Denormandie P, de l'Escalopier N, Gatin L, Grelier A, Genêt F
Service de chirurgie orthopédique, hôpital Raymond-Poincaré, 92380 Garches, France.
Service de chirurgie orthopédique, traumatologie et chirurgie réparatrice des membres, hôpital d'instruction des Armées-Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
Orthop Traumatol Surg Res. 2018 Feb;104(1S):S121-S127. doi: 10.1016/j.otsr.2017.04.015. Epub 2017 Nov 22.
Neurogenic heterotopic ossification of the hip is secondary to neurologic lesions such as cranial trauma, stroke, medullary injury or cerebral anoxia. We shall not deal here with the other etiologies of heterotopic ossification. There are numerous locations within the hip, depending on etiology and relations with adjacent neurovascular structures are sometimes close. Preoperative work-up should include contrast-enhanced CT; scintigraphy is non-contributive. Indications for surgery are decided in a multidisciplinary team meeting, with a contract laying out expected functional gain. It is this contract that determines the extent of resection, without seeking complete resection, which would incur an increased risk of complications. The surgical approach and resection strategy depend on lesion location and any resulting neurovascular compression. The most common complications are infection and postoperative hematoma. No adjuvant treatments have demonstrated efficacy against recurrence.
髋部神经源性异位骨化继发于颅脑创伤、中风、脊髓损伤或脑缺氧等神经病变。本文不讨论异位骨化的其他病因。根据病因不同，髋部有许多不同的发病部位，且与相邻神经血管结构的关系有时较为密切。术前检查应包括增强CT；骨闪烁显像无诊断价值。手术指征在多学科团队会议上确定，并签订一份阐明预期功能改善的协议。正是这份协议决定了切除范围，而非追求完全切除，因为那样会增加并发症风险。手术入路和切除策略取决于病变位置以及由此导致的神经血管受压情况。最常见的并发症是感染和术后血肿。尚无辅助治疗被证明对预防复发有效。
