Clin Orthop Relat Res. 2014 Jul;472(7):2162-7. doi: 10.1007/s11999-013-3304-0.
Heterotopic ossification (HO) is a common extrinsic cause of elbow stiffness after trauma. However, factors associated with the development of HO are incompletely understood.
QUESTIONS/PURPOSES: We retrospectively identified (1) patient-related demographic factors, (2) injury-related factors, and (3) treatment-related factors associated with the development of HO severe enough to restrict motion after surgery for elbow trauma. We also determined what percentage of the variation in HO restricting motion was explained by the variables studied.
Between 2001 and 2007, we performed surgery on 417 adult patients for elbow fractures; of these, 284 (68%) were available for radiographs at a minimum of 4 months and clinical review at a minimum of 6 months after surgery (mean, 7.9 months; range, 6–31 months). HO was classified according to the Hastings and Graham system. Patients with HO restricting motion (defined as a Hastings and Graham Class II or III) were compared with patients without HO restricting motion in terms of demographics, fracture location, elbow dislocation, open wound, mechanism of injury, ipsilateral fracture, head trauma, time from injury to surgery, number of surgeries within 4 weeks, total number of surgeries, bone graft, and infection, using bivariate and multivariable analyses. A total of 96 patients had radiographic HO, and in 27 (10% of those available for followup), it restricted motion.
There were no patient-related demographic factors that predicted the formation of symptomatic HO. Ulnohumeral dislocation in addition to fracture (odds ratio, 2.38; 95% CI, 1.01–5.64; p = 0.048) but not fracture location was associated with HO. Longer time from injury to definitive surgery and number of surgical procedures in the first 4 weeks were also independent predictors of HO (p = 0.01 and 0.004, respectively). These factors explained 20% of the variance in risk for HO restricting motion.
HO restricting motion after operative elbow fracture treatment associates with factors that seem related to injury complexity, in particular, ulnohumeral dislocation, delay, and number of early surgeries; however, a substantial portion of the variation among patients with elbow fracture who develop restrictive HO remains unexplained.
Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
异位骨化（HO）是创伤后肘部僵硬的常见外在原因。然而，与 HO 发展相关的因素尚未完全了解。
问题/目的：我们回顾性地确定了（1）患者相关的人口统计学因素，（2）损伤相关因素，以及（3）与肘部创伤手术后运动受限严重的 HO 相关的治疗相关因素。我们还确定了研究变量解释 HO 限制运动的变异百分比。
2001 年至 2007 年间，我们对 417 例成年患者进行了肘部骨折手术；其中 284 例（68%）在手术后至少 4 个月和至少 6 个月时进行了 X 线片检查和临床随访（平均 7.9 个月；范围，6-31 个月）。HO 根据 Hastings 和 Graham 系统进行分类。HO 限制运动（定义为 Hastings 和 Graham Ⅱ级或Ⅲ级）的患者与无 HO 限制运动的患者在人口统计学、骨折部位、肘部脱位、开放性伤口、损伤机制、同侧骨折、头部外伤、从损伤到手术的时间、4 周内手术次数、总手术次数、骨移植和感染方面进行比较，使用双变量和多变量分析。共有 96 例患者存在放射学 HO，其中 27 例（27%）出现了运动受限。
没有与症状性 HO 形成相关的患者相关人口统计学因素。除骨折外的尺骨肱骨脱位（比值比，2.38；95%置信区间，1.01-5.64；p = 0.048）而不是骨折部位与 HO 相关。从损伤到确定性手术的时间较长和前 4 周内的手术次数也是 HO 的独立预测因素（p = 0.01 和 0.004，分别）。这些因素解释了 HO 限制运动风险的 20%变异。
肘部骨折手术后 HO 限制运动与似乎与损伤复杂性相关的因素有关，特别是尺骨肱骨脱位、延迟和早期手术次数；然而，患有限制性 HO 的肘部骨折患者之间的大部分变异仍然无法解释。
三级，治疗性研究。请参阅作者说明，以获取完整的证据水平描述。
