Wu Xin-Bao, Yang Ming-Hui, Zhu Shi-Wen, Cao Qi-Yong, Wu Hong-Hua, Wang Man-Yi, Cuellar Derly O, Mauffrey Cyril
Department of Trauma and Orthopaedics, the Fourth School of Medicine of Peking University, Beijing Jishuitan Hospital, Beijing 100035, China.
Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, Denver, CO 80204, USA.
Injury. 2014 Oct;45(10):1604-10. doi: 10.1016/j.injury.2014.05.018. Epub 2014 May 27.
To evaluate the clinical results of surgical resection of severe heterotopic ossification (HO) after the open reduction and internal fixation (ORIF) of acetabular fractures.
A retrospective chart review was performed between October 2005 and November 2010 on patients undergoing severe HO resection following an acetabular fracture ORIF. Our primary outcome was functional status evaluated by the Harris hip score (HSS). HO resection and hip release was performed using a Kocher-Langenbeck approach in all cases, and a combined radiation and indomethacin regimen was used to prevent HO recurrence. Plain radiographs were also used to evaluate the hip joint for arthritic changes and HO recurrence.
A total of 18 patients (17 males and 1 female) were included in our study analysis. The mean patient age was 36.8 (range: 22-54 years old) when HO resection surgery was performed. The mean time interval between acetabular fracture ORIF and HO resection was 9.9 months (range: 3-30 months): it was within 6 months in 7 patients, 6-12 months in 8 patients, and >12 months in 3 patients. The HO was graded as Brooker grade III in 8 patients and grade IV in 10 patients. The mean time interval between HO resection and the latest follow-up was 4.5 years (range: 2.1-7.8 years). The mean Harris hip score (HHS) was 84.5 (range: 38-100), with a clinical outcome rating of excellent in 9 patients, good in 3 patients, fair in 4 patients, and poor in 2 patients (good and excellent rating accounted for 66.7%). The mean hip joint motion arc was 194° (range: 90-260°). Complications included one intraoperative femoral neck fracture, 1 sciatic nerve injury, 2 femoral head avascular necrosis, and 6 mild HO recurrences (33.3%). There was 28.6% recurrence if HO resection was within 6 months and 36.4% if >6 months. There were no cases of severe HO recurrence, wound infections, deep vein thrombosis, or pulmonary embolism.
The early surgical resection of severe HO after an acetabular fracture ORIF can provide satisfactory results, however the complication rate is relatively high.
评估髋臼骨折切开复位内固定（ORIF）术后严重异位骨化（HO）手术切除的临床效果。
对2005年10月至2010年11月期间接受髋臼骨折ORIF术后严重HO切除的患者进行回顾性病历审查。我们的主要结局是通过Harris髋关节评分（HSS）评估功能状态。所有病例均采用Kocher-Langenbeck入路进行HO切除和髋关节松解，并采用放疗和吲哚美辛联合方案预防HO复发。还使用X线平片评估髋关节的关节炎变化和HO复发情况。
我们的研究分析共纳入18例患者（17例男性和1例女性）。进行HO切除手术时患者的平均年龄为36.8岁（范围：22 - 54岁）。髋臼骨折ORIF与HO切除之间的平均时间间隔为9.9个月（范围：3 - 30个月）：7例患者在6个月内，8例患者在6 - 12个月内，3例患者超过12个月。HO分级为Brooker III级的有8例患者，IV级的有10例患者。HO切除至最近一次随访的平均时间间隔为4.5年（范围：2.1 - 7.8年）。平均Harris髋关节评分（HHS）为84.5（范围：38 - 100），临床结局评级为优的有9例患者，良的有3例患者，可的有4例患者，差的有2例患者（优良率为66.7%）。平均髋关节活动弧为194°（范围：90 - 260°）。并发症包括1例术中股骨颈骨折、1例坐骨神经损伤、2例股骨头缺血性坏死和6例轻度HO复发（33.3%）。HO切除在6个月内的复发率为28.6%，超过6个月的复发率为36.4%。没有严重HO复发、伤口感染、深静脉血栓形成或肺栓塞的病例。
髋臼骨折ORIF术后早期手术切除严重HO可提供满意的效果，但并发症发生率相对较高。
