创伤性和神经源性肘关节异位骨化手术疗效及其影响因素分析  

The effect and risk factors related to prognosis of surgical resection on traumatic and neurogenic elbow heterotopic ossification

作　　者：崔志刚[1] 刘克敏[1] 刘四海[1] 王飞[1] 王安庆[1] 

机构地区：[1]首都医科大学康复医学院,中国康复研究中心北京博爱医院骨科,100068

出　　处：《中国矫形外科杂志》2015年第10期865-870,共6页Orthopedic Journal of China

摘　　要：[目的]评价创伤性肘关节异位骨化（traumatic heterotopic ossification of elbow,THOE）和神经源性肘关节异位骨化（neurologic heterotopic ossification of elbow,NHOE）的手术效果,探讨影响肘关节异位骨化手术疗效的相关因素。[方法]回顾性分析2006年7月∽2011年9月间行肘关节异位骨化切除术的58例（66肘）患者资料。38肘为THOE组,20肘为NHOE组,8肘为混合组。测量患者术前、术后的肘关节活动角度,并进行Mayo评分。以术后2年肘关节僵硬情况和DASH上肢评分功能作为评定手术疗效的指标,分析可能对疗效产生影响的因素。[结果]屈伸活动度、旋转活动度和MEPS评分,THOE组、NHOE组、混合组各组术后与术前比较差异均有统计学意义（P〈0.01）。THOE组有1例出现异位骨化复发,而NHOE组有3例出现异位骨化复发。经多因素Logistic回归分析发现骨折数量（OR=16.158,P=0.005）、受伤距松解手术时间（OR=20.408,P=0.004）、术前旋转活动度（OR=12.824,P=0.005）是肘关节异位骨化切除术后2年关节僵硬的独立危险因素;而病因（OR=48.914,P=0.006）、运动控制（OR=72.019,P=0.000）是肘关节异位骨化切除术后2年上肢功能差的独立危险因素。[结论]手术治疗NHOE和THOE的疗效均满意,但NHOE术后可能更易复发。多处骨折、合并前臂旋转受限、伤后〉12个月手术影响肘关节异位骨化手术效果。运动控制异常的NHOE不利于术后上肢功能恢复。[Objective]The purpose of this study was to present the effect of surgical resection on traumatic and neurogenic elbow heterotopic ossification and analyze risk factors affecting the prognosis following heterotopic ossification resection. [Method]We reviewed 58 patients（64 elbows） surgically treated for heterotopic ossification from Jul. 2006 to Sep. 2011. A total of 38 patients had trauma as the primary etiology,20 had neurogenic injury and 8 had combined etiologies. Pre and post- operation functional and ROM outcomes were recorded. We used Mayo Elbow Performance Score（ MEPS） for evaluations. Their clinical data were analyzed to define risk factors related to two- year elbow stiffness and function of upper limb. [Result]The sagittal and rotational range of motion（ ROM） were significantly different preoperatively to postoperatively in any individual etiologic group.（ P 0. 01）. Three cases recurrent in NOE group and 1 case in TOE group. A multi- variate Logistic regression analysis revealed that the independent risk factors affecting two- year elbow stiffness included number of fractures（ OR = 16. 158,P =0. 005）,the interval from primary injury or operation to heterotopic ossification resection（ OR = 20. 408,P = 0. 004）,and ROM of forearm rotation pre- operatively（ OR = 12. 824,P = 0. 005）. The independent risk factors affecting the two- year upper limb functional recovery were etiology（ OR = 48. 914,P = 0. 006）,and the ability of motor control（ OR = 72. 019,P = 0. 000）. [Conclusion]Surgical excision of heterotopic bone about the elbow results in significant gains in ROM regardless of etiology. The likelihood of recurrence is higher in patients with central nervous system injuries than in patients with purely localized trauma.Multiple factures,elbow stiffness with forearm rotation limitation and delay of surgical resection for longer than 12 months from primary injuries impede ROM recovery after surgery.Neurogenic elbow heterotopic ossification without normal motor control direc

关 键 词：异位骨化 肘关节 危险因素 手术治疗 

分 类 号：R687.4[医药卫生—骨科学]