全髋关节置换后异位骨化的成因及影像诊断
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摘要
背景:异位骨化为全髋关节置换后常见的并发症之一,多无明显临床症状,但较严重的异位骨化可引起患者术后疼痛及关节活动度减低。异位骨化的发病机制尚不完全清楚,有多种因素可以增加异位骨化的发生率。由于目前临床上尚无有效的非手术方法治疗成熟的异位骨化,故对于异位骨化的早期诊断尤为重要。目的:总结目前全髋关节置换后异位骨化的相关研究进展。方法:第一作者以"total hip arthroplasty,heterotopic ossification"为英文检索词,以"全髋关节置换术,并发症,异位骨化"为中文检索词,通过PubMed、Springerlink英文数据库及CNKI中国期刊全文数据库检索2008至2018年间的相关文献。初检得到相关英文文献278篇,中文文献97篇,筛选后纳入53篇进行分析总结。结果与讨论:①目前对于异位骨化的发病机制尚不完全清楚,与全身及局部因素均有关;②异位骨化的危险因素分为可变因素及不可变因素,通常认为年龄、男性、强直性脊柱炎、既往髋部手术史、髋关节强直等因素可增加异位骨化的发生率;③异位骨化的确诊主要依靠影像学检查,不同时期异位骨化的影像学表现有所不同,且不同的影像学检查方法对于异位骨化检测的敏感性和特异度也有区别;④异位骨化的危险因素仍存在很多不同结论,且没有公认的最佳影像学检查方法,但众多研究及分析结果可为临床预防及诊断全髋关节置换后异位骨化提供相应依据。
BACKGROUND: Heterotopic ossification is a common complication after total hip arthroplasty, and there are no obvious clinical symptoms,but more severe heterotopic ossification can cause postoperative pain and joint mobility. The pathogenesis of heterotopic ossification is not fully understood, and there are many factors that can increase the incidence of heterotopic ossification. Because there is no effective non-surgical treatment of mature heterotopic ossification in clinical practice, it is especially important for the early diagnosis of heterotopic ossification.OBJECTIVE: To summarize the current research and progress of heterotopic ossification after total hip arthroplasty.METHODS: The first author searched PubMed, Springerlink and CNKI databases for the articles between 2008 and 2018. The keywords were"total hip arthroplasty, heterotopic ossification" in English and Chinese, respectively. Totally 278 English articles and 97 Chinese articles were retrieved, and 53 eligible articles were included for analysis and summary.RESULTS AND CONCLUSION:(1) At present, the pathogenesis of heterotopic ossification is not fully understood, and is related to systemic and local factors.(2) The risk factors for heterotopic ossification are divided into variable factors and invariable factors, and age, man, ankylosing spondylitis, history of hip surgery, hip ankylosis and other factors can increase the incidence of heterotopic ossification.(3) The diagnosis of heterotopic ossification mainly depends on imaging examination. The imaging findings of heterotopic ossification in different periods are different,and the sensitivity and specificity of different imaging examination methods for heterotopic ossification are also different.(4) There are various conclusions about the risk factors of heterotopic ossification, and there is no recognized best imaging examination method, but many research and analysis results can provide a basis for clinical prevention and diagnosis of heterotopic ossification after total hip arthroplasty.
BACKGROUND: Heterotopic ossification is a common complication after total hip arthroplasty, and there are no obvious clinical symptoms,but more severe heterotopic ossification can cause postoperative pain and joint mobility. The pathogenesis of heterotopic ossification is not fully understood, and there are many factors that can increase the incidence of heterotopic ossification. Because there is no effective non-surgical treatment of mature heterotopic ossification in clinical practice, it is especially important for the early diagnosis of heterotopic ossification.OBJECTIVE: To summarize the current research and progress of heterotopic ossification after total hip arthroplasty.METHODS: The first author searched PubMed, Springerlink and CNKI databases for the articles between 2008 and 2018. The keywords were"total hip arthroplasty, heterotopic ossification" in English and Chinese, respectively. Totally 278 English articles and 97 Chinese articles were retrieved, and 53 eligible articles were included for analysis and summary.RESULTS AND CONCLUSION:(1) At present, the pathogenesis of heterotopic ossification is not fully understood, and is related to systemic and local factors.(2) The risk factors for heterotopic ossification are divided into variable factors and invariable factors, and age, man, ankylosing spondylitis, history of hip surgery, hip ankylosis and other factors can increase the incidence of heterotopic ossification.(3) The diagnosis of heterotopic ossification mainly depends on imaging examination. The imaging findings of heterotopic ossification in different periods are different,and the sensitivity and specificity of different imaging examination methods for heterotopic ossification are also different.(4) There are various conclusions about the risk factors of heterotopic ossification, and there is no recognized best imaging examination method, but many research and analysis results can provide a basis for clinical prevention and diagnosis of heterotopic ossification after total hip arthroplasty.
引文
[1]Zeckey C,Hildebrand F,Frink M,et al.Heterotopic ossifications following implant surgery--epidemiology,therapeutical approaches and current concepts.Semin Immunopathol.2011;33(3):273-286.
[2]Brooker AF,Bowerman JW,Robinson RA,et al.Ectopic ossification following total hip replacement.Incidence and a method of classification.J Bone Joint Surg Am.1973;55(8):1629-1632.
[3]Neal B.Effects of heterotopic bone formation on outcome after hip arthroplasty.ANZ J Surg.2003;73:422-426.
[4]Shehab D,Elgazzar AH,Collier BD.Heterotopic ossification.J Nucl Med.2002;43:346-353.
[5]Shore EM,Kaplan FS.Inherited human diseases of heterotopic bone formation.Nat Rev Rheumatol.2010;6:518-527.
[6]陈松,高悠水,周祖彬,等.获得性异位骨化发病机制研究进展[J].国际骨科学杂志,2014,35(1):21-23.
[7]Shore EM,Kaplan FS.Fibroregulation of mesenchymal progenitor cells by BMP-4 after traumatic muscle injury.JOrthop Trauma.2012;26:693-698.
[8]Davis TA,O'Brien FP,Anam K,et al.Heterotopic ossification in complex orthopaedic combat wounds:quantification and characterization of osteogenic precursor cell activity in traumatized muscle.J Bone Joint Surg Am.2011;93:1122-1131.
[9]Ranganathan K,Loder S,Agarwal S,et al.Heterotopic ossification:basic-science principles and clinical correlates.J Bone Joint Surg Am.2015;97:1101-1111.
[10]Ramirez DM,Ramirez MR,Reginato AM,et al.Molecular and cellular mechanisms of heterotopic ossification.Histol.Histopathol.2014;29:1281-1285.
[11]Yu PB,Deng DY,Lai CS,et al.BMP type I receptor inhibition reduces heterotopic[corrected]ossification.Nat Med.2008;14(12):1363-1369.
[12]Medici D,Olsen BR.The role of endothelial-mesenchymal transition in heterotopic ossification.J Bone Miner Res.2012;27:1619-1622.
[13]Coons D,Godleski M.Range of motion exercises in the setting of burn-associated heterotopic ossification at the elbow:case series and discussion.Burns.2013;39:e34-38.
[14]DeLee J,Ferrari A,Charnley J,et al.Ectopic bone formation following low friction arthroplasty of the hip.Clin Orthop Relat Res.1976;(121):53-59.
[15]Kjaersgaard-Andersen P,Sletg?rd J,Gjerl?ff C,et al.Heterotopic bone formation after noncemented total hip arthroplasty.Location of ectopic bone and the influence of postoperative antiinflammatory treatment.Clin Orthop Relat Res.1990;(252):156-162.
[16]Della Valle AG,Ruzo PS,Pavone V,et al.Heterotopic ossification after total hip arthroplasty:a critical analysis of the Brooker classification and proposal of a simplified rating system.J Arthroplasty.2002;17:870-875.
[17]Hug KT,Alton TB,Gee AO.Classifications in brief:Brooker classification of heterotopic ossification after total hip arthroplasty.Clin Orthop Relat Res.2015;473:2154-2157.
[18]Ekelund A,Brosj?O,Nilsson O S,Experimental induction of heterotopic bone.Clin Orthop Relat Res.1991;(263):102-112.
[19]Kantak AP,Shah NN.Extensive surgical wound lavage reduces the incidence and severity of heterotopic ossification in primary total hip replacement:a study of 175hip replacements.Hip Pelvis.2017;29(4):234-239.
[20]刘勇,霍少川,唐宏宇,等.强直性脊柱炎患者全髋关节置换后异位骨化的危险因素[J].中国组织工程研究,2017,21(11):1641-1646.
[21]Thilak J,Panakkal JJ,Kim TY,et al.Risk Factors of Heterotopic Ossification Following Total Hip Arthroplasty in Patients With Ankylosing Spondylitis.J Arthroplasty.2015;30:2304-2307.
[22]Davis G,Patel RP,Tan TL,et al.Ethnic differences in heterotopic ossification following total hip arthroplasty.Bone Joint J.2016;98-B(6):761-766.
[23]Fahrer H,Koch P,Ballmer P,et al.Ectopic ossification following total hip arthroplasty:is diffuse idiopathic skeletal hyperostosis a risk factor?Br J Rheumatol.1988;27:187-190.
[24]Ferguson DJ,Itonaga I,Maki M,et al.Heterotopic bone formation following hip arthroplasty in Paget's disease.Bone.2004;34(6):1078-1083.
[25]Pavlou G,Salhab M,Murugesan L,et al.Risk factors for heterotopic ossification in primary total hip arthroplasty.Hip Int.2012;22:50-55.
[26]Aljurayyan A,Tanzer D,Tanzer M.Acute revision hip arthroplasty:a previously unrecognized risk factor for heterotopic ossification.Eur J Orthop Surg Traumatol.2016;26(2):1-6.
[27]Edwards DS,Barbur SA,Bull AM,et al.Posterior mini-incision total hip arthroplasty controls the extent of post-operative formation of heterotopic ossification.Eur JOrthop Surg Traumatol.2015;25(6):1051-1055.
[28]Zhu Y,Zhang F,Chen W,et al.Incidence and risk factors for heterotopic ossification after total hip arthroplasty:a meta-analysis.Arch Orthop Trauma Surg.2015;135(9):1307-1314.
[29]Kocic M,Lazovic M,Mitkovic M,et al Clinical significance of the heterotopic ossification after total hip arthroplasty.Orthopedics.2010;33(1):16.
[30]Bal BS,Lowe JA,Gietler A,et al.Heterotopic ossification after 2-incision total hip arthroplasty.J Arthroplasty.2010;25:538-540.
[31]Eggli S,Woo A.Risk factors for heterotopic ossification in total hip arthroplasty.Arch Orthop Trauma Surg.2001;121:531-535.
[32]吴锋锋,吴立东.全髋关节置换术后异位骨化及其研究进展[J].中华骨科杂志,2006,26(8):558-561.
[33]Kocic M,Lazovic M,Mitkovic M,et al.Clinical significance of the heterotopic ossification after total hip arthroplasty.Orthopedics.2010;33(1):16.
[34]Grzegorzewski A,Koz?owski P,Synder M,et al.Heterotopic ossification as a complication of total hip replacement.Chir Narzadow Ruchu Ortop Pol.2000;65:255-260.
[35]Eggli S,Rodriguez J,Ganz R.Heterotopic ossification in total hip arthroplasty:the significance for clinical outcome.Acta Orthop Belg.2000;66(2):174-180.
[36]Bressler EL,Marn CS,Gore RM,et al.Evaluation of ectopic bone by CT.AJR Am J Roentgenol.1987;148:931-935.
[37]鞠金勇,喻都,王永建,等.异位骨化影像学早期诊断研究进展[J].国际骨科学杂志,2016,37(5):282-285.
[38]Foley KL,Hebela N,Keenan MA,et al.Histopathology of periarticular non-hereditary heterotopic ossification.Bone.2018;109:65-70.
[39]Rama KR,Vendittoli PA,Ganapathi M,et al.Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty:a randomized study.J Arthroplasty.2009;24(2):256-262.
[40]Metzner G,Lindner B,Neumann D,et al.Incidence of anterior intertrochanteric ossifications after total hip arthroplasty--a retrospective long-term follow-up study.ZOrthop Unfall.2010;148(2):174-179.
[41]Lee YH,Park KK,Song HT,et al.Metal artefact reduction in gemstone spectral imaging dual-energy CT with and without metal artefact reduction software.Eur Radiol.2012;22(6):1331-1340.
[42]Zagarella A,Impellizzeri E,Maiolino R,et al.Pelvic heterotopic ossification:when CT comes to the aid of MRimaging.Insights Imaging.2013;4(5):595-603.
[43]Fritz J,Lurie B,Miller TT.Imaging of hip arthroplasty.Semin Musculoskelet Radiol.2013;17:316-327.
[44]Hayter CL,Koff MF,Potter HG.Magnetic resonance imaging of the postoperative hip.J Magn Reson Imaging.2012;35(5):1013-1025.
[45]Khodarahmi I,Fritz J.Advanced MR imaging after total hip arthroplasty:the clinical impact.Semin Musculoskelet Radiol.2017;21(5):616-629.
[46]De Smet AA,Norris MA,Fisher DR.Magnetic resonance imaging of myositis ossificans:analysis of seven cases.Skeletal Radiol.1992;21(8):503-507.
[47]Wang Q,Zhang P,Li P,et al.Ultrasonography monitoring of trauma-induced heterotopic ossification:guidance for rehabilitation procedures.Front Neurol.2018;9:771.
[48]Van den Wyngaert T,Paycha F,Strobel K,et al.SPECT/CTin postoperative painful hip arthroplasty.Semin Nucl Med.2018;48:425-438.
[49]Dobrindt O,Amthauer H,Krueger A,et al.Hybrid SPECT/CT for the assessment of a painful hip after uncemented total hip arthroplasty.BMC Med Imaging.2015;15:18.
[50]Vasileiadis GI,Sioutis IC,Mavrogenis AF,et al.COX-2inhibitors for the prevention of heterotopic ossification after THA.Orthopedics.2011;34(6):467.
[51]Joice M,Vasileiadis GI,Amanatullah DF.Non-steroidal anti-inflammatory drugs for heterotopic ossification prophylaxis after total hip arthroplasty.Bone Joint J.2018;100-B(7):915-922.
[52]Rumi MN,Deol GS,Bergandi JA,et al.Optimal timing of preoperative radiation for prophylaxis against heterotopic ossification.A rabbit hip model.J Bone Joint Surg Am.2005;87(2):366-373.
[53]Morcos M,Smith K,Tanzer M.The effect of late radiotherapy on the progression of heterotopic ossification following total hip arthroplasty.Eur J Orthop Surg Traumatol.2018;28(6):1125-1131.
[2]Brooker AF,Bowerman JW,Robinson RA,et al.Ectopic ossification following total hip replacement.Incidence and a method of classification.J Bone Joint Surg Am.1973;55(8):1629-1632.
[3]Neal B.Effects of heterotopic bone formation on outcome after hip arthroplasty.ANZ J Surg.2003;73:422-426.
[4]Shehab D,Elgazzar AH,Collier BD.Heterotopic ossification.J Nucl Med.2002;43:346-353.
[5]Shore EM,Kaplan FS.Inherited human diseases of heterotopic bone formation.Nat Rev Rheumatol.2010;6:518-527.
[6]陈松,高悠水,周祖彬,等.获得性异位骨化发病机制研究进展[J].国际骨科学杂志,2014,35(1):21-23.
[7]Shore EM,Kaplan FS.Fibroregulation of mesenchymal progenitor cells by BMP-4 after traumatic muscle injury.JOrthop Trauma.2012;26:693-698.
[8]Davis TA,O'Brien FP,Anam K,et al.Heterotopic ossification in complex orthopaedic combat wounds:quantification and characterization of osteogenic precursor cell activity in traumatized muscle.J Bone Joint Surg Am.2011;93:1122-1131.
[9]Ranganathan K,Loder S,Agarwal S,et al.Heterotopic ossification:basic-science principles and clinical correlates.J Bone Joint Surg Am.2015;97:1101-1111.
[10]Ramirez DM,Ramirez MR,Reginato AM,et al.Molecular and cellular mechanisms of heterotopic ossification.Histol.Histopathol.2014;29:1281-1285.
[11]Yu PB,Deng DY,Lai CS,et al.BMP type I receptor inhibition reduces heterotopic[corrected]ossification.Nat Med.2008;14(12):1363-1369.
[12]Medici D,Olsen BR.The role of endothelial-mesenchymal transition in heterotopic ossification.J Bone Miner Res.2012;27:1619-1622.
[13]Coons D,Godleski M.Range of motion exercises in the setting of burn-associated heterotopic ossification at the elbow:case series and discussion.Burns.2013;39:e34-38.
[14]DeLee J,Ferrari A,Charnley J,et al.Ectopic bone formation following low friction arthroplasty of the hip.Clin Orthop Relat Res.1976;(121):53-59.
[15]Kjaersgaard-Andersen P,Sletg?rd J,Gjerl?ff C,et al.Heterotopic bone formation after noncemented total hip arthroplasty.Location of ectopic bone and the influence of postoperative antiinflammatory treatment.Clin Orthop Relat Res.1990;(252):156-162.
[16]Della Valle AG,Ruzo PS,Pavone V,et al.Heterotopic ossification after total hip arthroplasty:a critical analysis of the Brooker classification and proposal of a simplified rating system.J Arthroplasty.2002;17:870-875.
[17]Hug KT,Alton TB,Gee AO.Classifications in brief:Brooker classification of heterotopic ossification after total hip arthroplasty.Clin Orthop Relat Res.2015;473:2154-2157.
[18]Ekelund A,Brosj?O,Nilsson O S,Experimental induction of heterotopic bone.Clin Orthop Relat Res.1991;(263):102-112.
[19]Kantak AP,Shah NN.Extensive surgical wound lavage reduces the incidence and severity of heterotopic ossification in primary total hip replacement:a study of 175hip replacements.Hip Pelvis.2017;29(4):234-239.
[20]刘勇,霍少川,唐宏宇,等.强直性脊柱炎患者全髋关节置换后异位骨化的危险因素[J].中国组织工程研究,2017,21(11):1641-1646.
[21]Thilak J,Panakkal JJ,Kim TY,et al.Risk Factors of Heterotopic Ossification Following Total Hip Arthroplasty in Patients With Ankylosing Spondylitis.J Arthroplasty.2015;30:2304-2307.
[22]Davis G,Patel RP,Tan TL,et al.Ethnic differences in heterotopic ossification following total hip arthroplasty.Bone Joint J.2016;98-B(6):761-766.
[23]Fahrer H,Koch P,Ballmer P,et al.Ectopic ossification following total hip arthroplasty:is diffuse idiopathic skeletal hyperostosis a risk factor?Br J Rheumatol.1988;27:187-190.
[24]Ferguson DJ,Itonaga I,Maki M,et al.Heterotopic bone formation following hip arthroplasty in Paget's disease.Bone.2004;34(6):1078-1083.
[25]Pavlou G,Salhab M,Murugesan L,et al.Risk factors for heterotopic ossification in primary total hip arthroplasty.Hip Int.2012;22:50-55.
[26]Aljurayyan A,Tanzer D,Tanzer M.Acute revision hip arthroplasty:a previously unrecognized risk factor for heterotopic ossification.Eur J Orthop Surg Traumatol.2016;26(2):1-6.
[27]Edwards DS,Barbur SA,Bull AM,et al.Posterior mini-incision total hip arthroplasty controls the extent of post-operative formation of heterotopic ossification.Eur JOrthop Surg Traumatol.2015;25(6):1051-1055.
[28]Zhu Y,Zhang F,Chen W,et al.Incidence and risk factors for heterotopic ossification after total hip arthroplasty:a meta-analysis.Arch Orthop Trauma Surg.2015;135(9):1307-1314.
[29]Kocic M,Lazovic M,Mitkovic M,et al Clinical significance of the heterotopic ossification after total hip arthroplasty.Orthopedics.2010;33(1):16.
[30]Bal BS,Lowe JA,Gietler A,et al.Heterotopic ossification after 2-incision total hip arthroplasty.J Arthroplasty.2010;25:538-540.
[31]Eggli S,Woo A.Risk factors for heterotopic ossification in total hip arthroplasty.Arch Orthop Trauma Surg.2001;121:531-535.
[32]吴锋锋,吴立东.全髋关节置换术后异位骨化及其研究进展[J].中华骨科杂志,2006,26(8):558-561.
[33]Kocic M,Lazovic M,Mitkovic M,et al.Clinical significance of the heterotopic ossification after total hip arthroplasty.Orthopedics.2010;33(1):16.
[34]Grzegorzewski A,Koz?owski P,Synder M,et al.Heterotopic ossification as a complication of total hip replacement.Chir Narzadow Ruchu Ortop Pol.2000;65:255-260.
[35]Eggli S,Rodriguez J,Ganz R.Heterotopic ossification in total hip arthroplasty:the significance for clinical outcome.Acta Orthop Belg.2000;66(2):174-180.
[36]Bressler EL,Marn CS,Gore RM,et al.Evaluation of ectopic bone by CT.AJR Am J Roentgenol.1987;148:931-935.
[37]鞠金勇,喻都,王永建,等.异位骨化影像学早期诊断研究进展[J].国际骨科学杂志,2016,37(5):282-285.
[38]Foley KL,Hebela N,Keenan MA,et al.Histopathology of periarticular non-hereditary heterotopic ossification.Bone.2018;109:65-70.
[39]Rama KR,Vendittoli PA,Ganapathi M,et al.Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty:a randomized study.J Arthroplasty.2009;24(2):256-262.
[40]Metzner G,Lindner B,Neumann D,et al.Incidence of anterior intertrochanteric ossifications after total hip arthroplasty--a retrospective long-term follow-up study.ZOrthop Unfall.2010;148(2):174-179.
[41]Lee YH,Park KK,Song HT,et al.Metal artefact reduction in gemstone spectral imaging dual-energy CT with and without metal artefact reduction software.Eur Radiol.2012;22(6):1331-1340.
[42]Zagarella A,Impellizzeri E,Maiolino R,et al.Pelvic heterotopic ossification:when CT comes to the aid of MRimaging.Insights Imaging.2013;4(5):595-603.
[43]Fritz J,Lurie B,Miller TT.Imaging of hip arthroplasty.Semin Musculoskelet Radiol.2013;17:316-327.
[44]Hayter CL,Koff MF,Potter HG.Magnetic resonance imaging of the postoperative hip.J Magn Reson Imaging.2012;35(5):1013-1025.
[45]Khodarahmi I,Fritz J.Advanced MR imaging after total hip arthroplasty:the clinical impact.Semin Musculoskelet Radiol.2017;21(5):616-629.
[46]De Smet AA,Norris MA,Fisher DR.Magnetic resonance imaging of myositis ossificans:analysis of seven cases.Skeletal Radiol.1992;21(8):503-507.
[47]Wang Q,Zhang P,Li P,et al.Ultrasonography monitoring of trauma-induced heterotopic ossification:guidance for rehabilitation procedures.Front Neurol.2018;9:771.
[48]Van den Wyngaert T,Paycha F,Strobel K,et al.SPECT/CTin postoperative painful hip arthroplasty.Semin Nucl Med.2018;48:425-438.
[49]Dobrindt O,Amthauer H,Krueger A,et al.Hybrid SPECT/CT for the assessment of a painful hip after uncemented total hip arthroplasty.BMC Med Imaging.2015;15:18.
[50]Vasileiadis GI,Sioutis IC,Mavrogenis AF,et al.COX-2inhibitors for the prevention of heterotopic ossification after THA.Orthopedics.2011;34(6):467.
[51]Joice M,Vasileiadis GI,Amanatullah DF.Non-steroidal anti-inflammatory drugs for heterotopic ossification prophylaxis after total hip arthroplasty.Bone Joint J.2018;100-B(7):915-922.
[52]Rumi MN,Deol GS,Bergandi JA,et al.Optimal timing of preoperative radiation for prophylaxis against heterotopic ossification.A rabbit hip model.J Bone Joint Surg Am.2005;87(2):366-373.
[53]Morcos M,Smith K,Tanzer M.The effect of late radiotherapy on the progression of heterotopic ossification following total hip arthroplasty.Eur J Orthop Surg Traumatol.2018;28(6):1125-1131.