髋臼骨折固定后的异位骨化危险因素预防及其治

背景：异位骨化是髋臼骨折手术治疗后的常见并发症，其发病机制尚不完全清楚，主要是由骨骼肌肉创伤、髋关节术后或者神经系统损伤所导致。近10年的研究来看，髋臼骨折术后促使异位骨化的危险因素有很多，但是对其的预防及治疗是有争议的。

目的：归纳总结近几年发表髋臼骨折术后异位骨化的诊断、预防、治疗及可能影响预后危险因素的相关文献，为临床预防及治疗髋臼骨折术后异位骨化提供依据。

方法：通过计算机检索万方医学网、中国知网(CNKI)、PubMed数据库，中文检索词为“异位骨化，髋臼骨折，危险因素，非甾体抗炎药，放疗，治疗”，英文检索词为“heteropic ossification，acetabular fractures surgery，NSAIDs，risk factors，radiotherapy，treatment”。通过纳入标准与排除标准，最终纳入67篇相关文献进行归纳总结。

结果与结论：①虽然异位骨化的病因学尚未完全了解，但公认的理论为异位骨化形成是由全身因素和局部组织变化共同决定的；异位骨化的危险因素是多方面的，对于高风险的患者应采取一定的预防措施；②髋臼骨折术后异位骨化预防主要包括药物、放疗以及联合预防，其中药物预防尤其是非类固醇抗炎药仍然是最经济有效的预防手段；③关于异位骨化的手术治疗主要为异位骨切除加髋关节松解成形术，而以生物分子机制为基础进行的相应治疗方法研究尚处于动物实验阶段，但其为异位骨化的治疗指明了方向；④在现有治疗方法中，手术是被公认的最有效的治疗手段。

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.

0 引言 Introduction

异位骨化是指在正常骨骼结构外形成板层骨的过程，主要为软组织中病理性骨组织的形成。髋臼骨折切开复位内固定术后异位骨化是一种常见的并发症，会引起患者术后髋部疼痛、活动范围缩小及神经受压，导致患者生活质量下 降[1-2]，从而需进行手术切除治疗和(或)髋关节翻修术[3-10]。文献报道髋臼骨折切开复位内固定术后异位骨化的发病率为17%-90%[11-17]，发病率之所以有这么大的差异可归因于个体治疗方案、研究人群规模、研究间隔、数据获得的方法及随访时间的长短[18-19]。髋臼骨折术后异位骨化的危险因素是多方面的，对于高风险的患者应当采取一定的预防措施。目前预防髋臼骨折术后异位骨化的方法较多，每种预防手段都有各自的优势与不足，尚未达成共识。文章将对目前国内外髋臼骨折术后异位骨化的相关文献进行综述，以指导髋臼骨折术后异位骨化的预防和治疗。

1 资料和方法 Data and methods

1.1 资料来源 通过计算机检索万方医学网、中国知网(CNKI)、PubMed 数据库中2010 至2020 年的文献，中文检索词为“异位骨化，髋臼骨折，危险因素，非甾体抗炎药，放疗，治疗”，英文检索词为“heteropic ossification，acetabular fractures surgery，NSAIDs，risk factors，radiotherapy，treatment”，并根据相关文献进行引文追踪检索。

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