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heterotopic ossification after arthroscopy for hip impingement syndrome

Chinese Medical Journal 2019年第7期132卷 827-833页

作者： Guan-Ying Gao Xin Zhang Ling-Hui Dai Hong-Jie Huang Rui-Qi Wu Xiao-Dong Ju Yu Mei Xing-Yue Niu Jian-Quan Wang Yan Xu Institute of Sports Medicine Beijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijing 100191China

Background:heterotopic ossification(HO)is a known complication of hip arthroscopy.We investigated incidence of HO after hip arthroscopy and determined whether revision for HO improved outcome.Methods:A retrospective study was conducted on 242 patients(140 men and 102 women,mean age:36.2±9.5 years)who underwent hip arthroscopy for femoroacetabular impingement(FAI)between January 2016 and January 2018.The average followup period was 22.88±11.74 months(range:11-34 months).Thirteen(5.37%)cases of HO(six men and seven women,five left hips and eight right hips;mean age:37.5±4.7 years)were observed.Among them,four cases with HO with obvious pain symptoms and persistent non-remission underwent revision surgery to remove HO.Monthly follow-up was conducted.Visual analog scale(VAS),modified Harris Hip Score(mHHS),and non-Arthritis Hip Score(NAHS)were evaluated and compared between HO and non-HO patients.Independent sample t test,Mann-Whitney U test and the Chi-square test were used for inter-group comparisons.HO degree was evaluated using Brooker classification.Symptoms and function were evaluated before and after revision.Results:A total of 242 patients were involved in this study.Thirteen cases(5.4%)had imaging evidence of HO.Nine(9/13)were classified as Brooker stageⅠ,three(3/13)Brooker stageⅡ,and one(1/13)Brooker stageⅢ.HO was detected by ultrasonography as early as 3 weeks after operation.After primary surgery,the mHHS of the HO group and non-HO group increased by 13.00(8.50,25.50)and 24.00(14.00,34.50)points(Z=-1.80,P=0.08),NAHS increased by 18.00(9.50,31.50)and 26.00(13.50,36.00)points(Z=-1.34,P=0.18),and VAS decreased by 3.00(2.00,4.00)and 4.00(3.00,4.50)points(Z=-1.55,P=0.12).Average follow-up time after revision was 9.00±2.94 months;mHHS increased by 34.75 points t=-55.23,P<0.01)and NAHS by 28.75 points t=-6.03,P<0.01),and VAS decreased by 4 points t=9.80,P<0.01).HO and non-HO patients were similar for demographic and surgical data,and clinical and functional scores.Conclusion:HO incidence after arthroscopic treat

关键词： heterotopic ossification Hip Arthroscopy Femoroacetabular impingement

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heterotopic ossification after the use of recombinant human bone morphogenetic protein-7

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World Journal of Orthopedics 2017年第1期8卷 36-41页

作者： Marianthi Papanagiotou Zoe H Dailiana Theophilos Karachalios Sokratis Varitimidis Michael Hantes Georgios Dimakopoulos Marianna Vlychou Konstantinos N Malizos Department of Orthopaedic Surgery Facultyof MedicineUniversity of Thessalia Medical Statistics Epirus Science and Technology ParkUniversity of Ioannina Campus Department of Radiology and Medical Imaging Faculty of MedicineUniversity of Thessalia

AIM To present the incidence of heterotopic ossification after the use of recombinant human bone morphogenetic protein-7(rhB MP-7) for the treatment of nonunions.METHODS Bone morphogenetic proteins(BMPs) promote bone formation by auto-induction. Recombinant human BMP-7 in combination with bone grafts was used in 84 patients for the treatment of long bone nonunions. All patients were evaluated radiographicaly for the development of heterotopic ossification during the standard assessment for the nonunion healing. In all patients(80.9%) with radiographic signs of heterotopic ossification, a CT scan was performed. Nonunion site palpation and ROM evaluation of the adjacent jointswere also carried out. Factors related to the patient(age, gender), the nonunion(location, size, chronicity, number of previous procedures, infection, surrounding tissues condition) and the surgical procedure(graft and fixation type, amount of rhB MP-7) were correlated with the development of heterotopic ossification and statistical analysis with Pearsons χ~2 test was performed.RESULTS Eighty point nine percent of the nonunions treated with rh BMP-7, healed with no need for further procedures. heterotopic bone formation occurred in 15 of 84 patients(17.8%) and it was apparent in the routine radiologi-cal evaluation of the nonunion site, in a mean time of 5.5 mo after the rh BMP-7 application(range 3-12). The heterotopic ossification was located at the femur in 8 cases, at the tibia in 6, and at the humerus in οne patient. In 4 patients a palpable mass was present and only in one patient, with a para-articular knee nonunion treated with rhB MP-7, the size of heterotopic ossification affected the knee range of motion. All the patients with heterotopic ossification were male. Statistical analysis proved that patient's gender was the only important factor for the development of heterotopic ossification(P = 0.007). CONCLUSION heterotopic ossification after the use of rh BMP-7 in nonunions was common but it did not compromise the final clinical outc

关键词： Nonunion Bone morphogenetic protein Recombinant human bone morphogenetic protein-7 heterotopic ossification Long bone Bone graft Osteoinduction

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Large heterotopic gastric mucosa and a concomitant diverticulum in the rectum:Clinical experience and endoscopic management

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World Journal of Gastroenterology 2018年第30期24卷 3462-3468页

作者： Wen-Guo Chen Hua-Tuo Zhu Ming Yang Guo-Qiang Xu Li-Hua Chen Hong-Tan Chen Department of Gastroenterology The First Affiliated HospitalCollege of MedicineZhejiang University

heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia.Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum.Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum.Narrow band imaging further confirmed the histological results.Endoscopic ultrasound indicated that the lesion originated from the mucosal layer,and partially involved the submucosal layer.Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion.No bleeding,perforation or other adverse events were observed.The presence of HGM in the diverticular cavity greatly increased the surgical difficulty.A literature review was also carried out in our study.

关键词： Endoscopic submucosal dissection Rectum Helicobacter pylori Endoscopy heterotopic gastric mucosa

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Severe heterotopic ossification in a seronegative spondyloarthritis patient after cervical Bryan disc arthroplasty: A case report

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World Journal of Clinical Cases 2019年第19期7卷 3047-3054页

作者： Chih-Wei Huang Chien-Lun Tang Hung-Chuan Pan Chung-Yuh Tzeng Hsi-Kai Tsou Neurological Institute Taichung Veterans General HospitalTaichung 407Taiwan Functional Neurosurgery Division Neurological InstituteTaichung Veterans General HospitalTaichung 407Taiwan Faculty of Medicine School of MedicineNational Yang-Ming UniversityTaipei 112Taiwan Division of Joint Reconstruction Department of OrthopedicsTaichung Veterans General HospitalTaichung 407Taiwan Department of Medicinal Botanicals and Health Applications Da-Yeh UniversityChanghua County 515Taiwan Department of Rehabilitation Jen-Teh Junior College of MedicineNursing and ManagementMiaoli County 356Taiwan

BACKGROUND Cervical disc arthroplasty(CDA)is an alternative treatment to traditional interbody fusion that maintains postoperative cervical spine mobility.However,the CDA postoperative period is impacted by osteolysis,subsidence,metallosis,or heterotopic ossification(HO).We report a case of severe HO in a seronegative spondyloarthritis patient after cervical Bryan disc arthroplasty.CASE SUMMARY A 34-year-old man received hybrid surgery for C4-C5 and C5-C6 arthroplasty with Bryan discs and C6-C7 arthrodesis with polyetheretherketone cage due to traumatic herniation of the intervertebral disc(HIVD).After four years,cervical spine radiographs revealed severe HO around the Bryan discs over the C4-C5 and C5-C6 levels.The magnetic resonance image revealed HIVD over the C3-C4 level with spinal cord compression.Seronegative spondyloarthritis was diagnosed after consultation with a rheumatologist.A second CDA for the adjacent segment disease HIVD with Baguera C disc over the C3-C4 level achieved an excellent outcome.CONCLUSION Minimizing intraoperative tissue trauma and achieving postoperative interbody stability avoid soft tissue traction to prevent HO formation after CDA.

关键词： Seronegative spondyloarthritis Disc arthroplasty heterotopic ossification Case report

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Comment on "heterotopic ossification after arthroscopy for hip impingement syndrome"

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Chinese Medical Journal 2019年第14期132卷 1763-1764页

作者： Ming-Jin Zhong Kan Ouyang Department of Sports Medicine The First Affiliated Hospital of Shenzhen UniversityHealth Science Center/Shenzhen Second People's HospitalShenzhenGuangdong 518000China

We have read with great interest the article "heterotopic ossification after arthroscopy for hip impingement syndrome" by Gao et al.[1] The authors showed the incidence of heterotopic ossification (HO) is an observed complication after hip arthroscopy for hip impingement syndrome which is not common (5.4%,13/242) and most HO has no or little effect on clinical symptoms.We also agree with them that oral nonsteroidal anti-inflammatory drugs (NSAIDs) are beneficial in the prevention of HO after primary hip arthroscopy.Although we agree with the conclusion similar to our previous studies in the clinic,there are some issues we like to comment on.

关键词： heterotopic ossification arthroscopy hip impingement syndrome

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Gastric carcinoma originating from the heterotopic submucosal gastric gland treated by laparoscopy and endoscopy cooperative surgery

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World Journal of Gastrointestinal Oncology 2015年第8期7卷 118-122页

作者： Taisuke Imamura Shuhei Komatsu Daisuke Ichikawa Hiroki Kobayashi Mahito Miyamae Shoji Hirajima Tsutomu Kawaguchi Takeshi Kubota Toshiyuki Kosuga Kazuma Okamoto Hirotaka Konishi Atsushi Shiozaki Hitoshi Fujiwara Kiyoshi Ogiso Nobuaki Yagi Akio Yanagisawa Takashi Ando Eigo Otsuji Division of Digestive Surgery Department of Digestive Surgery Kyoto Prefectural University of Medicine Kyoto 602-8566 Japan Department of Molecular Gastroenterology and Hepatology Kyoto Prefectural University of Medicine Kyoto 602-8566 Japan Department of Pathology Kyoto Prefectural University of Medicine Kyoto 602-8566 Japan Department of Gastroenterology and Hepatology Kyoto Kuramaguchi Medical Center Kyoto 603-8151 Japan

Gastric carcinoma is derived from epithelial cells in the gastric mucosa. We reported an extremely rare case of submucosal gastric carcinoma originating from the heterotopic submucosal gastric gland(HSG) that was safely diagnosed by laparoscopy and endoscopy cooperative surgery(LECS). A 66-year-old man underwent gastrointestinal endoscopy, which detected a submucosal tumor(SMT) of 1.5 cm in diameter on the lesser-anterior wall of the upper gastric body. The tumor could not be diagnosed histologically, even by endoscopic ultrasound-guided fine-needle aspiration biopsy. Local resection by LECS was performed to confirm a diagnosis. Pathologically, the tumor was an intra-submucosal well differentiated adenocarcinoma invading 5000 μm intothe submucosal layer. The resected tumor had negative lateral and vertical margins. Based on the Japanese treatment guidelines, additional laparoscopic proximal gastrectomy was curatively performed. LECS is a less invasive and safer approach for the diagnosis of SMT, even in submucosal gastric carcinoma originating from the HSG.

关键词： heterotopic submucosal gland Laparoscopyand endoscopy cooperative surgery Gastric carcinoma Gastric submucosal tumor Less invasive treatment

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Adenocarcinoma arising from heterotopic pancreas at the third portion of the duodenum

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World Journal of Gastroenterology 2015年第13期21卷 4082-4088页

作者： Nobutada Fukino Takatsugu Oida Kenji Mimatsu Youichi Kuboi Kazutoshi Kida Department of Surgery Japan Community Healthcare Organization Yokohama Central HospitalKanagawa 231-8553Japan Department of General Surgical Science Nihon University HospitalTokyo 101-8309Japan

A 62-year-old Japanese man presented to our hospital with a history of weight loss of 6 kg in 4 mo. Imaging examinations revealed a tumor located on the third portion of the duodenum with stenosis. We suspected duodenal carcinoma and performed pancreas-preserving segmental duodenectomy. Adenocarcinoma arising from a heterotopic pancreas at the third portion of the duodenum was finally diagnosed by immunohistochemical staining. Malignant transformation in the duodenum arising from a heterotopic pancreas is extremely rare; to our knowledge, only 13 cases have been reported worldwide, including the present case. The most common location of malignancy is the proximal duodenum at the first and descending portion. Herein, we describe the first case of adenocarcinoma arising from a heterotopic pancreas, which was located in the third portion of the duodenum, with a review of the literature.

关键词： Adenocarcinoma heterotopic pancreas Duodenum Segme

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Acupuncture at heterotopic acupoints enhances jejunal motility in constipated and diarrheic rats

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World Journal of Gastroenterology 2014年第48期20卷 18271-18283页

作者： Qing-Guang Qin Xin-Yan Gao Kun Liu Xiao-Chun Yu Liang Li Hai-Ping Wang Bing Zhu Department of Physiology Institute of Acupuncture and Moxibustion China Academy of Chinese Medical Sciences Department of Acupuncture and Moxibustion Henan Orthopedics Hospital Institute of Acupuncture and Moxibustion China Academy of Chinese Medical Sciences Shanxi University of Traditional Chinese Medicine

AIM:To investigate the effect and mechanism of acupuncture at heterotopic acupoints on jejunal motility,particularly in pathological conditions.METHODS:Jejunal motility was assessed using a manometric balloon placed in the jejunum approximately18-20 cm downstream from the pylorus and filled with approximately 0.1 m L warm water in anesthetized normal rats or rats with diarrhea or constipation.The heterotopic acupoints including LI11(Quchi),ST37(Shangjuxu),BL25(Dachangshu),and the homotopic acupoint ST25(Tianshu),and were stimulated for 60 s by rotating acupuncture needles right and left at a frequency of 2 Hz.To determine the type of afferent fibers mediating the regulation of jejunal motility by manual acupuncture,the ipsilateral sciatic A or C fibers of ST37 were inactivated by local application of the A-fiber selective demyelination agent cobra venom or the C fiber blocker capsaicin.Methoctramine,a selective M2 receptor antagonist,was injected intravenously to identify a specific role for M2 receptors in mediating the effect of acupuncture on jejunal motility.RESULTS:Acupuncture at heterotopic acupoints,such as LI11 and ST37,increased jejunal motility not only in normal rats,but also in rats with constipation or diarrhea.In normal rats,manual acupuncture at LI11 or ST37 enhanced jejunal pressure from 7.34±0.19 cmH2O to 7.93±0.20 cm H2O,an increase of 9.05%±0.82%(P0.05),respectivel

关键词： Acupuncture heterotopic acupoint LI11 ST37 BL25 Je

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Endoscopic diagnosis of cervical esophageal heterotopic gastric mucosa with conventional and narrow-band images

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World Journal of Gastroenterology 2014年第1期20卷 242-249页

作者： Chi-Liang Cheng Cheng-Hui Lin Nai-Jen Liu Jui-Hsiang Tang Yen-Lin Kuo Yi-Ning Tsui Department of Gastroenterology Zhongli Evergreen Hospital Department of Digestive Therapeutic Endoscopy Chang Gung Hospital and Chang Gung University

AIM:To compare the diagnostic yield of heterotopic gastric mucosa(HGM)in the cervical esophagus with conventional imaging(CI)and narrow-band imaging(NBI).METHODS:A prospective study with a total of 760patients receiving a CI examination(mean age 51.6years;47.8%male)and 760 patients undergoing NBI examination(mean age 51.2 years;45.9%male).The size of HGM was classified as small(1-5 mm),medium(6-10 mm),or large(>1 cm).A standardized questionnaire was used to obtain demographic characteristics,social habits,and symptoms likely to be related to cervical esophageal HGM,including throat symptoms(globus sensation,hoarseness,sore throat,and cough)and upper esophageal symptoms(dysphagia and odynophagia)at least 3 mo in duration.The clinicopathological classification of cervical esophageal HGM was performed using the proposal by von Rahden et al.RESULTS:Cervical esophageal HGM was found in 36of 760(4.7%)and 63 of 760(8.3%)patients in the CI and NBI groups,respectively(P=0.007).The NBI mode discovered significantly more small-sized HGM than CI(55%vs 17%;P<0.0001).For the 99 patients with cervical esophageal HGM,biopsies were performed in 56 patients;37(66%)had fundic-type gastric mucosa,and 19 had antral-type mucosa.For the clinicopathological classification,77 patients(78%)were classified as HGMⅠ(asymptomatic carriers);21 as HGMⅡ(symptomatic without morphologic changes);and one as HGMⅢ(symptomatic with morphologic change).No intraepithelial neoplasia or adenocarcinoma was found.CONCLUSION:NBI endoscopy detects more cervical esophageal HGM than CI does.Fundic-type gastric mucosa constitutes the most common histology.One-fifth of patients have throat or dysphagic symptoms.

关键词： Cervical esophagus heterotopic gastric mucosa Endo

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heterotopic Pancreas Presenting as Gastric Polyp

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Surgical Science 2014年第4期5卷 135-137页

作者： Devinder P. Singh Rohit Bansal Department of Surgery Govt. Medical College and Rajindra Hospital Patiala India

heterotopic pancreas is defined as pancreatic tissue found outside the usual anatomical location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathological changes such as inflammation, bleeding, obstruction, and malignant transformation. We report an unusual case of a 25-year-old male patient with pain epigastrium caused by a polyp at the body of stomach along greater curvature revealed at endoscopy. Endoscopic biopsy was s/o inflammatory pathology. Wide excision of polyp was done and a histological diagnosis of heterotopic pancreas was established. The difficulty of making an accurate preoperative diagnosis is highlighted.

关键词： heterotopic Pancreas Gastric Polyp Endoscopy Surgery

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