Wang WenTao, Mei QianQian, Zhao ChongZhi, Andreacchio Antonio, Tang ShengPing, Liu Hang, Chen ShunYou, Xiong Zhu, Canavese Federico, He ShengHua
Department of Orthopedics, Shenzhen Traditional Chinese Medicine Hospital, 1st Fuhua Road of Futian District, Shenzhen, 518033, Guangdong, China.
Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China.
J Orthop Traumatol. 2025 Apr 26;26(1):25. doi: 10.1186/s10195-025-00842-1.
The factors predicting the development of heterotopic ossification (HO) of the elbow in children with untreated chronic Monteggia fractures (UCMFs) remained unclear. This multicentre study was designed to evaluate the radiographic data from paediatric patients with UCMFs and to identify the risk factors for HO formation and their radiographic characteristics.
We retrospectively reviewed 274 patients (mean age at injury: 5.82 ± 2.62 years) with UCMFs with all types of anterior (group A) and non-anterior (group B) radial head (RH) dislocations. Radiographs were used to assess the presence, size and bone density of HO. The risk factors evaluated included age at injury, sex, laterality, interval from injury to diagnosis, presence of radial or median nerve injury, immobilization of the fractured ulna after injury, direction of RH dislocation and distance of RH dislocation (DD-RH). The results were compared with 76 patient demographics-matched paediatric acute Monteggia fractures (PAMFs) undergoing surgery within 48 h after injury.
The HO rate (13.1%) in children with UCMFs was significantly higher than that (0%) in children with PAMFs (P = 0.001). The incidence of HO (14.5%) in group A was significantly higher than that (0%) in group B (P = 0.032). Age at injury and DD-RH were confirmed as risk factors for HO in patients with UCMFs by both univariate and logistic regression analyses (P < 0.05). Receiver operating characteristic curve analysis and chi-squared analysis indicated that age at injury > 6.78 years and DD-RH < 1.59-fold of the narrowest radial neck width were the cut-off values for an increased HO rate in patients with UCMFs (P < 0.05). Increased age at injury (P = 0.041) and interval from injury to diagnosis (P = 0.006) were associated with high-bone density HO.
Patients with UCMFs with anterior RH dislocations, age at injury > 6.78 years, and DD-RH < 1.59-fold of the narrowest radial neck width were more likely to develop HO. The bone density of HO increases with age at injury and interval from injury to diagnosis. Timely RH reduction after acute injury may prevent HO.
III.
未经治疗的儿童慢性孟氏骨折（UCMF）中，预测肘部异位骨化（HO）发生发展的因素尚不清楚。本多中心研究旨在评估UCMF患儿的影像学数据，确定HO形成的危险因素及其影像学特征。
我们回顾性分析了274例UCMF患儿（受伤时平均年龄：5.82±2.62岁），这些患儿均存在各种类型的桡骨头（RH）前脱位（A组）和非前脱位（B组）。通过X线片评估HO的存在、大小和骨密度。评估的危险因素包括受伤时年龄、性别、患侧、受伤至诊断的时间间隔、桡神经或正中神经损伤的存在、受伤后尺骨骨折的固定情况、RH脱位方向和RH脱位距离（DD-RH）。将结果与76例受伤后48小时内接受手术的、人口统计学匹配的小儿急性孟氏骨折（PAMF）患儿进行比较。
UCMF患儿的HO发生率（13.1%）显著高于PAMF患儿（0%）（P = 0.001）。A组HO发生率（14.5%）显著高于B组（0%）（P = 0.032）。单因素分析和逻辑回归分析均证实，受伤时年龄和DD-RH是UCMF患儿发生HO的危险因素（P < 0.05）。受试者工作特征曲线分析和卡方分析表明，受伤时年龄>6.78岁和DD-RH<桡骨颈最窄宽度的1.59倍是UCMF患儿HO发生率增加的临界值（P < 0.05）。受伤时年龄增加（P = 0.041）和受伤至诊断的时间间隔增加（P = 0.006）与高密度骨HO相关。
存在RH前脱位的UCMF患儿、受伤时年龄>6.78岁以及DD-RH<桡骨颈最窄宽度的1.59倍更易发生HO。HO的骨密度随受伤时年龄和受伤至诊断的时间间隔增加而增加。急性损伤后及时复位RH可预防HO。
III级。
Zotero 插件
