Division of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
Wright State University Boonshoft School of Medicine, Fairborn, Ohio, USA.
BMJ Case Rep. 2022 May 13;15(5):e249705. doi: 10.1136/bcr-2022-249705.
A patient in his late 40s presented after 1-year following below knee amputation and targeted muscle reinnervation (TMR) with new prosthesis intolerance and pinpoint pain, suspicious for neuroma. X-ray confirmed fibular heterotopic ossification (HO). Operative revision identified HO encompassing a TMR construct with a large neuroma requiring excision and neuroplasty revision. Now approximately 1-year post procedure, the patient remains active, pain-free and ambulating with a prosthetic. Amputated extremities can be at risk for development of HO. Although described in literature, the pathophysiology and timeline for HO development is not well understood. Preventative measures for HO have been described, yet results remain variable. The gold standard for existing HO remains to be operative excision. Due to the unpredictable nature and debilitating presentation, risk of HO should be incorporated into patient-physician discussions. Additionally, new prosthetic intolerance absent of prior trauma should raise suspicion for possible HO development.
一位四十多岁的晚期患者在接受膝下截肢和靶向肌肉神经再支配（TMR）治疗 1 年后，因新义肢不耐受和刺痛出现神经瘤可疑症状。X 光片证实存在腓骨异位骨化（HO）。手术修正发现，HO 包含 TMR 结构，有一个大的神经瘤需要切除和神经成形术修正。现在，大约在手术后 1 年，患者仍然活跃，无疼痛，可使用义肢行走。截肢肢体可能有发生 HO 的风险。尽管 HO 在文献中有描述，但 HO 发展的病理生理学和时间进程尚未得到很好的理解。已经描述了 HO 的预防措施，但结果仍然存在差异。现有的 HO 的金标准仍然是手术切除。由于 HO 的不可预测性和使人虚弱的表现，HO 的风险应纳入患者-医生的讨论中。此外，新的义肢不耐受，且无先前创伤，应引起对可能发生 HO 的怀疑。
