未经证实:多达30%的脊髓损伤患者和20%的创伤性脑损伤患者发生神经源性异位骨化(NHO)。患者出现关节活动范围(ROM)的限制和日常生活活动的损害。当神经系统恢复时,关节功能障碍是患者自主性丧失的原因。
UNASSIGNED:我们介绍了一个39岁的白人男性发生车祸并经历了14天的创伤后昏迷的病例。康复后,没有残留的运动神经或感觉神经缺陷,但双侧NHO围绕髋关节发展。创伤后17个月,病人被我们研究所收治。他躺在床上,绝对不能走路,站或坐。放射学评估仅包括前后X射线视图,由于无法打开臀部进行横向观察,和3D计算机断层扫描。进行骨化的“功能性切除”,并从手术后第1天开始康复。在第二次手术后24个月的最后随访中,报告了较高的临床满意度。患者能够独立行走,穿上他的袜子,开车和骑自行车。无痛的左右臀部ROM是,分别,100°和90°屈曲,延伸10°,35°和30°外展,接近正常的内部和外部旋转。患者提到,流动性和流畅性的进一步改善仍然每天都在存在。
UNASSIGNED:这种罕见的情况经常会导致治疗延迟,并且缺乏具体的指南,使得治疗仍然依赖于外科医生的经验。多学科方法对于成功至关重要。外科医生应该意识到,将患者转诊到专业中心很重要,因为早期切除可以提供极好的结果,保留臀部,恢复功能和病人的独立性。
UNASSIGNED: Up to 30% of patients with spinal cord injury and to 20% of patients with traumatic brain injury develop neurogenic heterotopic ossification (NHO). Patients develop restriction in joint range of motion (ROM) and impairment in activities of daily life. When neurological recovery occurs, joints dysfunction represents the cause for patients\' autonomy loss.
UNASSIGNED: We present the case of a 39-year-old Caucasian male involved in a car accident and experienced 14 days of post-traumatic coma. After rehabilitation, no residual motor or sensory neurological deficit was present, but bilateral NHOs surrounding hip joints developed. Seventeen months after trauma, the patient was admitted to our institute. He was confined to bed, absolutely unable to walk, stand or sit. Radiological evaluation consisted in Antero-Posterior X-ray view only, due to the inability to open up his hips for lateral views, and 3D computed tomography scan. \"Functional resection\" of the ossifications was performed and rehabilitation started from day 1 after surgery. At the final follow-up 24 months from the second operation high grade of clinical satisfaction was reported. The patients were able to walk independently, to put on his socks, and to drive a car and bike. Painless right and left hip ROM was, respectively, 100° and 90° for flexion, 10° for extension, 35° and 30° for abduction, and near normal internal and external rotation. The patient referred that further improvement in mobility and fluency was still present day by day.
UNASSIGNED: The rarity of the condition frequently bring to a delay in treatment and the absence of specific guidelines made treatment still dependent on surgeon experiences. A multidisciplinary approach is essential for success. Surgeons should be aware that it is important to refer patients to specialized center, because early resection could provide excellent results, preserving hip, and restoring function and patient independency.