Surgical approaches for resection of heterotopic ossification in traumatic brain-injured adults.
Surgical approaches for resection of heterotopic ossification in traumatic brain-injured adults.
复制标题
成人创伤性脑损伤异位骨化切除的手术方法。
DOI：
10.1097/00003086-199102000-00006
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发表时间：
1991
影响因子：
4.2
通讯作者：
Douglas E. Garland
中科院分区：
文献类型：
--
作者：
Douglas E. Garland
手肘或髋部的异位骨化（HO）部位决定了切除的手术入路。三种入路用于手肘HO切除：（1）后外侧HO的后外侧入路;（2）前HO的前外侧入路;以及（3）内侧或后内侧HO或尺神经前方转移的医疗入路。建议采用两种入路切除髋关节HO：（1）前入路切除前或内侧下HO;（2）后入路切除后HO。后方HO常伴有髋关节屈曲挛缩，前方软组织松解也是必要的。体格检查提示功能改善和复发的预后。神经功能恢复接近正常的患者有轻微或无HO复发，肢体功能改善，关节活动增加，而神经功能恢复差和持续痉挛与HO复发和肢体功能无改善相关。标准X线片有助于选择合适的手术入路。放疗、消炎痛和二磷酸盐类药物已用于预防。物理治疗是必要的，直到活动范围稳定。
The site of heterotopic ossification (HO) at the elbow or the hip dictates the surgical approach for resection. Three approaches are used for HO resection at the elbow: (1) a posterolateral approach for posterolateral HO; (2) an anterolateral approach for anterior HO; and (3) a medical approach for medial or posteromedial HO or anterior transfer of the ulnar nerve. Two approaches are recommended for resection of HO at the hip: (1) an anterior approach for anterior or inferomedial HO and (2) a posterior approach for posterior HO. Posterior HO is often associated with a hip-flexion contracture, and an anterior soft-tissue release may be necessary as well. Physical examination indicates the prognosis for functional improvement as well as recurrence. Patients with a near normal neurologic recovery have minimal to no HO recurrence with improved limb function and increased joint motion, whereas a poor neurologic recovery and persistent spasticity are associated with recurrence of HO and no functional limb improvement. Standard roentgenograms aid in selecting the appropriate surgical approach. Radiation, indomethacin, and diphosphonates have been administered for prophylaxis. Physical therapy is necessary until range of motion stabilizes.