异位骨化的治疗进展

异位骨化（heterotopic ossification,HO）是指正常情况下非钙化组织发生新骨形成、关节周围软组织中出现成熟板层状骨的现象。多半发生在大关节周围,例如髋关节,肘关节。包括继发于肌肉、骨骼损伤后的异位骨化,创伤后神经源性异位骨化以及原发性进行性骨化性肌炎等。近年来随人工髋关节的广泛应用及人工髋臼骨折切开复位内固定的推广,异位骨化的发生率显著提高,日益受到骨科界的关注。     

脊髓损伤后异位骨化的病因学研究

临床上,异位骨化主要有3种形式：①神经源性异位骨化（neurogenic heterotopic ossification,NHO）,继发于严重神经疾患,如脑外伤、脊髓损伤（spinal cord injury,SCI）、中枢神经系统感染等;②创伤后异位骨化,包括骨折、脱位、人工关节置换术后等;③原发性异位骨化,如进行性骨化性肌炎（myositis ossificans progressiva,MOP）或进行性纤维不良性骨化（fibrodysplasia ossificans progressiva,FOP）.     

脑外伤后继发异位骨化1例及相关文献复习

目的:探讨脑外伤后继发异位骨化的临床影像特点、治疗及鉴别诊断,并复习回顾相关文献,以提高对此病例的诊治水平。方法:采用实验室指标及影像追踪对脑外伤后继发异位骨化进行观察,并复习相关文献。结果:此例患者入院行头颅CT检查,初诊为重型颅脑损伤,弥漫性轴索损伤。给予神经营养、改善循环、醒脑开窍促醒治疗,局部骨化区中药浸浴,局部按摩理疗,影像动态观察异位骨化区域变化,异位骨化未再增加,局部肌肉有所改善。结论:中西医结合是治疗脑外伤后继发异位骨化的有效方法,但后期仍需大样本观察,完善中医辨证施治。     

异位骨化治疗进展

异位骨化（heterotopic ossification，HO）是指在正常情况下没有骨组织的组织内的骨形成，根据成因可分为获得性及原发性两大类型。其中获得性HO包括：创伤后骨化性肌炎，可以源于任何形式的肌肉骨骼系统的损伤，如较常见的骨折、脱位、人工关节置换术、肌肉或软组织挫伤及较少见的肾脏、子宫、阴茎及胃肠道等手术或创伤：创伤后神经源性HO，源于脊髓损伤、闭合性颅脑损伤、中枢神经系统感染、肿瘤及脑血管意外等；     

神经源性骨化性肌炎1例影像学表现并文献复习

神经源性骨化性肌炎（neurogenic myositis ossification,NMO）是指因中枢神经系统遭受严重损伤,而在四肢关节周围软组织内出现的异位骨化（helerotopic ossification）。根据形成原因,异位骨化可分为3类：创伤性异位骨化,神经源性异位骨化,原发性异位骨化,NMO是异位骨化的一种类型。异位骨化可发生于身体任何部位,通常在重要关节,如髋、膝关节等关节,尤其是髋关节。     

关节周围异位骨化与关节功能康复

关节周围异位骨化是关节创伤、中枢神经损伤后常见的并发症,与关节功能康复关系密切。本文旨在结合临床实践,通过综述文献,探讨关节周围异位骨化的概念、临床特点、治疗策略及其与关节功能康复的关系。     

异位骨化发病机制的研究进展

异位骨化是一种病理性的骨形成，会造成受累关节的失功能，其形成受外因和内因的共同影响，有研究发现与手术及创伤、细胞因子、遗传因素以及围手术期的用药有关，但具体的发病机制目前尚不明了。成熟的异位骨化骨在组织学及影像学上表现与正常骨极其相似，动态的组织形态测定提示相对于正常骨，异位骨化骨代谢活性更高。形成异位骨化的危险因素很多，目前被广泛接受的有：严重的中枢神经损伤、长时间的昏迷、患肢的痉挛状态、患肢制动以及血清碱性磷酸酶升高。今后应加强在分子水平探讨与异位骨化形成的相关因素，为更好地预防创伤、手术后异位骨化的形成以及治疗提供支持。     

蛋白质组学在创伤后异位骨化调控蛋白研究中的意义

异位骨化是指不应发生骨化的软组织内出现病理性骨组织形成,多见于骨骼肌肉创伤、骨关节术后、神经系统损伤等.文章总结了运用蛋白质组学技术分析、比较异位骨组织在不同形成阶段的调控蛋白质在种类、数量存在的差异,据此可以筛选出不同时间点差异表达的功能蛋白,并针对性地对其中感兴趣的蛋白进行鉴定和功能验证,这种方式有助于发现新的调控蛋白,了解各种蛋白质之间相互作用的关系.证实蛋白质组学在创伤后异位骨化调控蛋白的研究中有广阔的应用前景,这有助于进一步阐明创伤后异位骨形成机制以及探索新的生物分子调控位点.     

异位骨化早期影像诊断初探

目的探讨异位骨化的早期影像表现。方法分析30例康复患者异位骨化的影像表现并复习文献。结果 X线和CT检查早期异位骨化表现为关节周围软组织水肿、密度增高;异位骨化的不同阶段MRI呈现不同的信号特点,早期表现为等或长T1长T2信号,增强扫描边缘呈"花边样"强化。结论异位骨化的不同阶段有不同的影像学特点,磁共振为诊断早期异位骨化的有效方法,X线和CT检查可用于复查。     

脊髓损伤后神经源性异位骨化

神经源性异位骨化(neurogenic heterotopic ossification，NH0)是在神经损伤患者的关节周围软组织中有多余骨的形成，是脊髓损伤(spinal cord injury，SCI)患者的常见并发症。本文对其病理生理、诊断与鉴别诊断、治疗及预防加以综述。     

异位骨化预防与治疗的新进展

异位骨化是指在机体骨骼系统之外骨形成,可导致严重的运动功能障碍。本文就异位骨化的定义、发病机制、发生率、临床表现和诊断、预防及治疗的新进展予以概述,旨在探讨异位骨化预防与治疗的有效方法。     

彩色多普勒超声及X线平片对异位骨化诊断的比较

目的比较彩色多普勒超声(彩超)及X线平片检查对脊髓损伤后异位骨化的早期诊断价值。方法对39例临床可疑异位骨化的脊髓损伤患者,在发生下肢水肿48h内进行首次彩超检查,每周复查,直至出现明确钙化灶。39例患者均同时进行X平片检查。结果脊髓损伤后异位骨化彩超所见:正常肌肉板层状结构肿胀增厚或被紊乱不规则结构取代,回声增强34例;出现弧形或长条形强回声带后伴声影39例;肌层内出现无回声血肿8例。外压性血管狭窄,流速增高4例。动态变化表现为:下肢水肿48h内,受累肌层肌纤维肿胀,回声增强,或病变中央区出现局限、形态不规则的非特异性低回声区;下肢水肿1周出现岛状回声增强区;1～2周后,出现大片弧形或长条形强回声带后伴声影,表面光滑或凹凸不平。下肢水肿1周内,彩超对异位骨化的检出率比X平片明显提高(P<0.01)。结论彩色多普勒超声可在患者起病初期检出阳性表现,是早期诊断异位骨化的可靠方法。     

工伤患者肘关节创伤后异位骨化早期综合康复疗效观察

目的观察工伤患者肘关节创伤后异位骨化早期综合康复的疗效。方法将80例肘关节创伤后异位骨化早期的工伤患者随机分为治疗组42例和对照组38例。对照组进行常规消炎镇痛药物和中频电治疗,治疗组进行综合康复治疗(包括运动疗法、作业疗法、理疗、中医传统康复治疗、病房康复和职前康复治疗),于治疗前及治疗3个月后分別评价两组患者的关节活动度(ROM)、目测类比法(VAS)疼痛评分。结果治疗组经3个月治疗后ROM、VAS疼痛评分与入院时的差异有非常显著性意义(P<0.01),疗效优于对照组(P<0.05)。出院后,治疗组39例患者重返原工作岗位,3例患者改变原工种。出院后1年随访,无1例行手术治疗。结论创伤后异位骨化早期经综合康复治疗,可缓解其临床症状,功能明显改善,使工伤患者重新走向工作岗位。     

异位骨化致全髋关节置换术后髋关节功能障碍的防治研究

目的探讨全髋关节置换术后异位骨化发生的原因、机制及其预防方法。方法将139例接受全髋关节置换的患者随机分为3组，A组53例，B组49例，C组37例，分别于术后次日口服维生素C、消炎痛和布洛芬。结果经统计学分析，异位骨化发生率A组与B组、C组之间有显著差别(P＜0.01)，B组与C组之间无显著差别(P＞0.05)。结论非甾体类消炎镇痛类药物可有效地预防全髓关节置换术后发生异位骨化的发生。     

Locally Delivered Nonsteroidal Antiinflammatory Drug: A Potential Option for Heterotopic Ossification Prevention

Oral nonsteroidal antiinflammatory drugs (NSAIDs) are prescribed for heterotopic ossification prophylaxis following at‐risk injuries and procedures. We hypothesized that NSAIDs may be delivered locally in a wound for heterotopic ossification prophylaxis. In in vitro work, we cultured osteoblasts with three commercially available NSAIDs and then measured cell viability and DNA content. Indomethacin caused a 50% decrease in DNA at the lowest dose (0.0001 mM) and the most potent decrease in cell viability (<10% of control at 0.0005 mM). Ketorolac and ibuprofen required 10 times the dose to achieve a comparable decrease (<20% of control at 0.005 mM). In an animal study, 20 rats per treatment group received a full‐thickness wound dressed with either saline‐moistened gauze, saline‐moistened chitosan sponge, or chitosan sponge loaded with indomethacin. After 28 days, we examined the tissue for healing. Wounds exposed to indomethacin loaded sponges demonstrated fewer inflammatory cells. All 20 rats in the indomethacin group had complete epithelial coverage at 28 days. Eighteen (90%) wounds in the saline‐chitosan group and 11 (55%) wounds in the saline‐gauze group were healed. Locally delivered NSAIDs may be useful for heterotopic ossification prophylaxis due to effects on osteoblast viability and lack of negative effects on wound healing.     

Warfarin in prevention of heterotopic ossification.

Patients with spinal cord injuries among others, commonly develop neurogenic heterotopic ossification. Current treatment with Didronel (disodium etidronate) inhibits bone matrix mineralization but not matrix production. To eliminate much morbidity and cost, a more efficatious prophylactic treatment is desirable. Because one of the proteins in bone, osteocalcin, is produced by a vitamin K-dependent carboxylation, this raises the possibility that treatment with warfarin may prevent the formation of ectopic bone. In the present study, 227 cases of spinal cord injury were reviewed. Among these patients, 15% were treated with warfarin and another 15% developed heterotopic ossification. None of the patients who were treated with warfarin developed heterotopic ossification, thus suggesting that warfarin may inhibit heterotopic ossification. Further prospective studies are planned.     

创伤后肘关节僵硬合并异位骨化手术疗效评价

目的评价手术治疗对创伤后肘关节僵硬合并异位骨化患者的治疗效果。方法 2008年7月至2010年12月,16例创伤后肘关节僵硬合并异位骨化患者进行手术治疗。其中,男12例,女4例,平均年龄38.1岁(14⁵9岁),手术松解距受伤时间8.9个月(659岁),手术松解距受伤时间8.9个月(6¹9个月)。所有病例行肘关节松解、异位骨化切除术,术后由同一组康复师训练,应用吲哚美辛预防异位骨化复发。测量患者术前、术后的肘关节屈伸、前臂旋转角度,并进行Mayo评分。术后由经过培训的专业医生进行标准化随访,评估疗效。结果肘关节屈伸活动度平均由术前32°±17.4°提高到108°±16.7°(t=13.295,P=0.000),旋转活动度由术前45°±8.8°提高到80°±11.0°(t=16.051,P=0.000),Mayo评分由术前平均(52.0±11.2)分提高到(82.0±8.1)分(t=8.722,P=0.001),术前、术后评分有统计学差异。有1例出现异位骨化的复发,2例采用外固定架后出现外固定尺骨针孔处骨折。结论异位骨化切除和肘关节松解术对治疗合并异位骨化创伤后肘关节僵硬的疗效满意。     

Management of Neurogenic Heterotopic Ossification: Three case histories to illustrate the role of physiotherapy

Neurogenic heterotopic ossification is a process of abnormal bone formation of multi-factorial aetiology. It occurs at varying sites to produce deformity and restriction of joint movement, and has a major impact on physical ability. There is extensive literature on the medical management of heterotopic ossification, but the role of physiotherapy is poorly described.This article aims to illustrate the importance of proactive physiotherapy in the team management and treatment of this condition. The authors show that physiotherapy is not contra-indicated in the presence of neurogenic heterotopic ossification and illustrate how interventions for improving range of movement can be used. The authors suggest that integrated team management was essential to the successful outcomes in these complex cases.     

Heterotopic ossification in children with burns: two case reports.

Heterotopic ossification is the formation of ectopic bone in soft tissue, and has been reported as a rare complication in pediatric burn patients. At our hospital, two 86% body surface area burn patients developed heterotopic ossification in the shoulder, elbows, distal femur, proximal tibia, fibula, and ribs approximately four months after the burn injury. These two rare and unusual cases are presented documenting the clinical involvement, radiological studies, laboratory data, as well as treatment of their heterotopic ossification. Discussion will focus on the incidence, diagnosis, pathophysiology, and treatment of heterotopic ossification in burn patients and how this information relates to the specific diagnosis and management of the complication of heterotopic ossification in the burn child.