Guo Jia, Kholinne Erica, Park Jiyeon, Ben Hui, Jeon In-Ho
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Faculty of Medicine, Department of Orthopedic Surgery, Universitas Trisakti, St. Carolus Hospital, Jakarta, Indonesia.
J Shoulder Elbow Surg. 2025 Sep;34(9):2205-2215. doi: 10.1016/j.jse.2024.12.013. Epub 2025 Jan 23.
Heterotopic ossification (HO) involves abnormal bone formation in soft tissues near joints, commonly occurring after elbow trauma or surgery, leading to pain and functional limitations. Previous studies have primarily characterized HO distribution based on bony landmarks, lacking a detailed investigation into the characteristics of its distribution in periarticular soft tissue in post-traumatic elbows. This study aimed to (1) develop a muscle-guided classification system using computed tomography (CT) to map HO relative to elbow muscle-tendon units and (2) investigate correlations between HO location and severity.
In a retrospective study, 56 patients with HO and elbow stiffness following trauma were analyzed. CT imaging was used to classify HO into 7 categories: Posterior - olecranon tip - triceps brachii; Posteromedial - medial gutter - flexor carpi ulnaris (PM-MG-FCU); Posterolateral - lateral gutter - anconeus; Medial - medial epicondylar - flexor muscles; Lateral - lateral epicondylar - extensor muscles; Anterior - humeroulnar joint - brachialis; and Anterior - humeroradial - supinator. HO severity was graded (1-3) based on CT morphology, and correlations between HO location and severity were assessed.
PM-MG-FCU was the most common HO location (67.9%). Significant correlations were found between HO severity and location, with higher rates of HO in grades 2 and 3, characterized by extensive mature bone formation and bone bridge development occurring in the posterolateral - lateral gutter - anconeus, posterior - olecranon tip - triceps brachii, and PM-MG-FCU.
The muscle-guided classification system effectively delineated HO distribution near elbow muscle-tendon units. HO locations surrounding the anconeus, triceps brachii, and flexor carpi ulnaris correlate with higher radiographic severity, providing valuable insights for treatment strategies.
异位骨化（HO）是指关节附近软组织内出现异常骨形成，常见于肘部创伤或手术后，会导致疼痛和功能受限。以往研究主要基于骨性标志来描述HO的分布，缺乏对创伤后肘部关节周围软组织中HO分布特征的详细研究。本研究旨在：（1）开发一种基于计算机断层扫描（CT）的肌肉引导分类系统，以描绘相对于肘部肌肉 - 肌腱单位的HO情况；（2）研究HO位置与严重程度之间的相关性。
在一项回顾性研究中，分析了56例创伤后出现HO和肘部僵硬的患者。利用CT成像将HO分为7类：后侧 - 鹰嘴尖 - 肱三头肌；后内侧 - 内侧沟 - 尺侧腕屈肌（PM - MG - FCU）；后外侧 - 外侧沟 - 肘肌；内侧 - 内上髁 - 屈肌；外侧 - 外上髁 - 伸肌；前侧 - 肱尺关节 - 肱肌；以及前侧 - 肱桡关节 - 旋后肌。根据CT形态对HO严重程度进行分级（1 - 3级），并评估HO位置与严重程度之间的相关性。
PM - MG - FCU是最常见的HO位置（67.9%）。发现HO严重程度与位置之间存在显著相关性，2级和3级HO发生率较高，其特征为在后外侧 - 外侧沟 - 肘肌、后侧 - 鹰嘴尖 - 肱三头肌和PM - MG - FCU区域出现广泛的成熟骨形成和骨桥发育。
肌肉引导分类系统有效地描绘了肘部肌肉 - 肌腱单位附近的HO分布情况。肘肌、肱三头肌和尺侧腕屈肌周围的HO位置与较高的影像学严重程度相关，为治疗策略提供了有价值的见解。
