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Objective To evaluate the maturity and metabolic status of heterotopic ossification(HO)by single-photon emission computed tomography(SPECT)/CT fusion bone imaging.Methods The clinical and SPECT/CT fusion bone imaging data of 57 patients with HO confirmed by pathology or follow-up were analyzed retrospectively.HO was graded by CT,and the characteristics of radioactive concentration of HO were analyzed.Results Of 57 cases,single lesion in 52 cases,and multiple lesions in 5 cases,with a total of 63 lesions,mostly located in the hip joint(55.6%,35/63)and thigh(19.0%,12/63).There were 41 lesions in the middle stage and 22 lesions in the late stage.In the visual evaluation of SPECT/CT fusion bone imaging,the middle stage lesions were mostly clumps or flakes,with moderate or high radioactive concentration(75.6%,31/41),furthermore,the concentration range was larger than or equal to the total or limited range of CT ossification(21/41,50.1%),with high concentration mainly located in the mixed areas of ossification density.The concentration of the late stage lesions was mostly non-radioactive(72.7%,16/22).Conclusion SPECT/CT fusion bone imaging can show the range,degree and maturity of HO radioactive concentration,and can accurately locate the area with osteoblastic activity,which provides scientific basis for the selection of surgical timing.
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A 31-year-old woman infected with severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) at 33-weeks pregnant was subject to cesarean delivery due to a worsening respiratory condition. On the fourth day of illness, the patient was placed on a ventilator, with extracorporeal membrane oxygenation (ECMO) treatment initiated on the ninth day. Passive range of motion (ROM) training started on the day 33 of illness. She was weaned off ECMO on day 55 of illness and taken off of the ventilator on day 8. The tracheostomy tube was replaced with a speech cannula on day 87 of illness, at which time the patient began to complain of pain during passive ROM training. Plain X-ray photography and computed tomography (CT) showed ossification around the bilateral shoulder and hip joints, as well as on medial thighs, accompanied by an alkaline phosphatase (ALP) value of 942 U/L. She was subsequently diagnosed with heterotopic ossification, after which passive ROM training was changed to protective ROM training, in addition to treatment with indomethacin farnesyl and etidronate disodium. The patient was transferred to our hospital on day 122 of illness for the purpose of continuing rehabilitation. On day 155 of illness, ossification decreased on the medial thighs, according to CT. She was able to walk independently indoors and was discharged home on day 181 of illness. This case demonstrates the importance of checking the ALP levels and palpating the periarticular area in patients infected with SARS‑CoV‑2 before initiating passive ROM training, as well as being aware of any pain experienced during training. In the case of any abnormalities, assessing the ossification around the joints of extremities by imaging examination is a priority.
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BACKGROUND:Heterotopic ossification of skeletal muscle is a clinically serious complication.For heterotopic ossification of skeletal muscles,the cells involved in the process of heterotopic ossification remain unclear. OBJECTIVE:To investigate the involvement of myocytes,fascia cells,and endothelial cells in the process of heterotopic ossification in skeletal muscle and to observe the cell origin of heterotopic ossification in skeletal muscle induced by bone morphogenetic protein 4. METHODS:Both C2C12 cells and the myotubes formed by the C2C12 cells in the induction medium were cultured,and 500 ng/mL bone morphogenetic protein 4 was added to the medium respectively,and whether the C2C12 cells and myotubes continued to proliferate within 10 days under the treatment were observed under a microscope.Myogenic cells(L6,derived from rats)and fibroblast-derived cells(derived from human)were co-cultured.After treatment with 500 ng/mL bone morphogenetic protein 4 and 10 ng/mL transforming growth factor-β,osteogenic and chondrogenic differentiation potential within 21 days were observed using Safranine O staining and Alcian blue staining.Using transgenic animal FVB/N-TgN(TIE2-LacZ)182Sato mice,15 μL of adeno-associated virus-bone morphogenetic protein 4(5×1010 PFU/mL)were implanted in the thigh muscle space of genetic mice for 10 and 14 days.X-gal staining was used to observe the formation of new blood vessel endothelium in the differentiated bone. RESULTS AND CONCLUSION:(1)Bone morphogenetic protein 4 caused myotube breakdown and increased C2C12 cell proliferation.Compared with other groups,the pure fibroblast-derived cell group had a higher area of positive alcian blue and safarin O staining(P<0.05)and a lower area of alkaline phosphatase staining(P<0.05),while the pure L6 group had a bigger area of alkaline phosphatase staining(P<0.05)but a smaller area of positive alcian blue and safarin O staining(P<0.05).(2)Transplantation of adeno-associated virus-bone morphogenetic protein 4-adsorbed gelatin sponge into FVB/N-TgN(TIE2-LacZ)182Sato mice resulted in heterotopic ossification.(3)X-gal staining results demonstrated that there was no obvious staining in chondrocytes and differentiated bones and Tie2+ endothelial cells did not participate in the formation of the alienated bone.(4)These findings verify that fibroblasts are the primary source of osteoblasts during the adeno-associated virus-bone morphogenetic protein 4-induced ectopic endochondral ossification in skeletal muscle,but myogenic cells are the main source of osteoblasts.Tie2+ endothelial cells might not be the cell source for cartilage and bone.
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BACKGROUND:Heterotopic ossification is a dynamic growth process.Diverse heterotopic ossification subtypes have diverse etiologies or induction factors,but they exhibit a similar clinical process in the intermediate and later phases of the disease.Acquired heterotopic ossification produced by trauma and other circumstances has a high incidence. OBJECTIVE:To summarize the molecular biological mechanisms linked to the occurrence and progression of acquired heterotopic ossification in recent years. METHODS:The keywords"molecular biology,heterotopic ossification,mechanisms"were searched in CNKI,Wanfang,PubMed,Embase,Web of Science,and Google Scholar databases for articles published from January 2016 to August 2022.Supplementary searches were conducted based on the obtained articles.After the collected literature was screened,131 articles were finally included and summarized. RESULTS AND CONCLUSION:(1)The occurrence and development of acquired heterotopic ossification is a dynamic process with certain concealment,making diagnosis and treatment of the disease difficult.(2)By reviewing relevant literature,it was found that acquired heterotopic ossification involves signaling pathways such as bone morphogenetic protein,transforming growth factor-β,Hedgehog,Wnt,and mTOR,as well as core factors such as Runx-2,vascular endothelial growth factor,hypoxia-inducing factor,fibroblast growth factor,and Sox9.The core mechanism may be the interaction between different signaling pathways,affecting the body's osteoblast precursor cells,osteoblast microenvironment,and related cytokines,thereby affecting the body's bone metabolism and leading to the occurrence of acquired heterotopic ossification.(3)In the future,it is possible to take the heterotopic ossification-related single-cell osteogenic homeostasis as the research direction,take the osteoblast precursor cells-osteogenic microenvironment-signaling pathways and cytokines as the research elements,explore the characteristics of each element under different temporal and spatial conditions,compare the similarities and differences of the osteogenic homeostasis of different types and individuals,observe the regulatory mechanism of the molecular signaling network of heterotopic ossification from a holistic perspective.It is beneficial to the exploration of new methods for the future clinical prevention and treatment of heterotopic ossification.(4)Meanwhile,the treatment methods represented by traditional Chinese medicine and targeted therapy have become research hotspots in recent years.How to link traditional Chinese medicine with the osteogenic homeostasis in the body and combine it with targeted therapy is also one of the future research directions.(5)At present,the research on acquired heterotopic ossification is still limited to basic experimental research and the clinical prevention and treatment methods still have defects such as uncertain efficacy and obvious side effects.The safety and effectiveness of relevant targeted prevention and treatment drugs in clinical application still need to be verified.Future research should focus on clinical prevention and treatment based on basic experimental research combined with the mechanism of occurrence and development.
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A 59-year-old man who was diagnosed with hypertension and a large thoracoabdominal aortic aneurysm was referred to our hospital for surgical treatment. He underwent open surgery and thoracic endovascular aneurysm repair in three stages. He developed paraplegia after the third surgery. Despite acute postoperative treatment and rehabilitation, his lower extremity motor function and bladder and bowel dysfunction did not improve. He was transferred to a recovery hospital 67 days after the third surgery. However, he was readmitted to our hospital about four months later for management of a refractory decubitus ulcer and recurrent urinary tract infections. Computed tomography revealed hematoma and calcification around the femur. Based on the clinical course and imaging findings, we diagnosed neurogenic heterotopic ossification associated with postoperative paraplegia in this patient. He had flap reconstruction for the ulcer. Finally, he was discharged 79 days after readmission. To date, no study has reported neurogenic heterotopic ossification associated with postoperative aortic aneurysm paraplegia. The mechanism underlying this condition is similar to the widely accepted process associated with traumatic spinal cord injury, and conservative treatment comprising pressure ulcer treatment and antibiotics was continued. Although acute rehabilitation is important after highly invasive aortic aneurysm surgery, rehabilitation is limited by the risk of neurogenic heterotopic ossification in patients with postoperative paraplegia, and recovery and maintenance of activities of daily living are challenging. To our knowledge, early diagnosis and prompt treatment for these complications are important considering neurogenic heterotopic ossification.
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Fibrodysplasia ossificans progressiva(FOP) is a rare congenital disease characterized by progressive heterotopic ossification, causing severe immobility with multi-system involvement. The relatively low incidence rate and incomplete knowledge among clinicians of the disease often result in misuse of invasive procedures or surgical treatment, leading to the progression of heterotopic ossification. To promote the knowledge of FOP, this article presents a comprehensive review involving epidemiology, pathological mechanisms, clinical features, diagnosis, and management of the FOP.
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@#Objective To systematically summarize the animal models of acquired heterotopic ossification (AHO), and provide reliable modeling methods for the study of disease prevention and treatment programs.Methods Literatures about the animal models of AHO were researched from PubMed, Web of Science, CNKI and Wanfang Database till November, 2021. The important contents of the literatures were extracted, and the animal models of various types of AHO were evaluated and analyzed by literature induction.Results A total of 20 literatures related to animal experiments were included, which could be divided into two types: post-traumatic and neurogenic heterotopic ossification animal models, which were used to simulate the occurrence and development of AHO. Currently, seven different animal models were commonly used to study post-traumatic heterotopic ossification, such as muscle injury, achilles tenotomy, muscle injury combined with joint immobilization, hip injury, heterotopic implantation, blast injury and burn. The studies of neurogenic heterotopic ossification animal models mainly included spinal cord injury and traumatic brain injury. At present, the methods of achilles tenotomy and osteogenic factor implantation were commonly used in the laboratory, and with the advantages of reliability, feasibility and high success rate; however, they could not accurately explain the pathogenesis of heterotopic ossification under complicated clinical conditions. Therefore, the improvement of modeling methods based on explosion injury, burn, nerve injury and other conditions became the basis for clinical research of molecular biological mechanism, prevention and treatment of heterotopic ossification.Conclusion Current modeling methods have their own advantages and disadvantages, but none of them can completely replicate all the characteristics of human heterotopic ossification. Therefore, there is no unified standard in the selection of animal model in clinic. According to different etiology of the disease, the selection of appropriate animal models is crucial to study effective intervention for different types of AHO in the early stage.
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INTRODUCCION En los últimos años, la artroplastia de disco cervical (ADC) se ha utilizado ampliamente en pacientes como alternativa a la disectomía y fusión cervical anterior (DFCA). Sin embargo, se han informado osificación heterotópica (OH) y fusion espontánea después de ADCs, y el desarrollo de OH puede dificultar el mantenimiento de movimiento después de la artroplastia. MATERIALES Y METODOS El procedimiento ADC con prótesis Activ C y M6-C se realizó en 127 pacientes. El tiempo medio de seguimiento fue de 58.4 meses, con un rango de 51 a 66 meses. RESULTADOS Las osificaciones de grado 1 estuvieron presentes en 11 niveles (8,6%). Un total de 45 (35,4%) segmentos eran de OH de grado 2. Las OHs que produjeron restricciones del rango de movimiento estuvieron presentes en 13 (10,2%) casos. A los 5 años de seguimiento, sólo había 9 (7,0%) pacientes con osificación de grado 4 en el grupo de prótesis de disco artificial M6-C. En el análisis de la supervivencia tras la ocurrencia de OH, la mediana de los pacientes fue de 28,3 5,6 meses. El grupo de prótesis de disco artificial Activ C tuvo una supervivencia estadísticamente más larga (49,5 7,8 meses) que el grupo de disco M6-C. CONCLUSIONES En este estudio, el 61,4% de los pacientes desarrollaron OH en un período de seguimiento medio de 58,4 meses. En el análisis de la supervivencia tras la ocurrencia de OH, la mediana de los pacientes fue de 28.3 5.6 meses. El grupo de prótesis de disco artificial Activ C tuvo una supervivencia estadísticamente más larga (49.5 7.8 meses) que el grupo de disco M6-C.
INTRODUCTION In recent years, cervical disk arthroplasty (CDA) has become widely used in patients as a substitute to anterior cervical diskectomy and fusion (ACDF). However, heterotopic ossification (HO) and spontaneous fusion after CDA have been reported, and maintenance of motion following arthroplasty can be hindered by the development of HO. MATERIALS AND METHODS The CDA procedure with Activ C and M6-C prostheses was performed on 127 patients. The mean follow-up time was of 58.4 months, ranging from 51 to 66 months. RESULTS Grade-1 ossifications were present in 11 (8.6%) levels. A total of 45 (35.4%) segments showed grade-2 HO. Cases of HO that led to restrictions in the range of motion were present in 13 (10.2%) patients. Fives year postoperatively, there were only 9 (7.0%) patients with grade-4 ossifications in the M6-C artificial disk prosthesis group. In the survival analysis after HO occurrence, the median survival of the patients was of 28.3 5.6 months. The Activ C artificial disk prosthesis group had a statistically longer survival (49.5 7.8 months) than the M6-C disk group. CONCLUSION In the present study, 61.4% of the patients developed HO at a mean follow-up period of 58.4 months. In the survival analysis after HO occurrence, the median survival of the patients was of 28.3 5.6 months. The Activ C artificial disk prosthesis group had a statistically longer survival (49.5 7.8 months) than the M6-C disk group.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Cervical Vertebrae/surgery , Ossification, Heterotopic/epidemiology , Survival Analysis , Prevalence , Measures of Disease OccurrenceABSTRACT
RESUMEN Introducción: La osificación heterotópica (OH) es una complicación descrita en los pacientes con daño neurológico. Reporte de caso: Paciente que sufrió un politraumatismo y traumatismo encéfalo craneano (TEC), con fracturas y déficit neurológico secundario al TEC, quien presentó varias osificaciones heterotópicas durante su evolución, que comprometieron el logro de los objetivos funcionales. Presentó como principal manifestación tumefacción y limitación del rango articular (RA) para la extensión de cadera y rodilla izquierda, lo que mantenía el miembro inferior izquierdo (MI) flexionado, impidiendo la bipedestación y marcha. Fue diagnosticado como osteoma secundario a trauma neurológico y recibió un manejo médico estructurado, que incluyó la intervención quirúrgica: "resección del osteoma y tenotomía en isquiotiobiales", obteniendo mejora del rango articular, logrando la bipedestación y marcha con apoyo biomecánico. Discusión: La fisiopatología se cree que está relacionada a la liberación sistémica de sustancias estimulantes de células madre pluripotenciales, que se diferencian como osteoblastos. Conclusión: Un manejo integral multidisciplinario provee mejores resultados funcionales, lo que contribuye a la meta de la independencia.
ABSTRACT Introduction: Heterotopic ossification (OH) is a complication described in patients with neurological damage. Case report: Patient who suffered a multiple trauma and traumatic brain injury (TBI), with fractures and neurological deficit secondary to TBI, who presented several heterotopic ossifications (OH) during his evolution that compromised the achievement of functional objectives. The main manifestation was swelling and limitation of the articular range (RA) for the extension of the left hip and knee, which kept the lower left limb (MI) flexed, preventing standing and walking. He was diagnosed as osteoma secondary to neurological trauma and received structured medical management, which included surgical intervention: "resection of the osteoma and tenotomy in hamstrings", obtaining improvement of the joint range, chieving standing and walking with biomechanical support. Discussion: The pathophysiology is believed to be related to the systemic release of stimulating substances from pluripotent stem cells, which differentiate as osteoblasts. Conclusion: A multidisciplinary comprehensive management provides better functional results, which contributes to the goal of the independence.
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ABSTRACT Objective: This study was designed to evaluate the prevalence and grading of heterotopic ossification (HO) at five years, among patients after cervical disk arthroplasty (CDA). Methods: The CDA procedure with Activ C and M6-C prostheses was performed on 127 patients. The mean age of the cohort of patients was 38.4 years (range 18-49). The mean follow-up time was 58.4 months, ranging from 51 to 66 months. Results: Grade 1 ossifications were present in 11 (8.6 %) levels. A total of 45 (35.4 %) segments showed grade 2 HO. HO that led to restrictions in range of motion were present in 13 (10.2 %) cases. Five years after surgery, 9 (7.0 %) patients with grade 4 ossifications were found only in the M6-C artificial disk prosthesis group. In the analysis of patient survival following the occurrence of HO, all patients showed median survival of 28.3±5.6 months. The group that received the Activ C artificial disk prosthesis showed statistically longer survival (49.5±7.8 months) than the M6-C disk group. Conclusions: In our study 61.4% of patients exhibited HO after a mean follow-up of 58.4 months. In the analysis of patient survival after HO, all patients showed median survival of 28.3±5.6 months. The group that received the Activ C artificial disk prosthesis showed statistically longer survival (49.5±7.8 months) than the M6-C disk group. Level of evidence III; Cross-sectional Observational Study.
RESUMO Objetivo: Este estudo foi desenhado para avaliar a prevalência e o grau de ossificação heterotópica (HO) entre pacientes depois de cinco anos de artroplastia de disco cervical (CDA). Métodos: O procedimento de CDA com próteses Activ C e M6-C foi realizado em 127 pacientes. A média de idade da coorte de pacientes foi de 38,4 anos (variação de 18 a 49). O tempo médio de acompanhamento foi de 58,4 meses, variando de 51 a 66 meses. Resultados: Ossificações de grau 1 foram encontradas em 11 (8,6%) níveis. Um total de 45 (35,4%) segmentos apresentou HO de grau 2. As HO que levaram à restrição da amplitude de movimento foram verificadas em 13 (10,2%) casos. Cinco anos depois da cirurgia, 9 (7,0%) pacientes com ossificações de grau 4 foram vistas apenas no grupo de prótese do disco artificial M6-C. Na análise de sobrevida depois da ocorrência de HO, todos os pacientes tinham sobrevida mediana de 28,3 ± 5,6 meses. O grupo que recebeu a prótese de disco artificial Activ C tinha sobrevida estatisticamente maior (49,5 ± 7,8 meses) do que a do grupo com disco M6-C. Conclusões: Em nosso estudo, 61,4% dos pacientes apresentaram HO no acompanhamento médio de 58,4 meses. Na análise de sobrevida depois de ocorrência de HO, todos os pacientes tinham sobrevida mediana de 28,3 ± 5,6 meses. O grupo que recebeu a prótese de disco artificial Activ C teve sobrevida estatisticamente maior (49,5 ± 7,8 meses) do que o grupo de disco M6-C. Nível de evidência III; Estudo Observacional Transversal.
RESUMEN Objetivo: Este estudio fue diseñado para evaluar la prevalencia y el grado de osificación heterotópica (HO) entre pacientes después de cinco años de artroplastia de disco cervical (CDA). Métodos: Se realizó el procedimiento de CDA con prótesis Activ C y M6-C en 127 pacientes. La edad promedio de la cohorte de pacientes fue de 38,4 años (rango 18-49). El tiempo medio de seguimiento fue de 58,4 meses, con un rango de 51 a 66 meses. Resultados: Se encontraron osificaciones de grado 1 en 11 (8,6%) niveles. Un total de 45 (35,4%) segmentos presentaron HO de grado 2. Las HO que llevaron a restricciones en el rango de movimiento estuvieron presentes en 13 (10,2%) casos. Cinco años después de la cirugía, se observaron 9 (7,0%) pacientes con osificaciones de grado 4 sólo en el grupo de prótesis de disco artificial M6-C. En el análisis de sobrevida tras la ocurrencia de HO, todos los pacientes presentaron una media de sobrevida de 28,3±5,6 meses. El grupo que recibió la prótesis de disco artificial Activ C presentó una sobrevida estadísticamente más larga (49,5±7,8 meses) que el grupo del disco M6-C. Conclusiones: En nuestro estudio el 61,4% de los pacientes presentaron HO en el seguimiento medio de 58,4 meses. En el análisis de sobrevida tras la ocurrencia de HO, todos los pacientes presentaron mediana de sobrevida de 28,3±5,6 meses. El grupo de prótesis de disco artificial Activ C tuvo una sobrevida estadísticamente más larga (49,5±7,8 meses) que el grupo de disco M6-C. Nivel de evidencia III; Estudio observacional transversal.
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Humans , Adult , Middle AgedABSTRACT
Abstract: Introduction: Distal biceps tear can lead to loss in flexion and supination strength. Early repair in active patients is recommended. Postoperative rehabilitation varies according to surgeon experience and surgical technique used. The aim of this study is to present the results of a series of patients using a standardized home rehabilitation protocol after a distal biceps repair with double incision technique. Material and methods: This is a retrospective case study. We registered 21 patients with distal biceps tear, surgically treated using a double incision technique and transosseous suture fixation, followed by a home-based exercise program. Patients were evaluated using MEPS score, DASH questionnaire, and the subjective/objective scoring system of Andrews and Carson. Radiographic assessment was done for heterotopic bone formation. Results: Mean MEPS was 95 (range 70 to 100), DASH score 0.4 (range 0 to 4.2), and subjective and objective Andrews and Carson score was 99 (range 90 to 100). Two patients developed heterotopic ossifications. Range of motion was recovered in every patient. All patients went back to their previous surgical activities. Conclusions: Patients treated with double incision repair for distal biceps tear can undergo a home rehabilitation protocol, expecting normal range of motion and strength recover.
Resumen: Introducción: Las lesiones del bíceps distal pueden generar pérdida de fuerza de flexión y supinación. En pacientes activos, se recomienda la reparación temprana. La rehabilitación postoperatoria varía de acuerdo con la experiencia del cirujano y la técnica quirúrgica utilizada. El objetivo del estudio es presentar los resultados de una serie de pacientes utilizando un protocolo de rehabilitación estandarizado posterior a la reparación del bíceps distal mediante la técnica de doble abordaje. Material y métodos: Este es un estudio retrospectivo. Se registraron 21 pacientes con lesión del bíceps distal, que fueron tratados quirúrgicamente utilizando un doble abordaje y fijación transósea con suturas, seguido de un programa de ejercicios en el domicilio. Los pacientes fueron evaluados utilizando el score de MEPS, el cuestionario DASH y el puntaje subjetivo/objetivo de Andrews y Carson. Se realizaron radiografías para evaluar osificaciones heterotópicas. Resultados: La media del MEPS fue 95 (rango de 70 a 100), del DASH 0.4 (rango 0 a 4.2) y del score de Andrews y Carson fue 99 (rango 95 a 100). Dos pacientes desarrollaron calcificaciones heterotópicas. El rango de movilidad se recuperó en todos los pacientes. Todos volvieron a sus actividades previas a la cirugía. Conclusiones: Los pacientes que fueron tratados mediante un doble abordaje por lesiones del bíceps distal pueden realizar un protocolo de ejercicios en su domicilio, siendo esperable un rango de movilidad normal y recuperación de la fuerza muscular.
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Fibrodysplasia ossificans progressiva (FOP) is an exceptionally atypical genetic disorder characterized by heterotopic bone formation within skeletal muscles, ligaments, tendons, and other connective tissues that affects one in 2 million people. A 4-year-old girl with FOP was referred to our practice with complaints of pain and discomfort in both sides of the lower jaw. Clinical examination revealed deep multiple caries and buccal gingival abscess in relation to multiple teeth. Endodontic care and conservative dental procedures were planned and performed chairside after a detailed discussion with FOP medical and dental experts. Very brief dental appointments were conducted with breaks to prevent muscle fatigue. No usage of regional anesthesia or dental dam clamps was done. The patient and her parents were counseled for oral hygiene maintenance, and periodic topical fluoride treatments were performed during successive follow-up appointments. The child is followed for 34 months post-treatment. The dental treatment modifications implemented for the present case were enough to institute good oral health and to prevent the creation of heterotopic ossifications in the maxillofacial region.
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BACKGROUND: Heterotopic ossification is a common complication of acetabular fracture. Its pathogenesis is still not completely clear, and it is mainly caused by skeletal muscle trauma, hip surgery or nervous system injury. From the research in the past 10 years, the risk factors for ectopic ossification after acetabular fracture surgery are numerous, but its prevention and treatment are controversial. OBJECTIVE: To summarize the relevant literature on the diagnosis, prevention and treatment of ectopic ossification after acetabular fracture surgery in recent years and the risk factors that may affect the prognosis, so as to provide a basis for the clinical prevention and treatment of ectopic ossification after acetabular fracture surgery. METHODS: The databases of Wanfang Medical Network, CNKI and PubMed were searched using computer. The key words were “heteropic ossification; acetabular fractures surgery; NSAIDs; risk factors; radiotherapy; treatment” in Chinese and English. According to the inclusion and exclusion criteria, 67 related articles were finally included and summarized. RESULTS AND CONCLUSION: (1) Although the etiology of heterotopic ossification is not fully understood, it is generally accepted that the formation of heterotopic ossification is determined by both systemic factors and local tissue changes. The risk factors of heterotopic ossification are various, and some preventive measures should be taken for high-risk patients. (2) The prevention of heterotopic ossification after acetabular fracture surgery mainly includes drug, radiotherapy and combined prevention, among which drug prevention, especially non-steroidal anti-inflammatory drugs, is still the most economical and effective prevention method. (3) The treatment of heterotopic ossification is mainly ectopic bone resection and hip arthroplasty. The corresponding treatment methods based on the biomolecular mechanism are still in the stage of animal experimental research, but it points out the direction for the treatment of heterotopic ossification. (4) Among the existing treatment methods, surgery is recognized as the most effective treatment.
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objective: Bone morphogenetic proteins have the function of inducing and promoting bone growth and formation. However, there is controversy between the research results of the treatment of acute tibial fracture with bone morphogenetic proteins, which makes the effect of bone morphogenetic proteins unclear. Meta-analysis was used to systematically evaluate the efficacy and safety of bone morphogenetic proteins for the treatment of acute tibial fracture. METHODS: PubMed, Elsevier, Web of Science, Cochrane Library, CNKI and Wanfang databases were searched to retrieve the clinical controlled trials of bone morphogenetic proteins for acute tibial fracture published before February 2020. Quality evaluation, bias risk assessment and data extraction of the included literatures were performed. Meta-analysis of outcome indicators was performed using RevMan 5.1 software provided by Cochrane system. RESULTS: (1) Seven articles were enrolled for meta-analysis, including six randomized controlled trials and one cohort study. A total of 1 256 cases of acute tibial fracture were included, with 793 cases in bone morphogenetic protein group and 463 cases in control group. (2) Meta-analysis results showed that bone morphogenetic proteins could not significantly improve the healing rate (P=0.07), but reduce the secondary intervention rate [RR=0.64, 95%CI(0.49, 0.84), P=0.001]. The application of bone morphogenetic proteins had no significant effect on postoperative pain, infection, hardware failure, edema and swelling (P > 0.05). Bone morphogenetic proteins significantly increased the incidence of heterotopic ossification and soft tissue calcification [RR=2.89, 95%CI(1.40, 5.95), P=0.004]. As for patients with open tibial fractures, bone morphogenetic proteins significantly improved the healing rate [RR=1.16, 95%CI(1.04, 1.30), P=0.009]. CONCLUSION: On the basis of conventional treatment, the application of bone morphogenetic proteins significantly reduces the secondary intervention rate and is more suitable for the auxiliary treatment of complex open tibial fracture. In addition, the higher rate of heterotopic ossification and soft tissue calcification is related to bone morphogenetic protein.
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Heterotopic ossification (HO) is one of the complications of a cervical cord injury that results in limited range of motion, which can interfere with basic movements and activities of daily living. We encountered a case of a cervical cord injury patient with limited range of motion and mobility due to HO of the hip joint who experienced improvement in both as a result of early surgery and rehabilitation. A 17-year-old boy was diagnosed with a cervical cord injury due to an anterior fracture of the sixth cervical vertebrae following a fall into a pool. It was classified as bilateral C6BII according to the Zancolli's classification for cervical cord injury. The patient presented with limited range of motion in his left hip and was diagnosed with HO four months after the injury. Eight months after the injury, his hip range of motion deteriorated further；consequently, he required continuous transfer assistance. Therefore, surgical HO removal was performed during this period of convalescent rehabilitation. The patient underwent constant post-operative rehabilitation, and the range of motion in his left hip joint improved；thus, he became independent in transfer activities. A concomitant HO after a cervical cord injury can lead to functional impairment in convalescent rehabilitation. In addition, no practice guidelines have been developed that include recommendations on when to perform surgical procedures for HO. Treatment of HO with a combination of immediate surgery and aggressive rehabilitation can be expected to restore function and maximize activity and participation in patients with cervical cord injury with concomitant HO.
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Heterotopic ossification (HO) is one of the complications of a cervical cord injury that results in limited range of motion, which can interfere with basic movements and activities of daily living. We encountered a case of a cervical cord injury patient with limited range of motion and mobility due to HO of the hip joint who experienced improvement in both as a result of early surgery and rehabilitation. A 17-year-old boy was diagnosed with a cervical cord injury due to an anterior fracture of the sixth cervical vertebrae following a fall into a pool. It was classified as bilateral C6BII according to the Zancolli's classification for cervical cord injury. The patient presented with limited range of motion in his left hip and was diagnosed with HO four months after the injury. Eight months after the injury, his hip range of motion deteriorated further；consequently, he required continuous transfer assistance. Therefore, surgical HO removal was performed during this period of convalescent rehabilitation. The patient underwent constant post-operative rehabilitation, and the range of motion in his left hip joint improved；thus, he became independent in transfer activities. A concomitant HO after a cervical cord injury can lead to functional impairment in convalescent rehabilitation. In addition, no practice guidelines have been developed that include recommendations on when to perform surgical procedures for HO. Treatment of HO with a combination of immediate surgery and aggressive rehabilitation can be expected to restore function and maximize activity and participation in patients with cervical cord injury with concomitant HO.
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OBJECTIVE@#To investigate the clinical effect of anterior cervical Hybrid surgery in the treatment of cervical degenerative diseases (CDD) and observe the incidence of heterotopic ossification of disc replacement segment at 1 year after surgery.@*METHODS@#From January 2015 to April 2018, 35 patients who received anterior cervical hybrid surgery met the inclusion and exclusion criteria and the complete clinical follow up data were analyzed retrospectively. Complete imaging follow-up data were obtained from 24 patients. There were 15 males and 20 females, aged from 39 to 70(55.57±7.73) years old. The amount of bleeding was for 20 to 100 (40.29±18.39) ml, and the hospitalstay was for 4 to 28(11.03±4.63) days, and the follow-up time was(12.97±1.36) months. Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score (YT20), and Japanese Orthopaedic Association (JOA) score. The occurrence of heterotopic ossification after Hybrid surgery was evaluated by X-ray according to McAfee standard one year after operation. Patients with or without heterotopic ossificationwere divided into two groups and their clinical effects were compared.@*RESULTS@#At the final follow up, the mean YT20 score and JOA score were significantly higher than those before operation (P <0.05), and the average improvement rate of JOA was (70.66 ±0.44)%. One year after operation, the heterotopic ossification occurred in 10 of 24 segments, with incidence of 41.70%(10/24), including 29.20% in gradeⅠand 12.50% in gradeⅡ. The results of clinical efficacy comparison between patients with and without heterotopic ossification were as follows:there was no significant difference in JOA score before and after operation (@*CONCLUSION@#The short-term clinical effect of Hybrid surgery is satisfactory for cervical degenerative diseases, and the cause of heterotopic ossification still needs tobe further explored.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Cervical Vertebrae/surgery , Follow-Up Studies , Intervertebral Disc Degeneration/surgery , Range of Motion, Articular , Retrospective Studies , Total Disc Replacement , Treatment OutcomeABSTRACT
Heterotopic ossification (HO) is the formation of ectopic bone at non-physiological location, such as soft tissues around a joint.HO is a common complication seen after trauma and certain surgeries (e.g., total hip arthroplasty) involving specific regionssuch as hip. In neurogenic HO, ectopic bone develops in patients sustaining a spinal cord injury or traumatic brain injury(incidence 20–30%). Neurogenic HO characteristically involves major joints with hip joint being the most common, followed byelbow, shoulder, and knee joint. No reported case of HO in wrists, ankles, legs, and feet has been documented, making thesehighly rare locations. The ectopic bone may be asymptomatic or can cause significant functional impairment of the involvedjoint presenting as erythema, warmth, swelling with loss of range of motion; however, this case is a rare presentation involvingankle joint with no signs of inflammation. Plain X-rays and CT scans diagnose the new bone. Management involves primaryprophylaxis with NSAIDs, bisphosphonates (not commonly used), and radiation therapy. Surgical excision is the definitivetreatment. Neurogenic HO cases should undergo comprehensive and extended follow-up with attention to even rarely involvedsites such as ankle, wrists, hands, and feet.
ABSTRACT
Abstract Objective To evaluate 15 patients with ruptured distal biceps tendon submitted to reinsertion via a single, anterior and transverse approach using two anchors. They were submitted to a rehabilitation protocol and, within six months, to an evaluation of the range of motion and strength intensity during flexion and supination of the operated elbow. Methods The data were collected prospectively, and were analyzed through the Mann-Whitney test and the mixed-model test to evaluate the force between the operated and non-operated elbows. Results A total of 80% of the patients were men, 60% were injured on the dominant side, 46% were manual workers, and 73% led sedentary lifestyles. The use of anabolic steroids was reported by two patients. After the treatment, the patients recovered supination strength by 98% and flexion by 94%. According to the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, 73% of the patients presented the score expected of a normal population. Conclusion The single, anterior and transverse approach associated with tendon repair using anchors was esthetically satisfactory, with good strength recovery during flexion and supination, and no occurrence of heterotopic ossification.
Resumo Objetivo Avaliar 15 pacientes com ruptura do tendão distal do bíceps submetidos a reinserção por meio de via única, anterior e transversa no antebraço com o uso de duas âncoras. Os pacientes foram submetidos a um protocolo de reabilitação e, ao término de seis meses, efetuou-se avaliação do arco de movimento do cotovelo operado e da intensidade de força durante a flexão e a supinação. Métodos Os dados foram coletados de maneira prospectiva, e foram analisados pelo teste de Mann-Whitney e pelo teste de modelos mistos para avaliar a força entre os cotovelos operado e não operado. Resultados Um total de 80% dos pacientes eram homens, 60% sofreram lesão do lado dominante, 46% eram trabalhadores braçais, e 73% não praticavam atividades físicas regularmente. O uso de anabolizante foi relatado por dois pacientes. Após o tratamento, os pacientes recuperaram 98% da força de supinação, e 94% da de flexão. De acordo com questionário de Disfunções do Braço, Ombro e Mão (Disabilities of the Arm, Shoulder and Hand, DASH), 73% dos pacientes encontram-se dentro do esperado para uma população normal. Conclusão A via única, anterior e transversa associada ao reparo do tendão com o uso de âncoras apresentou-se esteticamente satisfatória, com boa recuperação da força durante a flexão e a supinação, não ocorrendo casos de ossificação heterotópica ou complicações graves.
Subject(s)
Humans , Male , Female , Rehabilitation , Rupture , Surveys and Questionnaires , Range of Motion, Articular , Elbow , Forearm , Life Style , Occupational Groups , Hamstring MusclesABSTRACT
RESUMEN La fibrodisplasia osificante progresiva (FOP) es una enfermedad del tejido conectivo de etiología desconocida, de herencia autosómica dominante que se caracteriza por calcificaciones progresivas de las fascias, aponeurosis, ligamentos, tendones y tejido conectivo intersticial del músculo esquelético. Su prevalencia es de 1:2.000.000. Presenta desde el nacimiento morfología anormal del primer metatarsiano. Las osificaciones heterotópicas por lo común se hacen evidentes recién alrededor de los 5 años, posteriores a un trauma en los tejidos blandos. El compromiso funcional es progresivo y altamente incapacitante. Presentamos el caso de un niño de 6 años quien desde el año de edad inició las lesiones en las zonas de traumatismos, al comienzo acompañadas de dolor y signos inflamatorios que luego se petrificaban. Presentaba hállux valgus corto bilateral y se pudo corroborar la presencia de la misma malformación en un tío materno.
ABSTRACT Progressive ossifying fibrodysplasia (POF) is a connective tissue disease of unknown etiology, of autosomal dominant inheritance characterized by progressive calcifications of fasciae, aponeurosis, ligaments, tendons, and interstitial connective tissue of skeletal muscle. Its prevalence is 1: 2,000,000. Abnormal morphology of the first metatarsal is present at birth. Heterotopic ossifications usually become apparent only about 5 years after a soft tissue trauma. The functional compromise is progressive and highly disabling. We present the case of a 6-year-old boy who, beginning at one year of age, developed the lesiones in injured areas, with subsequent petrification, initially accompanied by pain and inflammatory signs. He presented bilateral short hallux valgus and we corroborated the presence of the same malformation in a maternal uncle.