Bodley R, Jamous A, Short D
Department of Radiology, Stoke Mandeville Hospital, Aylesbury, Bucks, England.
Paraplegia. 1993 Aug;31(8):500-6. doi: 10.1038/sc.1993.81.
Heterotopic ossification (HO) is a potentially disabling complication of spinal injuries and other chronic disorders. It is of unknown aetiology and currently there is no easy or convenient diagnostic method that will allow very early confirmation of the inflammatory changes that precede osteoid and, later, true bone formation. Clinical experience, however, indicates that early treatment with radiotherapy, antiinflammatory agents or diphosphonates is needed to control the progression. This study was undertaken to assess the role of ultrasound (US) in the very early diagnosis of HO in patients with spinal injuries. US was found to be very sensitive in detecting focal soft tissue abnormalities around joints and in the muscles of these patients. If combined with a Doppler study to exclude deep venous thrombosis (DVT), and infection or tumour could be excluded clinically, US was extremely accurate in predicting the presence or absence of early HO changes within hours of the clinical manifestation. In 2 patients it successfully predicted HO in the opposite leg before clinical signs were evident. This study also provided supportive evidence of the theory of microtrauma in the aetiology of HO. As ultrasound is portable, safe, cheap, reproducible and accurate, it is the method of choice in the early diagnosis of HO. It allows early treatment to prevent the formation of osteoid and subsequent bone formation.
异位骨化（HO）是脊髓损伤和其他慢性疾病可能导致功能障碍的并发症。其病因不明，目前尚无简便的诊断方法能在类骨质形成之前，更早地确认炎症变化，而类骨质形成之后会出现真正的骨形成。然而，临床经验表明，需要早期使用放疗、抗炎药或双膦酸盐进行治疗以控制病情发展。本研究旨在评估超声（US）在脊髓损伤患者HO早期诊断中的作用。研究发现，超声在检测这些患者关节周围和肌肉中的局灶性软组织异常方面非常敏感。如果结合多普勒检查以排除深静脉血栓形成（DVT），并且临床上可以排除感染或肿瘤，那么在临床表现出现数小时内，超声在预测早期HO变化的存在与否方面极其准确。在2例患者中，超声在临床体征出现之前成功预测了对侧腿部的HO。本研究还为HO病因中的微创伤理论提供了支持性证据。由于超声具有便携、安全、廉价、可重复性强和准确性高的特点，它是HO早期诊断的首选方法。它能实现早期治疗，以防止类骨质形成及随后的骨形成。
