Marks P H, Paley D, Kellam J F
Division of Orthopaedic Surgery, Sunnybrook Medical Centre, Toronto, Ontario, Canada.
J Trauma. 1988 Aug;28(8):1207-13. doi: 10.1097/00005373-198808000-00012.
Heterotopic ossification (HO) at the proximal end of a reamed intramedullary femoral nail is a complication of the procedure. Kuntscher stated that these "callus caps" were due to the prominence of the nail above the greater trochanter. A study of patients undergoing locked intramedullary nailing of the femur to assess subsequent development of heterotopic ossification at the proximal end of the implant was done. The purpose was to study the clinical significance of the ectopic bone and identify etiologic factors of bone formation. This group consisted of 59 patients with 60 locked intramedullary nails who were reviewed after prospective clinical and radiologic followup. Ectopic bone around the proximal end of the nail was classified with respect to quantity and clinical importance. A number of parameters were evaluated and a multifactorial analysis was performed. There were 52 males and seven females. Heterotopic bone was graded as: none--32%; minimal--20%, mild--28%; moderate--15%; and severe--5%. There was a positive correlation between bone formation and head injury, Injury Severity Score, and ventilator and ICU days. Prominence of the nail was not significant.
扩髓型股骨髓内钉近端的异位骨化是该手术的一种并发症。昆切尔指出，这些“骨痂帽”是由于髓内钉在大转子上方突出所致。对接受股骨带锁髓内钉固定的患者进行了一项研究，以评估植入物近端随后发生异位骨化的情况。目的是研究异位骨的临床意义并确定骨形成的病因因素。该组包括59例患者的60枚带锁髓内钉，经过前瞻性临床和影像学随访后进行了回顾。根据数量和临床重要性对髓内钉近端周围的异位骨进行了分类。评估了多个参数并进行了多因素分析。其中男性52例，女性7例。异位骨分级为：无——32%；极少——20%，轻度——28%；中度——15%；重度——5%。骨形成与头部损伤、损伤严重程度评分、呼吸机使用天数和重症监护病房住院天数之间存在正相关。髓内钉突出不显著。
