低度异位骨化会影响多发韧带重建的临床疗效吗?

Does Low-grade Heterotopic Ossification After Multiple Ligament Reconstruction Affect the Clinical Outcome?

目的：探讨膝关节多发韧带损伤术后低度异位骨化（HO）的发生率及其临床表现等。方法：选取2006年1月至2009年6月连续收住的72例多发韧带损伤患者,回顾性分析了患者的基本资料、病史、致伤原因、诊断和手术方法。记录异位骨化的发生部位,使用象限分度法将异位骨化分为5度,并将患者分为低度骨化组、高度骨化组和非骨化组进行对照研究。结果：共有57例患者（79.2%）获得随访,男36例,女19例,右侧30例,左侧27例,平均年龄29.3岁（17~44岁）,平均随访28.4个月（12~51个月）。21例患者发生异位骨化（36.8%）,其中低度异位骨化16例,占骨化患者的76.2%。低度骨化组和非骨化组之间的性别、年龄、受伤到手术时间、致伤原因、诊断、PCL手术技术、VAS疼痛评分、Lysholm评分和膝关节屈膝活动度差异均无统计学意义（P〉0.05）。低度骨化组和非骨化组损伤严重程度评分差异有统计学意义（P〈0.05）。而高度骨化组较以上两组的屈膝活动度、VAS疼痛评分和Lysholm评分有显著差异（P〈0.05）。结论：HO是膝关节多发韧带损伤的较常见并发症,发生率为36.8%,且膝关节多发韧带损伤术后多为低度HO,占HO患者的76.2%。低度HO患者疼痛评分、Lysholm评分和屈膝活动度与非HO患者无显著差异,即低度HO对膝关节功能无显著影响。

Objective The purpose of this study was to determine the incidence of low-grade heterotopic ossification（HO）and clinical outcome after repairing of multiple ligament injury of knee.Methods In this study,retrospective analysis of 72 consecutive patients with multiple ligament injury of knee in our department from January 2006 to June 2009 was conducted,including general data,history,mechanism of injury,diagnose,VAS score,Lysholm score and operation procedure.Radiographs of the patients were reviewed and the incidence and location of HO were documented.Additionally,the degree of HO were classified with a quadrant scale from 0 to 4.The patients were divided into：none HO group,low-grade HO group and high-grade HO group.Results 57 of 72 patients（36 men and 19 women,aged17~44 years）（79.2%）were followed up for an average of 28.4 months（12-51 months）.21 of 57 patients（36.8%）developed HO,including 16 low-grade HO（76.2%）.There was no significant difference in sex,age,time from injury to operation,mechanism of injury,diagnosis,VAS score,Lysholm score,range of motion and methods of operation between low-grade HO and none HO groups（P 〉 0.05）.There was a significant increase of injury severity score（ISS 13±8,P=0.039）in low-grade HO group as compared with none HO group.There were significant differences in range of motion,VAS score and Lysholm score of high-grade HO group as compared with low-grade HO and none HO group（P 〈 0.05）.Conclusions Heterotopic ossification,especially low-grade heterotopic ossification is a common complication following multiple ligament injury of knee.There were no differences in the range of motion of knee,VAS score and Lysholm score between patients with low-grade heterotopic ossification and those without heterotopic ossification.Low-grade heterotopic ossification did not affect the clinical outcome of knee multiple ligament reconstruction.