Surgical resection of severe heterotopic ossification after open reduction and internal fixation of acetabular fractures: A case series of 18 patients
Surgical resection of severe heterotopic ossification after open reduction and internal fixation of acetabular fractures: A case series of 18 patients
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DOI：
10.1016/j.injury.2014.05.018
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发表时间：
2014-10-01
影响因子：
2.5
通讯作者：
Mauffrey, Cyril
中科院分区：
文献类型：
--
作者：
Wu, Xin-Bao;Yang, Ming-Hui;Mauffrey, Cyril
目的：评价髋臼骨折切开复位内固定(ORIF)术后严重异位骨化(HO)手术切除的临床效果。方法：回顾分析2005年10月至2010年11月因髋臼骨折行严重异位骨化切除患者的临床资料。我们的主要结果是通过Harris髋关节评分(HSS)评估功能状态。所有病例均采用Kocher-Langenbeck入路行HO切除和髋关节松解术，并采用放射治疗和吲哚美辛联合治疗以防止HO复发。结果：共18例患者(男17例，女1例)纳入本研究分析。手术时患者平均年龄36.8岁(22-54岁)。髋臼骨折手术至HO手术的时间间隔为3~30个月，平均9.9个月，其中6个月内7例，6~12个月8例，12个月内3例，HO分级BrookerⅢ级8例，IV级10例。HO切除至最近一次随访的时间间隔为2.1~7.8年，平均4.5年。髋关节Harris评分38~100分，平均84.5分，其中优9例，良3例，可4例，差2例(良、优占66.7%)。髋关节活动度平均194°(90~260°)，术中股骨颈骨折1例，坐骨神经损伤1例，股骨头缺血性坏死2例，轻度HO复发6例(33.3%)。术后6个月内复发率为28.6%，6个月内复发率为36.4%。无严重HO复发、伤口感染、深静脉血栓形成、肺栓塞等并发症。结论：髋臼骨折后早期手术切除重度HO疗效满意，但并发症发生率较高。(C)2014爱思唯尔有限公司。保留所有权利。
Objective: To evaluate the clinical results of surgical resection of severe heterotopic ossification (HO) after the open reduction and internal fixation (ORIF) of acetabular fractures.Methods: A retrospective chart review was performed between October 2005 and November 2010 on patients undergoing severe HO resection following an acetabular fracture ORIF. Our primary outcome was functional status evaluated by the Harris hip score (HSS). HO resection and hip release was performed using a Kocher-Langenbeck approach in all cases, and a combined radiation and indomethacin regimen was used to prevent HO recurrence. Plain radiographs were also used to evaluate the hip joint for arthritic changes and HO recurrence.Results: A total of 18 patients (17 males and 1 female) were included in our study analysis. The mean patient age was 36.8 (range: 22-54 years old) when HO resection surgery was performed. The mean time interval between acetabular fracture ORIF and HO resection was 9.9 months (range: 3-30 months): it was within 6 months in 7 patients, 6-12 months in 8 patients, and > 12 months in 3 patients.The HO was graded as Brooker grade III in 8 patients and grade IV in 10 patients. The mean time interval between HO resection and the latest follow-up was 4.5 years (range: 2.1-7.8 years). The mean Harris hip score (HHS) was 84.5 (range: 38-100), with a clinical outcome rating of excellent in 9 patients, good in 3 patients, fair in 4 patients, and poor in 2 patients (good and excellent rating accounted for 66.7%). The mean hip joint motion arc was 194 degrees (range: 90-260 degrees).Complications included one intraoperative femoral neck fracture, 1 sciatic nerve injury, 2 femoral head avascular necrosis, and 6 mild HO recurrences (33.3%). There was 28.6% recurrence if HO resection was within 6 months and 36.4% if > 6 months. There were no cases of severe HO recurrence, wound infections, deep vein thrombosis, or pulmonary embolism.Conclusion: The early surgical resection of severe HO after an acetabular fracture ORIF can provide satisfactory results, however the complication rate is relatively high. (C) 2014 Elsevier Ltd. All rights reserved.