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首页> 外文期刊>Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine >Risk of symptomatic heterotopic ossification following plate osteosynthesis in multiple trauma patients: an analysis in a level-1 trauma centre
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Risk of symptomatic heterotopic ossification following plate osteosynthesis in multiple trauma patients: an analysis in a level-1 trauma centre

机译：多发性创伤患者中板骨合成后出现症状性异位骨化的风险：一级创伤中心的分析

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Background Symptomatic heterotopic ossification (HO) in multiple trauma patients may lead to follow up surgery, furthermore the long-term outcome can be restricted. Knowledge of the effect of surgical treatment on formation of symptomatic heterotopic ossification in polytrauma is sparse. Therefore, we test the effects of surgical treatment (plate osteosynthesis or intramedullary nailing) on the formation of heterotopic ossification in the multiple trauma patient. Methods We retrospectively analysed prospectively documented data of blunt multiple trauma patients with long bone fractures which were treated at our level-1 trauma centre between 1997 and 2005. Patients were distributed to 2 groups: Patients treated by intramedullary nails (group IMN) or plate osteosynthesis (group PLATE) were compared. The expression and extension of symptomatic heterotopic ossifications on 3-6 months follow-up x-rays in antero-posterior (ap) and lateral views were classified radiologically and the maximum expansion was measured in millimeter (mm). Additionally, ventilation time, prophylactic medication like indomethacine and incidence and correlation of head injuries were analysed. Results 101 patients were included in our study, 79 men and 22 women. The fractures were treated by intramedullary nails (group IMN n = 50) or plate osteosynthesis (group PLATE n = 51). Significantly higher radiologic ossification classes were detected in group PLATE (2.9 ± 1.3) as compared to IMN (2.2 ± 1.1; p = 0.013). HO size in mm ap and lateral showed a tendency towards larger HOs in the PLATE group. Additionally PLATE group showed a higher rate of articular fractures (63% vs. 28% in IMN) while IMN demonstrated a higher rate of diaphyseal fractures (72% vs. 37% in PLATE; p = 0.003). Ventilation time, indomethacine and incidence of head injuries showed no significant difference between groups. Conclusion Fracture care with plate osteosynthesis in polytrauma patients is associated with larger formations of symptomatic heterotopic ossifications (HO) while intramedullary nailing was associated with a higher rate of remote HO. For future fracture care of multiply injured patients these facts may be considered by the responsible surgeon.
机译：背景多发性创伤患者的症状性异位骨化症（HO）可能会导致后续手术，而且长期结局可能受到限制。关于手术治疗对多发性创伤中症状性异位骨化形成的影响的知识很少。因此，我们测试了在多发性创伤患者中手术治疗（钢板固定或髓内钉固定）对异位骨化形成的影响。方法我们回顾性分析了1997年至2005年在1级创伤中心接受治疗的多发性钝性长骨骨折钝性创伤患者的前瞻性文献资料。患者分为2组：髓内钉治疗（IMN组）或钢板固定（PLATE组）进行了比较。在影像学上对前后位（ap）和侧视图中3-6个月的有症状异位骨化的表达和扩展进行了放射学分类，最大扩展以毫米（mm）为单位进行了测量。此外，还分析了通气时间，吲哚美辛等预防性药物以及颅脑损伤的发生率和相关性。结果本研究共纳入101例患者，其中男性79例，女性22例。骨折采用髓内钉（IMN组= 50）或钢板固定（PLATE组= 51）进行治疗。与IMN（2.2±1.1; p = 0.013）相比，PLATE组（2.9±1.3）的放射性骨化明显更高。在PLATE组中，以mm ap和侧面为单位的HO尺寸显示出更大的HO趋势。此外，PLATE组关节骨折率更高（IMN为63％，而IMN为28％），IMN骨干骨折率更高（PLATE为72％，而37％; p = 0.003）。两组之间的通气时间，消炎痛和头部受伤的发生率无明显差异。结论多发伤患者的板状骨合成骨折护理与症状性异位骨化（HO）形成较大有关，而髓内钉固定与远距离HO发生率较高相关。对于将来的多发伤患者的骨折护理，负责任的外科医生可能会考虑这些事实。

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