1 Physical Medicine and Rehabilitation-Severe Brain Injuries Rehabilitation Unit, Ca' Foncello Hospital, Treviso, Italy.
2 School of Physical Medicine and Rehabilitation, University of Padova, Padova, Italy.
Clin Rehabil. 2018 Feb;32(2):255-262. doi: 10.1177/0269215517723161. Epub 2017 Aug 14.
To report occurrence and identify patient's features and risk factors of heterotopic ossifications in patients with severe acquired brain injury in intensive rehabilitation centres.
Multicentre cross-sectional survey.
A total of 48 severe acquired brain injury rehabilitation institutes.
Traumatic and non-traumatic severe brain-injured patients ( N = 689) in rehabilitation centres on 28 May 2016.
Occurrence of heterotopic ossifications diagnosed by standard radiological and/or sonographic evaluation on the basis of clinical suspicion.
Heterotopic ossification occurred around one or more joints in 94/689 patients (13.6%) with a significantly higher prevalence in young males. Occurrence did not significantly differ in relation to aetiology (16.3% traumatic, 19.2% anoxic, 11.7% vascular and 11.5% other). Prevalence was significantly higher in patients with diffuse (23.3%) rather than focal brain lesions (12.4%) or unspecified lesions (11.2%; chi-square = 7.81, df = 2, P = 0.020); longer duration of coma ( P = 0.0016) and ventilation support ( P = 0.0145); paroxysmal sympathetic hyperactivity (22.6% versus 11.6%; chi-square = 10.81, df = 1, P = 0.001); and spasticity (22.7% versus 10.1%; chi-square = 18.63, df = 1, P < 0.0001). A longer interval between acute brain injury and admission to rehabilitation centre was significantly associated with higher frequency of heterotopic ossifications.
Occurrence of heterotopic ossifications is frequent in patients with severe traumatic and non-traumatic brain-injury in rehabilitation centres. Our study confirms male gender, young age, paroxysmal sympathetic hyperactivity, spasticity, longer duration of coma and ventilation and longer interval between brain injury onset and admission to rehabilitation centre as possible risk factors. Further studies are necessary to investigate the role of early appropriate rehabilitation pathways to reduce occurrence of heterotopic ossifications.
报告重症获得性脑损伤患者在强化康复中心发生异位骨化的情况，并确定患者的特征和危险因素。
多中心横断面调查。
共有 48 个重症获得性脑损伤康复机构。
2016 年 5 月 28 日在康复中心的创伤性和非创伤性严重脑损伤患者（N=689 例）。
根据临床可疑情况，通过标准放射学和/或超声评估诊断为异位骨化的发生。
94/689 例（13.6%）患者出现一个或多个关节周围异位骨化，年轻男性的发生率明显更高。病因之间的发生率无显著差异（创伤性 16.3%、缺氧性 19.2%、血管性 11.7%和其他 11.5%）。弥漫性脑损伤患者（23.3%）的发生率明显高于局灶性（12.4%）或未特指性脑损伤（11.2%；卡方=7.81，df=2，P=0.020）；昏迷时间更长（P=0.0016）和通气支持时间更长（P=0.0145）；阵发性交感神经兴奋（22.6%比 11.6%；卡方=10.81，df=1，P=0.001）；痉挛（22.7%比 10.1%；卡方=18.63，df=1，P<0.0001）。急性脑损伤与进入康复中心之间的时间间隔较长与异位骨化的发生频率显著相关。
在康复中心的重症创伤性和非创伤性脑损伤患者中，异位骨化的发生率较高。本研究证实，男性、年轻、阵发性交感神经兴奋、痉挛、昏迷时间和通气时间较长以及脑损伤发病与进入康复中心之间的时间间隔较长可能是危险因素。需要进一步研究以探讨早期适当康复途径对减少异位骨化发生的作用。
