人工全髋关节置换术后异位骨化

作者报道６７例人工全髋关节置换术（ＴＨＡ）后异位骨化，发病率２４．５％，其中Ｂｒｏｏｋｅｒ分级，Ⅰ级２１例，Ⅱ级１８例，Ⅲ级１７例，Ⅳ级１１例。ＴＨＡ后异位骨化与全身（性别，髋关节疾病及术后解热镇痛药）和局部（骸关节手术史，大转子截骨，手术入路，麻醉方法及软组织创伤）因素密切相关。作者认为对于男性，增生性骨性关节炎和强直性脊柱炎等高危患者，ＴＨＡ应避免局麻和大转子截骨，术后采用解热镇痛药和放疗进行预防和治疗。     

人工全髋与股骨头置换术并发异位骨化的比较

本文报告人工全髋关节置换术与人工股骨头置换术164例,术后发生异位骨化39例。全髋关节置换术的异位骨化率为40％,人工股骨头置换术的异位骨化率为18.5％。异位骨化均按Brooker分类法分类,二种不同术式的异位骨化率有显著性差异（P<0.05）。作者就异位骨化的形成、异位骨化率在二种术式之间的差异进行了讨论,并提出了异位骨化对疗效的影响及其与术式选择之间的关系。     

股骨头缺血性坏死修复重建术后与全髋关节置换术后异位骨化的比较

目的 研究股骨头缺血性坏死修复重建术后与全髋关节置换术后异位骨化的发生率。方法1994年6月～2004年12月，收治因股骨头缺血性坏死行修复重建患者共1005例，其中随机选择Ficat和AlertX线分期Ⅲ、Ⅳ期患者74例（A组），观察异位骨化的发生率；与随机从465例同期全髋关节置换患者中选取80例（B组）的异位骨化发生率进行比较。结果A、B组术后均获随访2-10年，平均6．5年。修复重建术组发生异位骨化4例，异位骨化率5．4％；全髋关节置换术组发生异位骨化18例，异位骨化率22．5％；两组差异有统计学意义（P〈0．01）。结论股骨头缺血性坏死修复重建术后异位骨化发生率较低，适用于青壮年患者。全髋关节置换术后异位骨化发生率较高，适用于老年患者。     

全髋关节置换术后异位骨化预防的研究进展

异位骨化(heterotopic ossification,HO)是指在正常骨组织以外的组织中出现骨形成.HO是全髋关节置换术常见的并发症.目前已知的危险因素包括髋部强直、男性、既往HO史.最常用分型是采用Brooker分型将其分为4个等级.最有效的预防措施是放疗或服用NSAIDs.放疗方案是术后一次性给予7Gy的照射...     

全髋关节置换术后异位骨化的防治

异位骨化 (ｈｅｔｅｒｏｔｏｐｉｃｏｓｓｉｆｉｃａｔｉｏｎ ,ＨＯ)是指发生于肌肉或结缔组织中的非典型骨形成的现象 ,它可发生于脊髓、大腿、肘关节损伤及全髋关节置换术后。随着全髓关节置换 (简称ＴＨＡ)技术的广泛开展 ,髋关节周围的异位骨化现象受到了人们的高度重视 ,并对ＨＯ的病因、发病机制及防治问题进行了多方面的研究。1　ＨＯ的发生情况ＨＯ是人工全髋关节置换术后的主要并发症之一 ,文献报道其发生率为 8%～ 90 %不等[1] ,其中有 7%的病人可出现严重的疼痛和活动受限 ,尤其是髋关节活动受限。绝大多数ＨＯ发生于术后 6周之…     

全髋关节置换术后异位骨化的临床研究

目的探讨全髋关节置换术后异位骨化的发生率,以及假体类型和手术入路对异位骨化发生的影响。方法对245例(262髋)患者行全髋关节置换术,男115例,女130例;骨水泥型假体178髋,非骨水泥型假体84髋,采用改良直接外侧入路227髋,后外侧入路35髋。观察末次随访X线片假体周围异位骨化的范围,并按Brooker分型分为Ⅰ～Ⅳ型。结果全髋关节置换术后异位骨化的发生率为11.1%;男性和女性患者术后异位骨化的发生率分别为13.0%和10.8%,异位骨化在骨水泥型和非骨水泥型全髋关节置换术后的发生率分别为11.2%和10.7%,在后外侧入路和改良直接外侧入路的发生率分别为2.86%和12.3%,差异均无统计学意义(P0.05)。轻度(BrookerⅠ、Ⅱ型)和重度(BrookerⅢ、Ⅳ型)异位骨化的平均Harris评分分别为(90.47±3.76)和(81.35±2.34)分,差异有统计学意义(P0.01)。结论异位骨化是全髋关节置换术后常见的并发症之一,在不同性别间的发生率相近。采用不同的手术入路、不同类型的髋关节假体,术后异位骨化的发生率无明显差异。严重的异位骨化将限制术后髋关节的功能。     

全髋关节置换术后异位骨化及其研究进展

定义和发病机制 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. HO是全髋关节置换术（THA）后常见的并发症,它不同于创伤后肌肉损伤形成的骨化性肌炎或者继发性炎症,对其发病机制至今仍缺乏足够的认识.     

血清ALP预测股骨颈骨折全髋关节置换术后异位骨化的价值

目的 探究术前血清碱性磷酸酶(alkaline phosphatase, ALP)水平对股骨颈骨折患者全髋关节置换术后异位骨化发生的预测价值,为异位骨化的早期防治提供参考。方法 纳入2020年1月至2021年12月山东第一医科大学第三附属医院收治的116例股骨颈骨折患者作为研究对象,其中男71例,女45例;年龄54～79岁,平均(64.05±4.69)岁;骨折至手术时间21～47 h,平均(36.20±5.50)h。116例均进行全髋关节置换术治疗,根据患者术后随访1年期间异位骨化发生情况分为异位骨化组与无异位骨化组,比较两组一般资料及实验室指标,重点分析术前血清ALP水平对股骨颈骨折患者全髋关节置换术后异位骨化发生的预测价值。结果 术后随访1年,116例患者中13例出现异位骨化,发生率为11.21%(13/116),其中Brooker评估为1级3例,2级10例。异位骨化组中男性占比较无异位骨化组高,术前血清C反应蛋白、ALP水平较无异位骨化组高,差异有统计学意义(P<0.05);Logistic回归分析显示,术前血清ALP是股骨颈骨折患者全髋关节置换术后异位骨化发生的独立危险因...     

Heterotopic Ossification After 2-Incision Total Hip Arthroplasty

We examined the incidence of heterotopic ossification (HO) in a consecutive series of total hip arthroplasties (THAs) performed with the so-called minimally invasive, 2-incision technique. Standard preoperative hip radiographs were used to grade the extent of degenerative arthritis, and comparable follow-up radiographs at 30 months after surgery were used to detect and classify HO formation. Of 121 patients, 32 (26.5%) developed HO, with the Brooker class distribution as follows: stage I, 16 patients; stage II, 9 patients; stage III, 6 patients; stage IV, 1 patient. In this study, HO formation after 2-incision THA occurred with nearly the same frequency as that reported in other studies after standard THA.     

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.     

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。     

Heterotopic Ossification in Primary Total Hip Arthroplasty Using the Direct Anterior vs Direct Lateral Approach

Background

The formation and severity of heterotopic ossification (HO) may be influenced by type of surgical approach. Our hypothesis was that because of differences in soft tissue dissection, differences exist in HO formation in primary total hip arthroplasty using direct anterior (DA) vs direct lateral (DL) approach.

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.

Heterotopic Ossification Following Direct Anterior Total Hip Arthroplasty With and Without Postoperative Analgesic Nonsteroidal Anti-inflammatories

BackgroundHeterotopic ossification (HO) can result in poorer clinical outcomes following total hip arthroplasty (THA). Multiple modes of intervention have been evaluated for HO prevention, including the use of nonsteroidal anti-inflammatories. Additionally, multimodal pain management strategies including celecoxib have become more prominent. Therefore, this study aims to evaluate the influence of celecoxib as part of postoperative analgesia on the risk of developing HO following the direct anterior approach (DA) for THA.MethodsA retrospective query identified primary DA THAs performed by a single surgeon between 2013 and 2020. Patients were grouped according to those who received 3 weeks celecoxib upon discharge, and those who did not. Radiographs were used to categorize patients according to the Brooker classification system for HO. Preoperative and 2-week, 6-week, 3-month, and 1-year postoperative X-rays were evaluated.ResultsA total of 688 DA THAs were included, demonstrating a 9.6% (n = 66) incidence of HO with Brooker classification: 1: 5.7% (n = 39); 2: 2.6% (n = 18); 3: 1.2% (n = 8); and 4: 0.1% (n = 1). Patients who did not receive celecoxib had a 14.3% (52/364) rate of HO following THA (odds ratio 4.53, P < .001) vs only 4.3% (14/324) in the celecoxib group (odds ratio 0.22, P < .001). Overall, 9 patients (1.3%) went on to develop significant HO (Booker 3 or greater): 8 (2.2%) in the control group and 1 (0.3%) in the celecoxib group (P < .001).ConclusionOur findings suggest a significant reduction in the formation of HO following DA THA when using postoperative analgesic celecoxib as part of a multimodal pain protocol. Future prospective randomized studies are needed to identify ideal dosage, duration, and formulation to reduce the risk of HO while optimizing multimodal pain management.