Boffeli Troy J, Thompson Jonathan C, Waverly Brett J, Pfannenstein Ryan R, Mahoney Kevin J
Director, Foot and Ankle Surgical Residency Program, Regions Hospital/HealthPartners Institute for Education and Research, St. Paul, MN.
Attending Physician, Orthopedic Center at Mayo Clinic Health System, Eau Claire, WI.
J Foot Ankle Surg. 2016 Jul-Aug;55(4):714-9. doi: 10.1053/j.jfas.2016.01.026. Epub 2016 Feb 24.
Heterotopic bone growth is a common finding after partial foot amputation that can predispose to recurrent wounds, osteomyelitis, and reamputation. Heterotopic ossification is the formation of excessive mature lamellar bone in the soft tissues adjacent to bone that is exacerbated by trauma or surgical intervention. The relevance of heterotopic ossification is dependent on its anatomic location. Its occurrence as a sequela of partial foot amputation can lead to prominence on the plantar aspect of the foot that can predispose the patient to recurrent neuropathic ulceration or preclude appropriate wound healing. Reulceration puts the high-risk patient who has already undergone local amputation at greater risk of recurrent infection and further amputation. The present study aimed to assess the incidence and risk factors for heterotopic ossification to further evaluate its role in partial foot amputation. A retrospective analysis of 72 consecutive patients who had undergone partial metatarsal resection was performed, with 90% of the cohort having peripheral neuropathy and 88% diabetes mellitus. Our findings revealed a heterotopic ossification incidence of 75% diagnosed radiographically. The initial onset of heterotopic ossification was not appreciated >10 weeks postoperatively. Ten patients (18.5%) exhibited heterotopic ossification-associated ulceration. The incidence of heterotopic ossification was 30% less in patients with peripheral vascular disease. These results indicate that heterotopic ossification is a common sequela of partial ray resection in an already high-risk patient population. The perioperative use of pharmacologic or radiation prophylaxis in an attempt to minimize amputation-related morbidity should be considered.
异位骨生长是部分足部截肢术后常见的表现，可导致伤口复发、骨髓炎和再次截肢。异位骨化是指在邻近骨骼的软组织中形成过多成熟的板层骨，创伤或手术干预会加重这种情况。异位骨化的相关性取决于其解剖位置。它作为部分足部截肢的后遗症出现，可导致足底突出，使患者易发生复发性神经性溃疡或妨碍伤口正常愈合。溃疡复发会使已经接受局部截肢的高危患者面临更高的反复感染和进一步截肢风险。本研究旨在评估异位骨化的发生率和危险因素，以进一步评估其在部分足部截肢中的作用。对72例连续接受部分跖骨切除术的患者进行了回顾性分析，该队列中90%的患者患有周围神经病变，88%的患者患有糖尿病。我们的研究结果显示，经影像学诊断异位骨化的发生率为75%。异位骨化的最初发生在术后10周内未被发现。10例患者（18.5%）出现与异位骨化相关的溃疡。外周血管疾病患者的异位骨化发生率低30%。这些结果表明，异位骨化是高危患者群体中部分跖骨切除术后常见的后遗症。应考虑围手术期使用药物或放射预防措施，以尽量减少截肢相关的发病率。
