Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA.
Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea; Department of Orthopedics, MacKay Memorial Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.
J Shoulder Elbow Surg. 2019 Jul;28(7):1406-1410. doi: 10.1016/j.jse.2018.10.029. Epub 2019 Jan 23.
Heterotopic ossification (HO) is a well-recognized cause of limited flexion-extension, but it can also limit pronation-supination. There is a paucity of literature concerning restriction of pronation-supination due to HO.
We conducted a retrospective review of patients who had undergone elbow surgery for HO removal between January 1, 2003, and September 27, 2013. Computed tomography scans were reviewed to determine the presence of HO restricting forearm rotation and were rated independently by 4 observers. Each elbow was given 1 of 4 scores according to the likelihood that HO was restricting forearm rotation. Agreement was achieved when 3 or 4 observers thought that HO definitely or probably caused a loss of pronation-supination.
Of 132 post-traumatic patients undergoing HO excision for restricted elbow motion, 61 (46%) also lacked a functional arc of pronation and supination (50° and 50°, respectively). Of these 61 patients, 32 (53%) were considered to have lost forearm rotation because of HO. The remaining 29 patients (47%) were thought to have restricted forearm rotation for reasons unrelated to HO.
In this study, loss of pronation-supination affected almost half of the patients (61 of 132 [46%]) undergoing HO excision around the elbow. Of these 61 patients, 32 (52%) had HO extending into the proximal forearm and affecting rotation. From our data, one can expect that about one-quarter (24% of patients in this study, or 32 of 132) with post-traumatic HO of the elbow will have a significant functional loss of pronation-supination due to HO extending into the forearm.
异位骨化（HO）是导致屈伸受限的一个公认原因，但它也会限制旋前-旋后。由于 HO 导致旋前-旋后受限的文献很少。
我们对 2003 年 1 月 1 日至 2013 年 9 月 27 日期间因 HO 切除而行肘部手术的患者进行了回顾性研究。对计算机断层扫描进行了回顾，以确定 HO 是否限制了前臂旋转，并由 4 名观察者独立进行了评估。根据 HO 极有可能导致旋前-旋后丧失的可能性，每个肘部都被给予 4 分制中的 1 分。当 3 名或 4 名观察者认为 HO 确实或极有可能导致旋前-旋后丧失时，就达成了共识。
在 132 例因肘部运动受限而行 HO 切除的创伤后患者中，有 61 例（46%）也缺乏功能性旋前和旋后弧（分别为 50°和 50°）。在这 61 例患者中，有 32 例（53%）被认为因 HO 而丧失了前臂旋转功能。其余 29 例（47%）患者则被认为是由于与 HO 无关的原因而限制了前臂旋转。
在这项研究中，61 例（132 例的 46%）接受肘部 HO 切除的患者出现了旋前-旋后丧失。在这 61 例患者中，有 32 例（52%）HO 延伸至近侧前臂并影响旋转。根据我们的数据，可以预计，在因肘部 HO 而接受治疗的患者中，大约有四分之一（本研究中的 24%，即 132 例中的 32 例）会因 HO 延伸至前臂而出现明显的旋前-旋后功能丧失。
