Shivdasani Krishin, Scheidt Michael, Liu Stanley, Boubekri Amir, Chen Andrew, Garbis Nickolas, Salazar Dane
Department of Orthopaedic Surgery & Rehabilitation, Loyola Medicine, Maywood, IL, USA.
Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
JSES Int. 2024 Jul 15;8(6):1290-1296. doi: 10.1016/j.jseint.2024.06.019. eCollection 2024 Nov.
Heterotopic ossification in the elbow, often caused by trauma or neurogenic factors, can lead to limited range of motion and physical impairment, while severe cases may result in debilitating loss of function. Complete bony ankylosis of the elbow, though rare, presents challenges in treatment due to complex anatomy and high recurrence rates, with limited literature on management and outcomes. This study retrospectively investigates cases of elbow ankylosis secondary to heterotopic ossification, assessing long-term functional outcomes following operative intervention and standardized rehabilitation.
A retrospective case series was performed on patients who underwent surgical excision of heterotopic ossification of the elbow at our institution. Outcomes of interest were intraoperative flexion-extension arc, flexion-extension arc at the final long-term postoperative follow-up, visual analog scale pain scores at long-term follow-up, and Mayo Elbow Performance scores at long-term follow-up. The Wilcoxon signed-rank test was performed to identify a statistically significant difference between arc of motion achieved intraoperatively and the arc of motion maintained at the final long-term postoperative follow-up.
Between September 1999 and July 2021, 107 patients underwent operative resection for heterotopic ossification around the elbow, with 13 patients (16 elbows) exhibiting complete ankylosis at time of surgery. Patients were followed up for a minimum of 2 years. Long-term outcomes demonstrated an average visual analog scale pain score of 1.4 +/- 1.7, and an average Mayo Elbow Performance score of 85.9 +/-12.8, with 75% of cases maintaining at least 100 degrees of flexion-extension arc at the final long-term postoperative follow-up. On average, the flexion-extension arc of motion at the final follow-up was preserved at 95% of intraoperative levels. Patients did have an average residual flexion contracture of 18 +/- 9 degrees at the final follow-up.
Surgical excision for complete elbow ankylosis secondary to heterotopic ossification presents challenges due to potential complications. Our study shows favorable long-term outcomes in pain scores, range of motion, and Mayo Elbow Performance scores. Despite reported complications in the literature, our series exhibited no adverse events, supporting operative excision as a standard treatment with overall fair to excellent outcomes. Further research, particularly involving multicenter, randomized, prospective studies, is warranted to refine protocols and understand predictors for improved outcomes in this patient population.
肘部异位骨化常由创伤或神经源性因素引起，可导致活动范围受限和身体功能障碍，严重病例可能导致功能丧失。肘部完全骨性强直虽罕见，但由于解剖结构复杂且复发率高，治疗具有挑战性，关于其治疗和预后的文献有限。本研究回顾性调查异位骨化继发肘部强直的病例，评估手术干预和标准化康复后的长期功能结局。
对在本机构接受肘部异位骨化手术切除的患者进行回顾性病例系列研究。关注的结局指标包括术中屈伸弧度、术后最终长期随访时的屈伸弧度、长期随访时的视觉模拟评分疼痛评分以及长期随访时的梅奥肘关节功能评分。采用Wilcoxon符号秩检验来确定术中获得的活动弧度与术后最终长期随访时维持的活动弧度之间是否存在统计学上的显著差异。
1999年9月至2021年7月期间，107例患者接受了肘部周围异位骨化的手术切除，其中13例患者（16个肘关节）在手术时表现为完全强直。患者至少随访2年。长期结局显示，视觉模拟评分疼痛平均评分为1.4±1.7，梅奥肘关节功能平均评分为85.9±12.8，75%的病例在术后最终长期随访时维持至少100度的屈伸弧度。平均而言，最终随访时的屈伸活动弧度保持在术中水平的95%。患者在最终随访时平均残留屈曲挛缩为18±9度。
由于潜在并发症，异位骨化继发肘部完全强直的手术切除具有挑战性。我们的研究显示在疼痛评分、活动范围和梅奥肘关节功能评分方面有良好的长期结局。尽管文献报道有并发症，但我们的系列研究未出现不良事件，支持手术切除作为一种标准治疗方法，总体结局良好至优秀。有必要进行进一步研究，特别是多中心、随机、前瞻性研究，以完善方案并了解改善该患者群体结局的预测因素。
