Bauer Andrea S, Lawson Bryan K, Bliss Robin L, Dyer George S M
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA 02140, USA.
J Hand Surg Am. 2012 Jul;37(7):1422-9.e1-6. doi: 10.1016/j.jhsa.2012.03.013. Epub 2012 May 1.
Heterotopic ossification (HO) is well-known after surgical repair of elbow fractures, but little is known about risk factors for its development in these patients. The purpose of this study was to define factors associated with development of HO.
We used a prospective fracture registry collected in 2 Level I trauma centers and medical chart review to examine all elbow fractures treated surgically between 2002 and 2009. We determined which of these patients developed HO with an impact on range of motion (Hastings class II and III). We conducted a matched case-control study to examine factors associated with risk of HO. We used conditional logistic regression to compare occurrences of risk factors between cases and controls, matched by fracture type, age, and sex.
Our database contained 786 elbow fractures treated surgically. Of these, 55 developed clinically relevant HO. The risk of HO varied among types of elbow fractures, with combined olecranon and radial head fractures having no HO and floating elbows (fractures on both sides of the elbow joint) having the highest incidence of HO at 36%. In multiple conditional logistic regression, risk factors for the development of HO were days to surgery, with subjects waiting 8 or more days having 12 times the odds of HO than subjects having surgery within a day of injury, and time to postoperative mobilization, with subjects who had at least 15 days to mobilization having greater odds of HO than those who had less than 7 days to mobilization.
Heterotopic ossification of the elbow occurs frequently after surgical repair of elbow fractures, with an incidence of 7% in this registry. In the case-control sample, conditions associated with development of HO included longer time to surgery and longer time to mobilization after surgery.
肘关节骨折手术修复后异位骨化（HO）较为常见，但对于这些患者发生HO的危险因素却知之甚少。本研究的目的是确定与HO发生相关的因素。
我们使用了在2个一级创伤中心收集的前瞻性骨折登记资料，并通过病历审查来检查2002年至2009年间接受手术治疗的所有肘关节骨折。我们确定了其中哪些患者发生了影响活动范围的HO（黑斯廷斯II级和III级）。我们进行了一项匹配病例对照研究，以检查与HO风险相关的因素。我们使用条件逻辑回归来比较病例组和对照组之间危险因素的发生情况，对照组按骨折类型、年龄和性别进行匹配。
我们的数据库包含786例接受手术治疗的肘关节骨折。其中，55例发生了临床相关的HO。HO的风险在不同类型的肘关节骨折中有所不同，鹰嘴和桡骨头联合骨折未发生HO，而漂浮肘（肘关节两侧骨折）的HO发生率最高，为36%。在多因素条件逻辑回归中，HO发生的危险因素包括手术天数，受伤后等待8天或更长时间的患者发生HO的几率是受伤后1天内接受手术患者的12倍；以及术后活动时间，术后至少15天才能活动的患者发生HO的几率高于术后不到7天就能活动的患者。
肘关节骨折手术修复后肘关节异位骨化经常发生，本登记研究中的发生率为7%。在病例对照样本中，与HO发生相关的情况包括手术时间延长和术后活动时间延长。
