创伤后肘关节僵硬的异位骨化区域分布特点及相关危险因素分析  

Locational distribution characteristics and risk factors of heterotopic ossification following traumatic elbowstiffness

作　　者：花克涵 陈辰[1] 查晔军[1] 公茂琪[1] 孙伟桐 肖丹 季尚蔚 张曦公 蒋协远[1] Hua Kehan;Chen Chen;Zha Yejun;Gong Maoqi;Sun Weitong;Xiao Dan;Ji Shangwei;Zhang Xigong;Jiang Xieyuan(Department of Orthopaedic Trauma,Bejing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院创伤骨科,北京100035

出　　处：《中华创伤骨科杂志》2022年第11期928-934,共7页Chinese Journal of Orthopaedic Trauma

基　　金：北京积水潭医院院内青年基金(QN-202105);北京市属科研院所公益发展改革试点项目(京医研2019-9);北京市自然科学基金(L192049)。

摘　　要：目的评估创伤后肘关节僵硬患者的异位骨化区域分布特点,探究出现不同位置异位骨化的危险因素。方法根据纳入标准连续纳入2018年1月至2018年12月就诊于北京积水潭医院创伤骨科拟行肘关节松解的存在异位骨化的创伤后肘关节僵硬患者。收集患者基线资料及CT数据并通过Mimics 20.0软件进行重建,对患者的前内、前外、后内、后外、正后方、纯内、纯外、上尺桡等8个区域的异位骨化区域分布特点进行分析。将患者的原始损伤情况划分为肱骨远端骨折、尺骨鹰嘴骨折、桡骨头骨折、冠状突骨折、肘关节脱位5种类型。以是否出现某种位置异位骨化作为因变量,以原始损伤和基线资料等作为自变量,进行单因素分析后,将P<0.1的因素纳入logistic回归分析,分别评估出现每种位置异位骨化的危险因素。结果本研究共纳入91例患者,其中88例(96.7%,88/91)后内侧异位骨化,62例(68.1%,62/91)正后方异位骨化,60例(65.9%,60/91)后外侧异位骨化,41例(45.1%,41/91)前内侧异位骨化,26例(28.6%,26/91)前外侧异位骨化,13例(14.3%,13/91)上尺桡区域异位骨化,8例(8.8%,8/91)纯外侧异位骨化,7例(7.7%,7/91)纯内侧异位骨化。logistic回归分析结果显示存在尺神经症状(OR=4.354,P=0.017)、原始肘关节脱位损伤(OR=2.927,P=0.042)是出现前内侧异位骨化的危险因素,而原始尺骨鹰嘴骨折损伤(OR=0.277,P=0.023)更不容易出现前内侧异位骨化。原始桡骨头骨折损伤是出现前外侧异位骨化(OR=2.891,P=0.033)和后外侧异位骨化(OR=3.123,P=0.043)的危险因素。结论创伤后肘关节僵硬患者的异位骨化与原始损伤情况密切相关。后内侧异位骨化发生率非常高。存在尺神经症状、原始损伤存在肘关节脱位是出现前内侧异位骨化的危险因素,而原始损伤存在尺骨鹰嘴骨折更不容易出现前内侧异位骨化。原始损伤存在桡骨头骨折是出现前外侧及后外侧异Objective To study the locational distribution characteristics of the heterotopic ossification(HO)following traumatic elbow stiffness and the risk factors for HOdevelopment at different loca-tions.Methods Consecutively included according to our inclusion criteria in the present study were the patients who had been admitted to Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from January 2018 to December 2018 for elbow release due to traumatic elbow stiffness but developed postoperative HO.Their baseline data and CT data were collected and processed using Mimics 20.0.The HO distribution for each patient was characterized at the anteromedial,anterolateral,posteromedial,posterolateral,posterior,medial,lateral,and proximal radioulnar locations.The patient's original injury was categorized into 5 types:distal humerus fracture,olecranon fracture,radial head fracture,coronoid fracture,and elbow dislocation.After the univariate analysis with the HO occurrence at a specific location as the dependent variable and the original injury and baseline data as the independent variables,the factors with P value less than O.1 were included in the logistic regression analysis to determine the risk factors for HO at each location.Results A total of 91 patients were included in this study.Of them,88 had posteromedial HO(96.7%,88/91),62posteriorH0(68.1%,62/91),60 posterolateral H(65.9%,60/91),41anteromedial HO(45.1%,41/91),26anterolateral HO(28.6%,26/91),13proximal radioulnarHO(14.3%,13/91),8lateral H0(8.8%,8/91),and 7medial H0(7.7%,7/91).Logistic regression analysis showed that presence of ulnar nerve symptoms(OR=4.354,P=0.017)and presence of original elbow dislocation(OR=2.927,P=0.042)were the independent risk factors for the anteromedial HO development and that presence of original olecranon fracture(OR=0.277,P=0.023)was the protective factor for the anteromedial HO development.Presence of original radial head fracture was the independent risk factor for the anterolateral HO development(OR=2.891,P=0.033)and the posterolat

关 键 词：肘关节 骨化 异位性 危险因素 创伤后肘关节僵硬 位置分布特点 

分 类 号：R684[医药卫生—骨科学]