Rizvi Syed Muhammad Hannan Ali, Sharaf Joudi, Williams Kerry-Ann D, Tariq Maha, Acharekar Maitri V, Guerrero Saldivia Sara Elena, Unnikrishnan Sumedha, Chavarria Yeny Y, Akindele Adebisi O, Jalkh Ana P, Eastmond Aziza K, Shetty Chaitra, Mohammed Lubna
Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2022 Aug 4;14(8):e27683. doi: 10.7759/cureus.27683. eCollection 2022 Aug.
Neurogenic heterotopic ossification (NHO) is the formation of mature lamellar bone in peri-articular tissues following a neurological insult, most commonly traumatic brain injury (TBI) or spinal cord injury (SCI). NHO is a debilitating condition associated with significant morbidity and reduced quality of life. However, its pathophysiology remains poorly understood. While surgery is the mainstay of treatment once NHO has been diagnosed, prophylactic options are limited and not well studied. This review aimed to determine the efficacy of various interventions used in the primary prevention of NHO. We conducted an electronic literature search using five databases (PubMed, Embase, ScienceDirect, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) for records published until April 10, 2022. We identified 2,610 potentially eligible records across all databases. Nine reports met our eligibility criteria and were included in this review. Four were clinical trials (three randomized control trials, one nonrandomized trial), four were observational studies, and one was a systematic review/meta-analysis. The medications/interventions used included: warfarin, pulse low-intensity electromagnetic field therapy (PLIMF), bisphosphonates, and nonsteroidal anti-inflammatory drugs (NSAIDs). We did not find conclusive evidence to recommend the use of bisphosphonates and warfarin in the prevention of NHO. On the contrary, we found NSAIDs and PLIMF as effective prophylactic options based on the results of high-quality randomized control trials. Further prospective randomized studies with prolonged follow-ups are needed to confirm the long-term efficacy of these preventive interventions.
神经源性异位骨化（NHO）是指在神经损伤后，关节周围组织中形成成熟的板层骨，最常见于创伤性脑损伤（TBI）或脊髓损伤（SCI）后。NHO是一种使人衰弱的疾病，与显著的发病率和生活质量下降相关。然而，其病理生理学仍知之甚少。虽然一旦诊断出NHO，手术是主要的治疗方法，但预防性选择有限且研究不足。本综述旨在确定用于NHO一级预防的各种干预措施的疗效。我们使用五个数据库（PubMed、Embase、ScienceDirect、Cochrane图书馆和护理及联合健康文献累积索引（CINAHL））进行了电子文献检索，以查找截至2022年4月10日发表的记录。我们在所有数据库中识别出2610条潜在符合条件的记录。九份报告符合我们的纳入标准并被纳入本综述。四份是临床试验（三项随机对照试验、一项非随机试验），四份是观察性研究，一份是系统评价/荟萃分析。使用的药物/干预措施包括：华法林、脉冲低强度电磁场疗法（PLIMF）、双膦酸盐和非甾体抗炎药（NSAIDs）。我们没有找到确凿的证据推荐使用双膦酸盐和华法林预防NHO。相反，根据高质量随机对照试验的结果，我们发现NSAIDs和PLIMF是有效的预防选择。需要进一步进行长期随访的前瞻性随机研究，以确认这些预防干预措施的长期疗效。
