Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France.
PLoS One. 2011 Jan 31;6(1):e16632. doi: 10.1371/journal.pone.0016632.
Heterotopic ossification (HO) is a frequent complication after central nervous system (CNS) damage but has seldom been studied. We aimed to investigate features of HO for the first time in a large sample and the rate of early recurrence of HO in terms of the time of surgery.
METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively analyzed data from an anonymous prospective survey of patients undergoing surgery between May 1993 and November 2009 in our institution for troublesome HO related to acquired neurological disease. Demographic and HO characteristics and neurological etiologies were recorded. For 357 consecutive patients, we collected data on 539 first surgeries for HO (129 surgeries for multiple sites). During the follow-up, recurrences requiring another surgery appeared in 31 cases (5.8% [31/539]; 95% confidence interval [CI]: 3.8%-7.8%; 27 patients). Most HO requiring surgery occurred after traumatic brain injury (199 patients [55.7%]), then spinal cord injury (86 [24.0%]), stroke (42 [11.8%]) and cerebral anoxia (30 [8.6%]). The hip was the primary site of HO (328 [60.9%]), then the elbow (115 [21.3%]), knee (77 [14.3%]) and shoulder (19 [3.5%]). For all patients, 181 of the surgeries were performed within the first year after the CNS damage, without recurrence of HO. Recurrence was not associated with etiology (p = 0.46), sex (p = 1.00), age at CNS damage (p = 0.2), multisite localization (p = 0.34), or delay to surgery (p = 0.7).
CONCLUSIONS/SIGNIFICANCE: In patients with CNS damage, troublesome HO and recurrence occurs most frequently after traumatic brain injury and appears frequently in the hip and elbow. Early surgery for HO is not a factor of recurrence.
异位骨化（HO）是中枢神经系统（CNS）损伤后的常见并发症，但鲜有研究。我们旨在首次对大量样本中 HO 的特征进行研究，并探讨手术时间对 HO 早期复发的影响。
方法/主要发现：我们回顾性分析了 1993 年 5 月至 2009 年 11 月期间在我院因获得性神经疾病行手术治疗的麻烦性 HO 的匿名前瞻性调查数据。记录了人口统计学和 HO 特征以及神经病因。对 357 例连续患者，我们收集了 539 例首次 HO 手术（129 例为多处部位手术）的数据。在随访期间，31 例（5.8% [31/539]；95%置信区间[CI]：3.8%-7.8%；27 例）出现需要再次手术的复发。需要手术的大多数 HO 发生在创伤性脑损伤后（199 例[55.7%]），然后是脊髓损伤（86 例[24.0%]）、中风（42 例[11.8%]）和脑缺氧（30 例[8.6%]）。HO 的主要部位是髋部（328 例[60.9%]），其次是肘部（115 例[21.3%]）、膝部（77 例[14.3%]）和肩部（19 例[3.5%]）。对于所有患者，181 例手术在 CNS 损伤后的一年内进行，HO 无复发。复发与病因无关（p = 0.46）、性别（p = 1.00）、CNS 损伤时的年龄（p = 0.2）、多部位定位（p = 0.34）或手术延迟无关（p = 0.7）。
结论/意义：在 CNS 损伤患者中，麻烦性 HO 及复发最常发生在创伤性脑损伤后，且髋关节和肘部常受累。HO 的早期手术不是复发的因素。
