Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 8 Hakdong, Donggu, Gwangju, 501-757, South Korea.
J Bone Joint Surg Am. 2011 Apr 20;93(8):751-8. doi: 10.2106/JBJS.J.00178.
Heterotopic ossification following lower-limb joint arthroplasty is a challenging clinical problem. No comprehensive study has been conducted on heterotopic ossification after total ankle arthroplasty, to our knowledge. The purpose of this study was to evaluate the prevalence and location of heterotopic ossification after primary total ankle arthroplasty, predisposing factors, and effects on clinical outcomes, and to develop a method of classification.
Eighty ankles in eighty patients with a primary total ankle arthroplasty were followed for a mean (and standard deviation) of 31.9 ± 11.3 months (range, twenty-four to sixty-five months). The prevalence and location of heterotopic ossification, predisposing factors, and outcomes were analyzed, and a method of classification was developed.
Twenty (25%) of the eighty ankles demonstrated postoperative heterotopic ossification, with the majority of the cases in the posterior aspect of the ankle. The heterotopic ossification was Class I in four cases (20%); Class II, in five (25%); Class III, in four (20%); and Class IV, in seven (35%). Symptomatic heterotopic ossification was reported in eight patients (10%), and two required surgical resection because of intractable pain. Ankles that developed heterotopic ossification had significantly longer operative times, less postoperative motion, and lower American Orthopaedic Foot & Ankle Society ankle-hindfoot scores at the six, twelve, and twenty-four-month follow-up examinations (p < 0.05 for all).
This study demonstrates that the prevalence of heterotopic ossification following primary total ankle arthroplasty is considerable, and that heterotopic ossification is associated with reduced ankle motion and a poor clinical outcome at a mean of two years postoperatively. Care is needed to attempt to reduce the occurrence of heterotopic ossification.
下肢关节置换术后异位骨化是一个具有挑战性的临床问题。据我们所知，目前还没有关于全踝关节置换术后异位骨化的全面研究。本研究旨在评估初次全踝关节置换术后异位骨化的发生率和部位、易患因素以及对临床结果的影响，并制定一种分类方法。
80 例初次全踝关节置换术的 80 例患者平均（标准差）随访 31.9±11.3 个月（24-65 个月）。分析了异位骨化的发生率和部位、易患因素和结果，并制定了一种分类方法。
80 例踝关节中，20 例（25%）术后出现异位骨化，多数位于踝关节后外侧。异位骨化 4 例（20%）为Ⅰ级，5 例（25%）为Ⅱ级，4 例（20%）为Ⅲ级，7 例（35%）为Ⅳ级。8 例（10%）患者出现症状性异位骨化，2 例因顽固性疼痛需要手术切除。发生异位骨化的踝关节手术时间明显延长，术后活动度明显减少，美国矫形足踝协会踝后足评分在 6、12 和 24 个月随访时明显降低（均 p<0.05）。
本研究表明，初次全踝关节置换术后异位骨化的发生率相当高，且异位骨化与术后 2 年踝关节活动度降低和临床结果不良有关。需要注意尽量减少异位骨化的发生。
