严重异位骨化伴骨性强直的人工全髋置换术

目的：分析严重异位骨化伴髋关节骨性强直的人工全髋置换术的疗效及预防对策。方法：对12例髋关节严重异位骨化伴骨性强直者进行人工全髋置换术，术后经3－10年的随访。结果：所有病例经3－10（平均6．3）年随访，髋关节功能得到明显改善。结论：人工全髋置换术是髋关节严重异位骨化伴骨性强直的一种理想的治疗方法。     

一期后前路手术治疗多节段脊髓型颈椎病

目的　探讨治疗多节段重度脊髓型颈椎病的手术方式及疗效。方法　采用一期后路“双开门”椎板成形、侧块钛板固定加前路减压支撑植骨钛板固定术治疗术前MRI显示三个节段以上 (含三个节段 )颈脊髓前后方受压 ,X线动态片显示颈椎失稳或后突畸形的 2 0例脊髓型颈椎病。结果　一期后、前路手术 2 0例 ,手术时间平均 5 5h (5～ 7h) ,失血量平均 5 0 0ml。术后 1～ 2d病人戴颈围离床活动 ,颈围外固定 1 2周 ,所有病例随访 6～ 1 8个月 (平均 1 0个月 ) ,无伤口感染 ,未见颈椎内固定及植骨块松脱移位 ,X线摄片显示术后 4个月前方植骨块与椎体融合。临床颈痛消失 ,四肢神经症状按Nurick分级均较术前上升一级以上 ,平均从术前 3 3级升至术后 2 4级。结论　一期后、前路颈椎管减压、内固定、植骨融合术为复杂棘手的多节段的脊髓型颈椎病手术治疗提供了一种比较安全、可靠的方法。在达到充分解除颈脊髓前后压迫同时稳定颈椎 ,预防了前方支撑植骨的松脱、颈椎的后突畸形发生 ,提高了植骨融合成功率     

Heterotopic Ossification in Total Ankle Arthroplasty: Case Series and Systematic Review

Heterotopic ossification after total ankle arthroplasty (TAA) is a known sequela and has been reported to contribute to reduced range of motion and poor functional outcomes. However, conflicting results have been reported in the literature. The present study documents the incidence of heterotopic ossification for a novel fourth-generation fixed-bearing 2-component prosthesis and reports a systematic review of the literature. We reviewed the incidence and functional outcome of consecutively enrolled patients who underwent primary Infinity TAA between 2013 and 2015 in a prospective observational study. Preoperative and postoperative radiographic and functional outcome data were collected. A systematic review was also conducted investigating all published studies between 1998 and 2018 reporting the incidence of heterotopic ossification after TAA. The incidence of heterotopic ossification was 70.5% in the 61 patients who underwent primary TAA in the case series. There was no association between heterotopic ossification and American Orthopaedic Foot and Ankle Society (AOFAS) score, foot function index (FFI), visual analogue scale (VAS), and ankle osteoarthritis scale (AOS). Sixteen studies on 1339 TAA implants were included. The overall incidence of heterotopic ossification after TAA was 66.0% at average 3.6 years (range 22.2% to 100%). Four studies (299 ankles) did not address functional outcomes. Eleven studies (960 ankles) reported no association between heterotopic ossification and functional outcomes. One study (80 ankles) reported a statistically significant difference in range of motion (7°) and AOFAS score (7 points). In conclusion, although the incidence of heterotopic ossification after TAA is considerable, there is insufficient literature to suggest that heterotopic ossification after TAA impacts range of motion or functional outcome.     

Heterotopic Ossification Negatively Influences Range of Motion After Revision Total Knee Arthroplasty

BackgroundThe incidence of heterotopic ossification (HO) after total knee arthroplasty (TKA) varies and is of unclear clinical significance. This study aimed to identify the incidence of HO in patients undergoing revision TKA for either stiffness or aseptic loosening/instability and determine if the presence of HO is associated with inferior absolute range of motion (ROM) and ROM gains.MethodsEighty-seven patients were prospectively enrolled and separated into 2 cohorts to evaluate ROM after revision TKA (2017-2019). Group 1 (N = 40) patients were revised for stiffness, while group 2 (N = 47) patients were revised for either aseptic loosening or instability. Goniometer-measured ROM values were obtained preoperatively and at 6 weeks, 6 months, and 1 year postoperatively. Statistical analysis included a Fisher’s exact test to assess for an association between preoperative HO and final ROM at 1 year after revision TKA.ResultsHO was identified on preoperative radiographs in 17 patients (20%). There was a significantly higher rate of preoperative HO in patients revised for stiffness compared to patients revised for instability or loosening (30% vs 11%; P = .03). Five cases of HO qualitatively identified as most clinically severe were associated with lower ROM at each time point compared to the remainder of HO cases in this study cohort (P < .02).ConclusionThe presence of HO is greater in patients undergoing revision TKA for stiffness. Additionally, HO severity appears to have a major effect on preoperative and postoperative ROM trajectory. This information should help guide patient expectations and highlight the need for a comprehensive, standardized classification system for HO.     

混合型与生物型人工全髋关节置换术后并发异位骨化的比较

目的 研究使用混合型与生物型假体的全髋关节置换术(THA)术后异位骨化(H0)的情况.方法 回顾性研究自2004年1月～2010年1月行初次单侧人工THA患者,从中配对选取76对,配对的参数为年龄、性别、体重.A组患者行混合型人工THA,B组患者行生物型人工THA.HO诊断依据术后3个月和12个月的髋关节前后位X线片,按Brooker分级记录.结果 A组发生HO的例数为21例,总发生率27.63%,B组发生HO例数为30例,总发生率为39.47%,两者差异无统计学意义.结论 混合型与生物型人工THA术后HO的发生率没有明显差异.     

Incidence of Heterotopic Ossification in Direct Anterior Total Hip Arthroplasty: A Retrospective Radiographic Review

Heterotopic ossification (HO) is a complication following total hip arthroplasty (THA) with traditional approaches. The direct anterior approach (DAA) has become a popular approach for THA; however, no study has evaluated HO formation following DAA THA. We examined the incidence of HO in a consecutive series of THA using the DAA in two separate hospitals. Standard preoperative radiographs were examined to determine the type of degenerative arthritis, and follow-up radiographs of at least 6 months after surgery were evaluated for the presence and classification of HO. The overall incidence of HO after DAA THA in this study was 98/236, or 41.5%, which falls within the reported range from recent studies involving more traditional approaches to the hip.     

Heterotopic Ossification Prophylaxis After Total Hip Arthroplasty: Randomized Trial of 400 vs 700 cGy

Background

Heterotopic ossification (HO) is a known complication following total hip arthroplasty. Radiation is an effective prophylaxis, but an optimal protocol has yet to be determined. We performed a randomized, double-blinded clinical trial in high-risk patients to determine the efficacy of 400 vs 700 cGy doses of radiation.

融合与非融合杂交技术在多节段颈椎前路手术中的应用

目的 探讨颈椎病多节段前路减压手术中融合与非融合技术组合使用的应用指证并评价其疗效.方法 2008年1月至2012年1月,采用颈椎前路融合与非融合杂交技术治疗涉及多个节段的颈椎病18 例,其中男11 例,女7 例,年龄28～52 岁,平均36.7 岁.18 例中,脊髓型颈椎病8 例,神经根型颈椎病3 例,混合型颈椎病7 例.非融合间隙均为1个,其中采用Prodisc-C人工椎间盘置换16 例,颈椎动态稳定器2 例.单间隙融合5 例（椎间盘摘除cage植入）,2间隙融合11 例,3间隙融合2 例.术前、术后进行JOA评分和颈椎残障功能量表（neck disability index,NDI）评定,按Odom标准评定治疗效果.结果 18 例患者术后平均随访22.9个月（15～42个月）,所有患者临床症状、脊髓功能改善明显,未出现钛网下沉、假体松动、颈椎反屈、融合节段假关节形成及二次手术.融合节段术后融合时间平均5.2个月（3～9个月）,JOA评分由术前平均9.8分（7～12分）上升至术后平均14.9分（12～17分）.末次随访时JOA评分、NDI评分与术前比较差异有统计学意义（P＜0.05）.按Odom标准评价手术效果,优10 例,良5 例,尚可3 例,优良率83.5%.结论 颈椎病多节段融合手术中选择性组合使用非融合技术,能够减少融合节段,降低长节段融合后邻近节段的应力,为预防邻近节段退变提供了一种可行的方式.     

Low-Dose Aspirin Administered for Venous Thromboembolism Prophylaxis Reduces the Incidence of Heterotopic Ossification in Total Joint Arthroplasty

BackgroundHeterotopic ossification (HO) is a common complication following total joint arthroplasty (TJA). However, the pathophysiology of HO is not entirely understood. Inflammation may play a significant role in the pathogenesis of HO as nonsteroidal anti-inflammatory drugs are effective in the prevention of HO. The purpose of this study is to examine if aspirin (ASA), when used as venous thromboembolism (VTE) prophylaxis, influenced the rate of HO formation following TJA.MethodsWe queried our longitudinally maintained database to identify all patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) for osteoarthritis between January 2016 and June 2018 with at least 3-month radiographic follow-up. In total, 1238 THAs and 1051 TKAs were included for analysis. Radiographs were reviewed and HO formation graded according to the Brooker classification. Patient demographic and VTE prophylaxis data were collected and reviewed for accuracy. Univariate and multivariate analysis was performed to evaluate the effect of ASA on HO formation.ResultsThe overall rate of HO was 37.5% after THA and 17.4% after TKA. Patients receiving ASA were less likely to develop HO after THA (34.8% vs 45.5%; P < .001), as well as HO after TKA (13.4% vs 18.4%; P = .047) compared to patients receiving non-ASA VTE prophylaxis. The rate of HO formation trended to be lower, albeit not statistically significantly, in patients receiving low-dose ASA (81 mg) vs high-dose ASA (325 mg).ConclusionPatients undergoing primary TJA receiving ASA for VTE prophylaxis were less likely to develop HO compared to patients who were administered non-ASA VTE prophylaxis.     

Heterotopic Ossification of Rectal Adenocarcinoma: Report of a Case

Heterotopic ossification of gastrointestinal tract tumors is rare. We report the case of a 67-year-old man with heterotopic ossification of a rectal adenocarcinoma. The patient presented with intermittent abdominal pain and frequent diarrhea, and colonoscopic examination showed a large polypoid tumor partially obstructing the rectal lumen. Abdominal computed tomography (CT) revealed a large tumor in the rectal lumen with calcified spots. We performed low anterior resection of the rectum, and histologic examination showed a well-differentiated adenocarcinoma with heterotopic ossification infiltrating the full thickness of the rectum. Local recurrence and liver metastases were found 2 months after surgery, and the patient died 3 months later. Such a rapidly progressive course of rectal adenocarcinoma with heterotopic ossification is very unusual.     

放疗联合吲哚美辛对髋关节异位骨化切除术的辅助治疗作用

目的探讨放疗联合吲哚美辛对髋关节异位骨化（heterotopic ossification,HO）切除术的辅助治疗效果。方法回顾分析2005年11月～2008年12月对有完整随访资料的15例高危髋关节HO形成（均为男性,中位年龄34岁）的临床资料。采用常规K-L入路关节松解术,放疗采用前后对穿照射,照射野包括整个手术区域,6MV-X,源轴距100 cm,剂量以髋关节中心平面计算,术前1～4 h内或术后24 h内单次放疗组织剂量（dose of tissue,DT）7～8 Gy。所有患者术后常规服用吲哚美辛4周（25 mg,tid）。结果 15例中位随访时间20.5月（5.5～42.5月）,随访时牛津髋关节功能评分（Oxford hipscore,OHS）评分为（15.7±6.2）分,较治疗前OHS评分（33.5±10.8）分明显降低（t=6.259,P=0.000）。11例（73.3%）关节活动完全恢复正常,3例（20.0%）好转,1例（6.7%）加重。5例治疗前有关节疼痛者,随访时4例疼痛消失,1例明显减轻。未观察到毒副反应。2例（13.3%）分别在术后6、3个月X线片显示HO复发,其中1例无临床症状,另1例发展为临床型HO,关节活动障碍较前加重。结论放射治疗联合吲哚美辛辅助用于预防高危患者的髋关节术后HO可能具有一定的疗效。     

Anteriorty Cervical Decompression and Fusion for Cervical Spondylosis Using Vertebral Grafts Obtained from the Fusion site. Technical Advantages and Follow-up Results

Summary  A retrospective analysis was done in 60 consecutive patients who underwent anterior cervical fusion using vertebral grafts obtained from the fusion site at the Nagoya University and its affiliated hospitals by a single surgeon (MT). Follow-up results and technical advantages are reported. The average follow-up period was 33 months (range 6 to 55 months). Sufficient decompression of the anterior cervical pathology was performed successfully via a wider operative field. The symptoms and neurological score improved significantly without any new deficits in all patients except in one with a three-level fusion who needed re-operation for further decompression. No major graft complications such as graft extrusion or pseudoarthrosis occurred. Graft fracture was noted in five cases. However, good bony fusion was observed in all these cases without any further treatment. Normal cervical lordosis was preserved in most cases except in four, who lost lordotic alignment but did not show kyphosis. Major advantages of this method are a wider operative field, excellent graft fusion rate, and no need for an additional incision to obtain autogenous bone graft.  These benefits seem have to contributed to satisfactory surgical results in this series.     

Prophylaxis of Heterotopic Ossification of the Hip: Systematic Review and Meta-Analysis

Heterotopic ossification (HO) is a potentially severe, if infrequent, complication in hip surgery, and uncertainty exists regarding whether to use NSAIDs or radiation in its prevention. Thus, we systematically reviewed the literature in MedLine, EMBASE, CINAHL, and the Cochrane Controlled Trial Register and, after ruling out publication bias and data heterogeneity, performed a meta-analysis of randomized, controlled trials to assess effectiveness and complications of NSAIDs and radiation in the prevention of HO. We identified nine studies reporting on effectiveness and complications including a total of 1295 patients. The pooled risk ratio for the effectiveness in HO prevention was 0.96 (95% confidence interval, 0.88–1.06) and was independent of the type of surgery (THA or open reduction and internal fixation). There was no association with gender, age, length of followup, or year of publication. The risk ratio for associated complications was 0.79 (95% confidence interval, 0.45–1.41), and, again, was independent of the aforementioned factors. We found no evidence for a statistically significant or clinically important difference between NSAIDs or radiation in preventing HO.     

A Surgical Protocol for Management of Post Traumatic Heterotopic Ossification of Elbow

BackgroundOpen excision remains the gold standard of treatment for posttraumatic heterotopic ossification (HO) of the elbow. The purpose of this study is to evaluate the functional outcome of early surgical excision done by adhering to a proposed surgical protocol with exclusive posttraumatic HO of the elbow.MethodsA retrospective study was conducted with 31 patients (25 males and 6 females) with a mean follow-up of 40.5 ± 27.44 months. Excision was done according to our surgical protocol based on the location of HO, associated fractures, stability, need for ulnar nerve transposition, previous operative scar. Improvement in elbow function, Mayo elbow performance score (MEPS) preoperatively and at final follow-up was compared, and statistical analysis was done.ResultsMean flexion–extension arc, supination-pronation arc and MEPS improved by 74.68° ± 29.32°, 26.13° ± 32.93°, 30.48 ± 11.57, respectively. Flexion arc deteriorated by 10.81° ± 10.42° from intraoperative to final follow-up. Improvement at final follow-up was significant in all the cases (P < 0.05). 19 patients had limited HO, and 12 had global HO. Their mean flexion–extension arc increase was 77.63° ± 29.12° and 70° ± 30.3° respectively, and the final mean MEPS score was 96.05 ± 5.16 and 88.75 ± 11.51, respectively. Nine patients had no initial fracture (Group 1), 13 had some fracture (Group 2), nine had a fracture-dislocation of the elbow (Group 3). Their flexion–extension improvement, final MEPS were 88.33° ± 30.82°, 98.33 ± 5, (Group 1); 81.15° ± 16.73°, 92.31 ± 9.27 (Group 2) and 51.67° ± 31.32°, 89.44 ± 9.5 (Group 3), respectively. We had two complications (6.45%).ConclusionThe surgical protocol described here enabled us to achieve good functional results and was in concordance with similar studies done previously.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43465-021-00381-x.