髋关节置换术后异位骨化的蛋白质组研究

目的使用蛋白质组方法,通过比较髋关节置换术后并发异位骨化与未并发异位骨化患者血清蛋白,寻找差异表达蛋白,筛选蛋白质标志物。方法收集2009年8月～2012年3月14例髋关节置换术后患者血清,以髋关节置换术后并发异位骨化（heterotopic ossification,HO）记为HO组,以未并发异位骨化为正常组,蛋白质芯片联合表面增强激光解析离子化飞行时间质谱（SELDI—TOF—MS）技术检测分析两组蛋白质表达谱,寻找差异蛋白。对每个质荷比峰值进行Wilconxon秩和检验,筛选P〈0．05的差异蛋白质峰。结果检测到154个高质量质谱蛋白质峰,其中质荷比为2748的蛋白点的峰值较正常组明显下调,匹配蛋白质为“一2一HS糖蛋白B链（Alpha一2一HS．glycoproteinchainB,AHSGB一链）。结论AHSGB一链的低表达与髋关节置换术后并发HO密切相关,可能为HO的敏感蛋白质标志物。     

全髋关节置换术后异位骨化的X线观察

目的了解人工髓关节置换术（totalhiparthroplasty,简称THA）后异位骨化的发病情况及其X线表现。方法对333例（352个髋关节）接受THA的病例作了术后X线随访，时间最短者1年，最长者12年。按Brooker分级法加以分级记录，并与性别、年龄、手术原因等作了比较。结果在随访X线片上共发现异位骨化69例，检出率20.7％，男性较女性检出率高7.2％，但与年龄关系不大。85．5％（59例）的异位骨化出现在术后1年内，但也有迟至术后8年者(1例）。按Brooker分级方法，85．0％均属Ⅰ-Ⅲ级，Ⅳ级者仅15％。因强直性脊柱炎手术而发生严重异位骨化者要较其他病因为多。在X线片上早期的骨化皆位于髋关节外侧，以后在内侧也逐渐出现，形态各异以条片状为多，即使在Ⅳ期时仍以髓关节外侧骨化数量为多。结论异位骨化是THA术后常见的并发症，X线平片是诊断本病最简便经济的方法，也是临床确定治疗方案的主要依据。     

Radiotherapy for the prophylaxis of heterotopic ossification after total hip arthroplasty: A systematic review and meta-analysis of randomized controlled trails

Heterotopic ossification (HO) refers to the formation of lamellar bone in soft tissues and is a significant complication after total hip arthroplasty (THA). Radiotherapy has been proven as an effective prophylaxis especially for those patients with high risk of HO after THA. However the dose, timing, and frequency of radiation have yet to be determined. To compare HO progressions with different radiotherapy strategies and explore an optimal radiation option. We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trails (through December 1, 2019; no language restrictions) collecting patients who accepted prophylaxis radiation for whom HO progression outcomes were reported. Of 87 identified studies, 10 randomized controlled trails including 1203 patients and 1268 hips were taken to this analysis. Compared with the low biologically effective radiation dose group (biologically effective dose [BED] < 20 Gy), the medium biologically effective radiation dose group (20 Gy ≤ BED ≤ 24 Gy) had statistically significant difference on the prophylaxis of HO (p = 0.003). But for overall incidence of HO, there was no statistically significant difference between low BED group and high BED group (BED > 24, p = 0.21). There was statistically significant reduction in the prophylaxis of HO progression with multiple fractions as opposed to single fraction radiotherapy (p = 0.04). Hips with preoperative radiation were no more likely to observe HO progression than those with postoperative radiotherapy (p = 0.43). Radiotherapy with medium dose (20 Gy ≤ BED ≤ 24 Gy) after THA is an effective dose for preventing HO. In the prophylaxis of HO, multiple fractions seem to be more effective than single fraction radiation. Preoperative radiotherapy could prevent HO progression with the same efficacy postoperative.     

Methods of the physical medicine therapy in prevention of heterotopic ossification after total hip arthroplasty

BACKGROUND/AIM: In the prevention of periarticular heterotopic ossification (HO), a common complication after total hip arthroplasty (THA), nonsteroidal antiinflammatory drugs (NSAID) and irradiation are used. Some theories presume that local hypoxia of the soft tissue causes HO. The aim of this study was to investigate if the early use of pulsed electromagnetic fields (PEMF) could prevent this ossification since it accelerates the circulation and oxigenation of soft tissue. METHODS: The study included three groups of the patients with primary THA. The group C consisted of 66 patients/79 hips who had only kinesitherapy in postoperative rehabilitation. The group B consisted of 117 patients/131 hips who had PEMF and interferential current (IC) which, on average, started on the 14th day after the surgery combined with the standard kinesitherapy. The group A consisted of 117 patients/131 hips who had PEMF from the third postoperative day and IC from, on average, the 14th postoperative day with the standard kinesitherapy. The classification of HO was done on a standard AP roentgenograms of the hips, taken at least one year after the surgery. RESULTS: The overall HO was seen in 50.63% of the group C patients, in 43.51% of the B group and in 16.67% of the group A. Severe HO (III and IV class according to Brooker) was seen in 26.58% of the group C patients and in 6.10% of the group B, but none in the group A. CONCLUSION: According to the obtained results an early treatment with PEMF could prevent severe HO and reduce the overall HO.     

Infrapatellar heterotopic ossification after anterior cruciate ligament reconstruction

Reconstruction of the anterior cruciate ligament (ACL) is currently a common procedure. We report a case of ACL reconstruction using an autologous patellar tendon graft, where great infrapatellar heterotopic ossification occurred post-operatively. We found no similar cases in the literature. We discuss about the probable origin.     

脊髓损伤后异位骨化的影像表现

异位骨化（heterotopic ossification,HO）是脊髓损伤（spinal cord injury,SCI）患者常见的并发症之一,多发生于髋关节（70%～97%）,其次为膝关节、肘关节和肩关节[1]。表现为受累关节周围软组织密度增高,有新骨形成。目前,有关异位骨化的影像学表现报告不多,回顾我院2002年1月～2008年12月经X线随访证实的64例脊髓损伤患者的异位骨化情况,旨在分析脊髓损伤后异位骨化的影像学表现,报告如下。     

Multifocal variant of heterotopic ossification

In this case report, we present a 25 year follow-up of a single patient with a previously undescribed multifocal variant of heterotopic ossification. The patient presented with multiple occurrences of lesions similar to myositis ossificans atraumatica as well as some lesions resembling exostoses/osteochondromas. Several images and histological sections show the range of appearances and locations of her somewhat disparate lesions, including an exostosis with intraspinal extension. Until additional similar cases are brought forward, we consider this a unique variant of heterotopic ossification. The precise aetiology of this patient's condition is unknown.     

Pelvic heterotopic ossification: MR imaging characteristics.

PURPOSE: To evaluate the magnetic resonance (MR) signal intensity characteristics of pelvic heterotopic ossification (HO) in various stages of maturation. MATERIALS AND METHODS: Thirty-six patients with HO proved at computed tomography (CT) (n = 17) or radiography (n = 19) who underwent 1.5-T pelvic MR imaging within 3 months were included. HO was defined at CT or radiography as grade 1, fluid attenuation without calcification at CT; grade 2, calcification; grade 3, immature ossification; or grade 4, mature ossification. The location and MR signal intensity of all HO sites were noted. RESULTS: HO was determined to be grade 1 at 20 of 141 sites, grade 2 at 39, grade 3 at 30, and grade 4 at 52. With increasing HO grade, the following findings were observed: (a) decreasing T2 signal intensity (grade 1, 70%; grade 2, 58%; grade 3, 44%; grade 4, 4%), (b) increasing fat and cortical bone signal intensity at T1-weighted imaging (grade 1, 0%; grade 2, 3%; grade 3, 13%; grade 4, 86%), and (c) decreasing contrast enhancement (from 100% for grade 1 to 20% for grade 4). Fifteen (88%) patients with CT correlation had HO in the anatomic area of the trochanteric or iliopsoas bursa (55 [60%] of 91 sites). CONCLUSION: With progressive maturity of HO, T2 signal intensity and contrast enhancement decrease, but fat and cortical bone-equivalent signal intensity increases.     

Periarticular heterotopic ossification after multiple knee ligament reconstructions. A report of three cases

Heterotopic ossification is a frequently encountered clinical and radiographic entity. There are no previous reports in the English literature of heterotopic ossification after arthroscopically assisted ligament reconstructions for knee dislocations. Further, a link between the PCL reconstruction and posterior capsular ossification has not been heretofore recognized. Our three cases should raise the clinical awareness of such an entity.     

手术联合超选择性动脉栓塞治疗异位骨化

目的根据创伤性异位骨化血管造影表现及供血特点,探讨超选择性动脉栓塞联合手术治疗异位骨化的有效性。方法随机选取25例异位骨化患者,12例给予手术+超选择性动脉栓塞(栓塞组),13例不予栓塞,按传统治疗方案在异位骨化成熟后给予手术切除(传统治疗组),比较两组手术中失血量、术后血红蛋白下降值、关节功能表现、复发率。结果12例患者血管造影显示,局部血管过度增生、微血管瘤形成是创伤性异位骨化形成和复发的病理基础。术中失血量栓塞组为(450±120)ml,与传统治疗组(800±130)ml比较,差异有统计学意义(P<0.01);术后血红蛋白下降值栓塞组与传统治疗组比较,差异有统计学意义(P<0.01);关节功能优良率栓塞组为83%,与传统治疗组46%比较,差异有统计学意义(P<0.05);1年复发率栓塞组为0,传统治疗组为15%(2例)。结论超选择性动脉栓塞联合手术治疗能够有效减少术中失血量,早期干预并提高异位骨化的治疗成功率,是一个有前景的治疗手段。     

Syndesmosis sprains of the ankle. The influence of heterotopic ossification.

A retrospective study of 50 syndesmosis sprains in 44 football players was performed. Five patients (6 ankles) were lost to follow-up, allowing review of 44 injuries. Average follow-up was 47 months. The patients were evaluated for recurrent injury, overall ankle function, and for persistent ankle symptoms, including stiffness, pain, limping, and swelling. Follow-up radiographs of the injured ankle were obtained in 22 patients. The average return time to full activity was 31 days. Pain with pushing-off was a major factor preventing return to activity. At final followup, 36% of the patients complained of persistent mild to moderate stiffness of the ankle. Twenty-three percent had mild to moderate pain, usually with activity. One patient had a mild limp with activity, and 18% of the ankles had persistent mild to moderate swelling. Ankle function was rated as good to excellent in 86%. All patients with fair results had recurrent ankle sprains. There were no poor results. Eleven of the 22 patients with follow-up radiographs developed heterotopic ossification within the interosseous membrane, but no patient developed a frank synostosis. The patients with heterotopic ossification required an average of 11 days more recovery time than those without ossification. There was no significant difference between the 2 groups' ultimate ratings of ankle function or ankle symptoms, but the ankles with heterotopic ossification were associated with more recurrent lateral ankle sprains. We conclude that syndesmosis sprains require a longer recovery period than other types of ankle sprains. Most of these injuries showed good to excellent ankle function after recovery, unless there was a recurrent ankle sprain.2+ formation of heterotopic ossification.     

异位骨化的实验研究现状

异位骨化（HO）以骨骼系统外骨形成为特点。有关创伤引起的HO的实验进展报道较多。某些特定细胞能诱导HO,它们分泌骨形态发生蛋白（BMP）诱导受体间充质细胞向软骨和骨组织分化。BMP不同亚型诱导HO能力不同,联合应用更有效。近年发现BMP基因可能与HO关系密切。受到关注的还有Msx2、c-fox等基因。     

Heterotopic ossification. Effect on dual-photon absorptiometry of the hip

Dual-photon absorptiometry (DPA) is now widely used to determine bone mineral density of the lumbar spine and hips. Because the resulting images are often not of sufficient resolution to identify many bone or soft tissue abnormalities that may influence results, clinical and radiographic correlation is necessary. Presented are two cases in which results of DPA of the hips were elevated because of the presence of heterotopic ossification.     

Re-irradiation of soft-tissue sarcoma.

Re-irradiation for local recurrence of malignancy after radical radiotherapy is of proven benefit at head and neck sites but has seldom been used elsewhere. This paper reports a series of 10 patients re-irradiated with external-beam techniques for local recurrence of soft-tissue sarcoma of the limb and limb girdle following initial limb conserving management with surgery and radiotherapy (dose range 33-60 Gy). Median survival was 14 months following re-treatment. Two cases received treatment with high-energy electrons and the rest with megavoltage photons. Five patients re-treated with radical intent (dose range 40-60 Gy) had a median survival of 36 months and median recurrence-free survival of 16 months. All five patients treated palliatively (dose range 12-50 Gy) have died, although two demonstrated local control until death. Acute reactions were not severe. Radionecrosis was seen in one patient who was re-irradiated twice (total dose 145 Gy) and subsequently required amputation. One other case required amputation for persistent local disease, but in the remaining eight, limb conservation was achieved. Re-irradiation of soft-tissue offers good local control and may avoid amputation.     

肘关节松解术前放射治疗预防异位骨化形成

目的探讨术前1～4h内单次放疗预防既往有肘关节异位骨化(HO)形成史的病人肘关节HO形成的效果及不良反应。方法回顾性分析了32例肘关节HO病人采用肘关节松解术前1～4h内单次放疗预防术后HO形成的研究结果,其中31例病人术前1～4h内单次放疗剂量总量(DT)7～8Gy;1例病人术前1～4h内单次放疗DT8Gy,术后第6天因出现部分关节功能障碍单次加量DT4Gy。3例病人放疗后短期服用NSAIDS类药物。对治疗前及末次随访时的肘关节功能进行分级,同时对治疗前及末次随访时的肘关节功能评分进行统计学分析。结果中位随访时间28.25个月(12～38.5个月),7例(21.9%)病人X线片显示HO复发,4例(12.5%)发展为临床型HO,有不同程度关节活动障碍。19例(59.4%)关节活动完全恢复正常。1例病人骨折不愈合,其他病人未观察到明显短期或长期放疗反应。治疗前及末次随访时的肘关节功能分为4级,2组间差异具有统计学意义(Z=4.198,P<0.01)。结论术前1～4h单次DT7～8Gy的放射治疗预防肘关节HO安全有效。     

Radiological diagnosis of abductor denervation after hip surgery

A case of total hip arthroplasty through a direct lateral approach is described. The patient had a markedly positive Trendelenburg test at follow-up. Radiographs showed features consistent with the denervation of the gluteus medius. This was confirmed on CT scan. The standard post-operative radiograph following a total hip replacement may suggest denervation of the gluteus medius. Received: 20 July 2000 Revision requested: 23 August 2000 Revision received: 8 October 2000 Accepted: 10 October 2000