due to posttraumatic heterotopic ossification.
The study included seven patients (6 males, 1 female; mean age 36 years; range 23 to 55 years) who developed heterotopic ossification and ankylosis of the elbow joint following surgical treatment of high-energy fractures in the circumference of the elbow. Two patients had comminuted olecranon fractures and elbow luxation, and five patients had comminuted intra-articular distal humeral fractures. Three patients had open fractures. Involvement was in the right elbow in two patients, and in the left elbow in five patients. One patient was monitored and treated in the intensive care unit for head trauma for 22 days. Initially, six patients were treated with plate osteosynthesis and one patient with tension band wiring. Foci of heterotopic ossification were detected on the radiographs taken after a mean of 24 days (range 20 to 32 days) following surgical treatment of fractures. The patients were followed-up with conventional radiography and scintigraphy for a mean of 11 months (range 7 to 15 months) before surgical treatment, during which functional loss in elbow joint movements deteriorated and ankylosis developed. All the patients had Hastings type IIIC ankylosis and poor Mayo elbow performance scores (mean score 50.7). A posterior incision was used in three patients, and a double-column incision was used in four patients. At surgery, the ulnar nerve and the lateral and medial collateral ligaments were preserved, and a posterolateral capsular release, removal of heterotopic ossification, purging of the olecranon fossa, and resection of the tip of the olecranon were performed. After completion of capsular release, cartilage pathologies were evaluated. Four patients were found to have no definite cartilage damage, whereas in three patients the joint cartilage was seriously damaged. At final controls, the patients were assessed with the Mayo elbow performance score. The mean follow-up period was 23.4 months (range 10 to 36 months).
In all cases, the range of motion and stability of the elbow joint were controlled and were found to be complete and stable at the end of the operation. At final controls, the Mayo elbow performance scores were good in three patients, moderate in one patient, and poor in three patients. All the patients with a poor elbow score had severe joint cartilage damage intraoperatively.
Patients who develop heterotopic ossification and ankylosis of the elbow following trauma or elbow surgery may benefit from removal of heterotopic ossification foci and elbow relaxation procedures provided that there is not severe damage to the articular cartilage.
肘部损伤或肘部手术后可能发生的异位骨化可能导致肘部功能完全丧失。我们评估了创伤后异位骨化所致肘关节强直的手术治疗结果。
该研究纳入了7例患者（6例男性，1例女性；平均年龄36岁；范围23至55岁），这些患者在肘部周围高能骨折的手术治疗后发生了肘关节异位骨化和强直。2例患者有鹰嘴粉碎性骨折并肘关节脱位，5例患者有肱骨远端关节内粉碎性骨折。3例患者为开放性骨折。2例患者右侧肘部受累，5例患者左侧肘部受累。1例患者因头部创伤在重症监护病房监测和治疗了22天。最初，6例患者接受钢板内固定治疗，1例患者接受张力带钢丝固定治疗。在骨折手术治疗后平均24天（范围20至32天）拍摄的X线片上检测到异位骨化灶。在手术治疗前，对患者进行平均11个月（范围7至15个月）的传统X线摄影和骨闪烁显像随访，在此期间肘关节活动功能丧失恶化并出现强直。所有患者均为Hastings IIIC型强直，Mayo肘关节功能评分较差（平均评分50.7）。3例患者采用后正中切口，4例患者采用双柱切口。手术时，保留尺神经及内外侧副韧带，行后外侧关节囊松解、异位骨化清除、鹰嘴窝清理及鹰嘴尖切除。关节囊松解完成后，评估软骨病变情况。4例患者未发现明确的软骨损伤，而3例患者关节软骨严重受损。在最终检查时，用Mayo肘关节功能评分对患者进行评估。平均随访期为23.4个月（范围10至36个月）。
所有病例中，肘关节的活动范围和稳定性均得到控制，且在手术结束时发现是完整和稳定的。在最终检查时，3例患者的Mayo肘关节功能评分良好，1例患者中等，3例患者较差。所有肘关节评分较差的患者术中均有严重的关节软骨损伤。
创伤或肘部手术后发生肘关节异位骨化和强直的患者，只要关节软骨没有严重损伤，切除异位骨化灶并进行肘关节松解手术可能会受益。
