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中华临床医师杂志(电子版) ›› 2025, Vol. 19 ›› Issue (07) : 526 -531. doi: 10.3877/cma.j.issn.1674-0785.2025.07.007

综述

全关节置换术后异位骨化的研究进展
姜宇丰1, 张睿2, 闵红巍1,2,()   
  1. 1 100068 北京,首都医科大学康复医学院中国康复研究中心
    2 100068 北京,北京博爱医院骨与关节康复科
  • 收稿日期:2025-07-10 出版日期:2025-07-30
  • 通信作者: 闵红巍
  • 基金资助:
    中国康复研究中心科研基金(2021zx-06); 中国康复研究中心研究者发起科研课题(2024IIT-28)

Heterotopic ossification following total joint arthroplasty: A review

Yufeng Jiang1, Rui Zhang2, Hongwei Min1,2,()   

  1. 1 School of Rehabilitation Medicine, Capital Medical University, China Rehabilitation Research Center, Beijing 100068, China
    2 Department of Orthopedic and Joint Rehabilitation, Beijing Bo'ai Hospital, Beijing 100068, China
  • Received:2025-07-10 Published:2025-07-30
  • Corresponding author: Hongwei Min
引用本文:

姜宇丰, 张睿, 闵红巍. 全关节置换术后异位骨化的研究进展[J/OL]. 中华临床医师杂志(电子版), 2025, 19(07): 526-531.

Yufeng Jiang, Rui Zhang, Hongwei Min. Heterotopic ossification following total joint arthroplasty: A review[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(07): 526-531.

全关节置换(TJA)手术已成为治疗多种骨科疾病的重要手段。TJA后异位骨化(HO)可致关节功能受限、疼痛甚至僵硬,严重影响手术效果,增加翻修风险,是影响远期疗效的重要并发症。TJA术后HO发病率较高,一旦发生,可显著影响患者功能,但目前临床医生尚未形成统一共识。本文系统梳理TJA术后HO的流行病学与危险因素、发病机制,概述X线-CT-MRI/超声-骨扫描的分层诊断策略与Brooker分级应用,比较不同风险人群的预防与治疗选择,提出“高危识别+个体化联合预防”的管理框架,为临床实践提供参考。

Total joint arthroplasty (TJA) is a crucial treatment modality for various orthopedic diseases. Heterotopic ossification (HO) following TJA can lead to limited joint function, pain, and even joint stiffness, significantly compromising the surgical outcomes and increasing the risk of revision surgery. Therefore, HO is a major complication that affects the long-term efficacy of TJA. The incidence of HO after TJA is relatively high. Once it occurs, it can notably impact patients' functionality. However, there is currently no unified consensus on its prevention and treatment among clinicians. This paper systematically reviews the epidemiology, risk factors, and pathogenesis of HO after TJA, outlines the stratified diagnostic strategies involving X-ray, CT, MRI/ultrasound, and bone scan, as well as the application of the Brooker classification, compares the preventive and therapeutic options for different risk populations, and proposes a management framework of "high-risk identification + individualized combined prevention" to provide a reference for clinical practice.

图1 不同部位TJA的HO发病率 注:THA为全髋关节置换术;TKA为全膝关节置换术;TEA为全肘关节置换术;TAA为全踝关节置换术;TSA为 全肩关节置换术
表1 TJA术后HO的诊断
阶段 关键步骤 内容及操作要点
临床初筛 关注患者主诉及症状 (1)ROM进行性下降(屈曲/伸展受限);(2)活动时深部疼痛;(3)关节周围触及硬结或骨性包块;(4)关节周围红肿热感也应引起注意。
识别高危因素 男性、年龄>65岁、强直性脊柱炎病史、既往HO史、术前骨赘形成、术中广泛软组织剥离/骨屑残留、术后血肿等。
影像学确诊 首选:X线 时机:术后6周常规复查,高危者4周起每4~6周追踪;
表现:早期:云雾状高密度影;成熟期:骨皮质+骨小梁结构(>3~6个月);分级:采用Brooker系统分级
CT扫描 作为X线的补充,用于X线不明确/术前切除评估的患者,可以检出早期钙化、精确定位、评估骨成熟度。
MRI 显示早期HO周围软组织的变化情况,对异位骨成熟的判断较X线和CT更有优势。
超声 超声不受关节假体等金属伪影的影响,未成熟的HO在超声下表现为关节周围软组织的肿胀。
放射性核素扫描 早期敏感,最早可检出进展1周左右的HO,可评估HO活动性,但特异性低,需结合X线/CT。
辅助检查 实验室检查 ALP、24 h尿PGE2辅助识别早期HO,但特异性不高,需结合影像学检查;鉴别感染及其他并发症可监测ESR、CRP、血常规。
鉴别诊断 排除其他疾病 (1)假体周围感染:ESR/CRP↑+骨吸收;(2)假体松动:X线检查出现透亮带;(3)关节纤维化:无骨性阻挡;(4)DVT:超声可确诊
综合诊断 确诊标准 (1)影像学明确新骨形成(X线/CT);(2)进行性ROM受限+疼痛;(3)排除感染/松动等并发症
表2 TJA术后HO预防治疗措施
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