Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Huang Pu District, Shanghai, 200011, China.
Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, No. 639 Zhi Zao Ju Road, Huang Pu District, Shanghai, 200011, China.
BMC Musculoskelet Disord. 2022 Jul 4;23(1):638. doi: 10.1186/s12891-022-05582-5.
Heterotopic ossification (HO) is one of the serious complications leading to the failure of alloplastic temporomandibular joint replacement (TJR). However, there was few research on its exact incidence and occurrence. Severe HO might result in pain and limited mouth opening after surgery. Therefore, it is necessary to clarify its clinical and imaging manifestations. The purpose of this study was to study the occurrence and classify HO after the alloplastic TJR.
Patients who underwent standard TJR (Zimmer Biomet stock prostheses or Chinese stock prostheses) with fat graft and at least 1-year-follow-up were included. HO was classified into 4 types according to postoperative computed tomography (CT) scans. Type and occurrence in different TMJ disease were compared. Joint space within 1 week after operation was measured and compared between HO and non-HO TJRs. Maximum incisal opening (MIO), pain, and quality of life (QoL) were recorded and their relevance with HO was analyzed statistically.
81cases with 101 joints were included in the study. The mean follow-up time was 22.9 months (12 ~ 56 months). Among the 48 joints, 27 (56.3%) were type I (bone islands); 16 (33.3%) were type II (bone spurs from the mandibular ramus); 3 (6.3%) were type III (bone spurs from the fossa); and 2 (4.2%) were type IV (bone spurs from both the mandibular ramus and fossa). In HO patients, joint space in type IV was smaller than the other 3 types. Pain scores in HO were significantly greater than non-HO patients before and after operations (p < 0.05). 1 patient in Type IV HO developed ankylosis and had prosthesis revision which accounted for 2.1% in HO patients and 1.0% in all TJR patients.
HO after alloplastic TJR with fat graft was not severe except for type IV, which was easy to cause ankylosis. Preserving sufficient TJR space was important for ankylosis prevention.
异位骨化（HO）是导致关节置换术失败的严重并发症之一。然而，对于其确切的发生率和发生情况，研究较少。严重的 HO 可能导致术后疼痛和张口受限。因此，有必要明确其临床和影像学表现。本研究旨在研究关节置换术后 HO 的发生和分类。
纳入接受标准关节置换术（Zimmer Biomet 假体或国产假体）并进行脂肪移植且随访至少 1 年的患者。根据术后 CT 扫描将 HO 分为 4 型。比较不同 TMJ 疾病的 HO 类型和发生率。测量术后 1 周内关节间隙，并比较 HO 和非 HO 关节置换术后关节间隙。记录最大张口度（MIO）、疼痛和生活质量（QoL），并进行统计学分析。
本研究纳入 81 例患者共 101 个关节，平均随访时间为 22.9 个月（12~56 个月）。其中 48 个关节中，27 个（56.3%）为 I 型（骨岛）；16 个（33.3%）为 II 型（下颌支骨突）；3 个（6.3%）为 III 型（关节窝骨突）；2 个（4.2%）为 IV 型（下颌支和关节窝均有骨突）。HO 患者中，IV 型关节间隙较小。HO 患者术后疼痛评分明显高于非 HO 患者（p<0.05）。1 例 IV 型 HO 患者发生关节强直，需进行假体翻修，占 HO 患者的 2.1%，占所有关节置换患者的 1.0%。
除 IV 型外，关节置换术后脂肪移植治疗的 HO 并不严重，易引起关节强直。保持足够的关节置换空间对预防强直很重要。
