膝关节脱位后异位骨化形成的危险因素。
Risk factors for the development of heterotopic ossification after knee dislocation.
作者信息
Whelan Daniel B, Dold Andrew P, Trajkovski Tomce, Chahal Jas
机构信息
Department of Surgery, University of Toronto, c/o St Michael's Orthopaedic Associates, 55 Queen Street E, Suite 800, Toronto, ON, M5C 1R6, Canada,
出版信息
Clin Orthop Relat Res. 2014 Sep;472(9):2698-704. doi: 10.1007/s11999-014-3730-7.
BACKGROUND
Results of treatment for acute knee dislocations and multiligament knee injuries may be influenced by a multitude of patient- and injury-related factors, including neurologic function, vascular status, ipsilateral fractures, and joint stability. The development of heterotopic ossification (HO) may nullify any benefits of reconstruction, because it can cause stiffness and discomfort. Identifying factors associated with HO after knee dislocation may help identify patients who might benefit from prophylaxis.
QUESTIONS/PURPOSES: The purposes of this study were (1) to identify specific risk factors for the development of HO in patients with knee dislocation; and (2) to elucidate the relationship between the presence of absence of HO and postoperative range of motion.
METHODS
Between 2005 and 2010, we performed 101 multiligament reconstructions for patients with knee dislocations, of which 91 (90%) in 91 patients were available for followup at a minimum of 6 months (mean, 18 months; range, 6-44 months), and were reviewed here. AP and lateral radiographs were reviewed for all patients and HO was classified according to the Mills and Tejwani classification system. This knee dislocation cohort was separated into two groups based on the presence or absence of HO for comparison. Using a significance level of p < 0.05 for factors in the univariate analyses, we identified potential variables for a multivariate logistic regression model to identify risk factors predicting development of HO in patients with multiligament knee injuries; multivariate analysis then was performed to mitigate the influence of potentially confounding variables. Thirty patients (34%) developed HO after multiligament knee injury in our series.
RESULTS
Posterior cruciate ligament reconstruction was the only independent predictor of HO that we identified (odds ratio, 6.3; 95% confidence interval, 1.2-34.6). Patients who developed HO were more likely to develop stiff knees and undergo surgery (50%; 15 of 30 patients) versus those without HO (12%; seven of 58 patients) to attempt to restore functional range of motion (p < 0.001).
CONCLUSIONS
HO is a common complication after knee dislocation and can diminish range of motion and cause patients to undergo further surgery. Posterior cruciate ligament reconstruction is an independent risk factor for the development of HO. Strategies to identify risk factors for, and safe prevention of, HO after multiple ligament injury and surgery should be investigated going forward.
LEVEL OF EVIDENCE
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
急性膝关节脱位和膝关节多韧带损伤的治疗结果可能受到多种与患者和损伤相关的因素影响，包括神经功能、血管状况、同侧骨折和关节稳定性。异位骨化（HO）的发生可能会抵消重建带来的任何益处，因为它会导致僵硬和不适。识别膝关节脱位后与HO相关的因素可能有助于确定哪些患者可能从预防措施中获益。
问题/目的：本研究的目的是（1）确定膝关节脱位患者发生HO的特定危险因素；（2）阐明HO的存在与否与术后活动范围之间的关系。
方法
2005年至2010年期间，我们为膝关节脱位患者进行了101例多韧带重建手术，其中91例患者的91例手术（90%）至少随访了6个月（平均18个月；范围6 - 44个月），并在此进行回顾性分析。对所有患者的前后位和侧位X线片进行了评估，并根据米尔斯（Mills）和特杰瓦尼（Tejwani）分类系统对HO进行分类。根据HO的存在与否，将该膝关节脱位队列分为两组进行比较。在单因素分析中，以p < 0.05为显著性水平，我们确定了多因素逻辑回归模型的潜在变量，以识别预测膝关节多韧带损伤患者发生HO的危险因素；然后进行多因素分析以减轻潜在混杂变量的影响。在我们的系列研究中，30例患者（34%）在膝关节多韧带损伤后发生了HO。
结果
我们确定后交叉韧带重建是唯一独立的HO预测因素（比值比，6.3；95%置信区间，1.2 - 34.6）。与未发生HO的患者（12%；58例中的7例）相比，发生HO的患者更有可能出现膝关节僵硬并接受手术（50%；30例中的15例）以试图恢复功能活动范围（p < 0.001）。
结论
HO是膝关节脱位后的常见并发症，可减少活动范围并导致患者接受进一步手术。后交叉韧带重建是HO发生的独立危险因素。未来应研究识别多韧带损伤和手术后HO的危险因素及安全预防策略。
证据水平
III级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
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