Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Mil Med. 2023 Nov 3;188(11-12):e3477-e3481. doi: 10.1093/milmed/usad129.
Traumatic hip and pelvic level amputations are uncommon but devastating injuries and associated with numerous complications that can significantly affect quality of life for these patients. While heterotopic ossification (HO) formation has been reported at rates of up to 90% following traumatic, combat-related amputations, previous studies included few patients with more proximal hip and pelvic level amputations.
We conducted a retrospective review of the Military Health System medical record and identified patients with both traumatic and disease-related hip- and pelvic-level amputations performed between 2001 and 2017. We reviewed the most recent pelvis radiograph at least 3 months following amputation to determine bony resection level and the association between HO formation and reason for amputation (trauma versus disease related).
Of 93 patients with post-amputation pelvis radiographs available, 66% (n = 61) had hip-level amputations and 34% (n = 32) had a hemipelvectomy. The median duration from the initial injury or surgery to the most recent radiograph was 393 days (interquartile range, 73-1,094). HO occurred in 75% of patients. Amputation secondary to trauma was a significant predictor of HO formation (χ2 = 24.58; P < .0001); however, there was no apparent relationship between the severity of HO and traumatic versus non-traumatic etiology (χ2 = 2.92; P = .09).
Amputations at the hip were more common than pelvic-level amputations in this study population, and three-fourths of hip- and pelvic-level amputation patients had radiographic evidence of HO. The rate of HO formation following blast injuries and other trauma was significantly higher compared with patients with non-traumatic amputations.
创伤性髋部和骨盆水平截肢较为少见，但后果严重，可引起多种并发症，严重影响患者的生活质量。尽管创伤性、与战斗相关的截肢后异位骨化（HO）的发生率高达 90%，但以前的研究中仅有少数患者为更靠近髋部和骨盆水平的截肢。
我们对军事医疗系统的病历进行了回顾性分析，确定了 2001 年至 2017 年间接受创伤性和与疾病相关的髋部和骨盆水平截肢的患者。我们回顾了截肢后至少 3 个月的最新骨盆 X 线片，以确定骨切除水平以及 HO 形成与截肢原因（创伤或疾病相关）之间的关系。
在可获得截肢后骨盆 X 线片的 93 例患者中，66%（n=61）为髋部水平截肢，34%（n=32）为半骨盆切除术。从初始损伤或手术到最近 X 线片的中位时间为 393 天（四分位距，73-1,094）。75%的患者发生 HO。创伤性截肢是 HO 形成的显著预测因素（χ2=24.58；P<.0001）；然而，HO 的严重程度与创伤性与非创伤性病因之间似乎没有明显关系（χ2=2.92；P=.09）。
在本研究人群中，髋部截肢比骨盆水平截肢更为常见，四分之三的髋部和骨盆水平截肢患者有 X 线片证据表明存在 HO。与非创伤性截肢患者相比，爆炸伤和其他创伤后 HO 的形成率显著更高。
