The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland The Center for Rehabilitation Sciences Research, Department of Physical Medicine & Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, Maryland
Departments of Orthopaedics (B.K.P.) and Rehabilitation (P.F.P.), Walter Reed National Military Medical Center, Bethesda, Maryland Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland.
J Bone Joint Surg Am. 2016 Apr 20;98(8):647-57. doi: 10.2106/JBJS.15.00895.
Heterotopic ossification (HO) is a debilitating condition that occurs following traumatic injury and may restrict range of motion and delay rehabilitation. The timing and efficacy of surgical resection have varied widely, and there is a gap in knowledge between clinical predictors of HO recurrence and histological analysis.
Thirty-three service members seen at Walter Reed National Military Medical Center for symptomatic HO were enrolled in an institutional review board-approved study. Participants took oxytetracycline on four scheduled days prior to HO resection to determine the mineral apposition rate (bone growth rate).
Detailed histological analyses included scanning electron microscopy with backscattered electron imaging and light microscopy. Data indicated that the mineral apposition rate of trauma-induced HO was approximately 1.7 μm/day at the time of operative intervention, which was 1.7 times higher than the rate in non-pathological human bone. The mineral apposition rate and postoperative alkaline phosphatase values were demonstrated to be positively and significantly related (ρ = 0.509, p = 0.026, n = 19). When the analysis was limited to patients with no more than a two-year period from injury to excision (thereby removing outliers who had a longer time period than their counterparts) and traumatic brain injury and nonsteroidal anti-inflammatory drugs (known correlates with HO development) were controlled for in the statistical analysis, the mineral apposition rate and recurrence severity were significantly related (ρ = -0.572, p = 0.041, n = 11).
Data demonstrated a link between benchtop research and bedside care, with the mineral apposition rate elevated in patients with HO and correlated with recurrence severity; however, a larger sample size and more clinical factors are needed to refine this model.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
异位骨化（HO）是一种在创伤后发生的使人虚弱的病症，可能会限制运动范围并延迟康复。手术切除的时间和效果差异很大，HO 复发的临床预测因素和组织学分析之间存在知识差距。
在 Walter Reed 国家军事医学中心因症状性 HO 就诊的 33 名军人参加了机构审查委员会批准的研究。参与者在 HO 切除前四天的四个预定日子服用土霉素，以确定矿物质附着率（骨生长速度）。
详细的组织学分析包括扫描电子显微镜和背散射电子成像以及光镜。数据表明，手术干预时创伤性 HO 的矿物质附着率约为 1.7 μm/天，这是正常人类骨骼的 1.7 倍。矿物质附着率和术后碱性磷酸酶值呈正相关（ρ=0.509，p=0.026，n=19）。当分析仅限于从受伤到切除的时间不超过两年的患者（从而消除了比对照组时间更长的异常值），并且控制了创伤性脑损伤和非甾体抗炎药（已知与 HO 发展相关的因素）在统计分析中，矿物质附着率与复发严重程度呈显著相关（ρ=-0.572，p=0.041，n=11）。
数据表明了基础研究与床边护理之间的联系，HO 患者的矿物质附着率升高，并与复发严重程度相关；然而，需要更大的样本量和更多的临床因素来完善该模型。
预后 II 级。请参阅作者说明，以获取证据水平的完整描述。
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