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Traumatic heterotopic ossification (also known as myositis ossificans) is a relatively common acute injury of joints secondary disease. The occurrence of more than the elbow fracture, dislocation, and joint capsule, tendon, ligament damage, joint hematoma and injury of man-made machine powerful passive stretch, repeated traumatic effusion, due to the formation of subperiosteal ossification. Clinical common in young people, to create joints of patients with more severe dysfunction, it is to be taken seriously enough.
For the 1 case of heterotopic ossification maturity joints in patients with joint dysfunction caused by needle knife I pulled loose with the way the treatment methods, better joint function of patients improved.
First, clinical data
Patient: female, aged 40, in September 2005 a fall caused by dislocation of the right, after reset splinting techniques. Right elbow stiffness after March, the line in other hospitals increased swelling and pain after massage. April 2006 to diagnosis, examination: the right elbow joint swelling, stiffness, skin temperature is not high, brachial ulnar joint range of motion ROM was 70 Â° ~ 90 Â° (the extension is 0 Â° total), forearm supination by limited, mild radial deviation. Hypothenar palm and little finger were numb, light hypoesthesia. X ray showed the right humerus and the olecranon fossa coronoid bone-like density at the shadow edges more clearly, with normal bone is connected; near the lateral condyle of the humerus and soft tissue within the existence of the shadow of wadding sheet. Diagnosis: Right elbow heterotopic ossification.
Second, treatment and outcome
Mainly patients with needle knife, manual, supplemented by the treatment.
B-orientation, respectively, before the selected cubital fossa, the lateral condyle, olecranon and the ulnar nerve at the elbow tube 5 into the pin area, local povidone-iodine disinfection twice, covered hole sterile towels, the surgeon wearing sterile gloves, Ultrasound caps sterile latex gloves, B-surveillance to avoid the nerves and blood vessels. Shallow subcutaneous 1% lidocaine local anesthesia needle backward along the longitudinal direction of the line organization prick stripping, when the knife-edge contact with the bone surface, the soft tissue away from the bone surface shovel, stripping sparse sequential longitudinal and transverse dissection. Of surgery with sterile gauze dressing, more than 5min of local pressure to reduce the surgical area bleeding. 1 times / week, each time starting the second day after the needle knife, plucked and pull soft tissue manipulation therapy.
4 times to improve joint mobility in patients with brachial ulnar joint ROM was 15 Â° ~ 110 Â°, forearm supination may be, carrying angle of about 15 Â°. Review of CT reconstruction: no ossification block was significantly reduced, but the separation of the normal bone. Knife and means to continue the line treatment, needle-knife 1 / 3 weeks, with t
Of the discussions
Diagnosis of heterotopic ossification:
Heterotopic ossification (myositis ossificans, Heterotopic Ossification) in fact has nothing to do with muscle inflammation, and is not limited to the muscles. Myositis ossificans is a rare disease of unknown mechanism of ossification of the limitations of benign soft tissue mass, is a muscle and its adjacent structures limited, with non-tumor calcification and ossification of the lesion. It is with the bone Myositis (Inherited ossifying disease, Myositis ossificans progressive, Fibrodysplasia Ossifcans Progressive) does not - which is an autosomal dominant genetic disease, which may be 4 or variation of chromosome 17 is related to poor prognosis. Myositis ossificans occurred in adolescents and adults, to the elbow, shoulder and hip joints as much, but can occur at the neck, nuchal ligament. Most have a clear history of trauma and surgery, but the injury is not the only factor, it was suggested may be related to infection or ischemia.
Myositis ossificans is a special form of body repair, experience trauma, inflammation, granulation tissue and heterotopic ossification four stages. Synovial injury hematoma formation may produce a prerequisite for myositis ossificans, osteoblasts invade muscle tissue in the periosteum and within under a similar callus new bone formation, causing joint dysfunction.
Myositis ossificans-like clinical manifestations of bone mass, swelling, may be associated with local pain and night pain, limited joint movement and stiffness. AKP, erythrocyte sedimentation rate are mostly normal. However, in acute, subacute, AKP, ESR, white blood cells can be increased. Most studies suggest that changes in clinical imaging into the early under the (false inflammatory phase), and mature (full ossification of).
Myositis ossificans as a typical X-ray damage to the soft tissue sheet or layer of high density calcification, ossification of the film, combined with a history of trauma and pathological features, diagnosis is not difficult. Ultrasound, CT and MRI in the diagnosis also have a certain value.
Treatment of heterotopic ossification:
There is no specific effective treatment method.
Drug treatment: Some scholars believe that the second phosphate and non-steroidal anti-inflammatory drugs inhibit the limitations of the formation and development of myositis ossificans, but after stopping easy rebound. Some studies also report severe pain can be local injection of lysine aspirin (to more than forest) = Um â’† significantly brighter Viacom plans to send 5 basis shading beer blast?
Surgical treatment: surgical removal of ossification of the block, larger wound, and can cause ossification of the new organization. Generally adopted a prudent attitude.
Chinese Medicine: Chinese medicine, this disease was caused by traumatic injury in the meridians, blood runs sluggish, tendons and Juji, meridian unreasonable together, so much the use of local drug deposition or fumigation, oral medicine, massage and other treatment methods .
It is noteworthy that rough massage, passive stretching joints strong again, resulting in duplication of iatrogenic injury, recurrent bleeding, repeated formation of adhesions ossification, can cause stiff joints completely. Some studies on massage therapy or opposed elbow injury doubts. This paper reports the brutal stretch of patients had a strong history of massage therapy, this treatment specifically to stop the stimulation. After this patient underwent needle knife during a massage and practicing hand traction treatment, but stressed the soothing techniques, pain intensity within a small stretch, better.
In fact practicing hand therapy has Shujin, swelling and pain, loosen adhesions, smooth the joint function, the absorption of the hematoma, reduced ossification of local organizations have a positive effect. Once you have the right, it is also the prevention and treatment of myositis ossificans is one important way. Last a long time with a smaller traction forces can be as soft tissue techniques viscosity mechanism to extend the continuity of a larger, conducive to the protection of motion, increase muscle strength, improve joint fiber adhesion and joint contracture. In the course of treatment must be gradual and gentle movements, hair strength precise, rigid combination. Active activities must be limited to passive stretch within the pain.
Needle knife Notes:
Blast Table Tennis needle cavity Temple Mount ã„‹? About âŠ™ wish? Shell ammonia Ç– Huan yo friends?
This paper argues that the way knife release by minimally invasive tendon, joint capsule contracture, a faster improvement in range of motion. This paper argues that knife into the edge of ossification and soft tissue, the flat blade knife can not cut off the continuous prick and ossification of soft tissue connections, may reach only the purpose of reducing the tension is too high, can not be stripped.
After the release of acupuncture must be a long time local oppression, we must avoid the knife prick caused by hematoma. In particular, to avoid bleeding into the joint cavity.
Elbow complex structure, the selected entry point may adversely affect blood vessels and nerves. Moreover, this patient had heterotopic ossification caused by compression of the ulnar nerve symptoms, the paper suggested that B-guidance and monitoring, you can very well avoid injuring important structures.
After Needle Prick patients had improvement in joint mobility, several months after the imaging contrast can reduce the block to see the ossification. Needle prick that when the soft tissue by reducing the tension, improve range of motion, and ossification caused by the absorption of Wolff's law, rather than direct surgical removal.
Li Ping, Nanshan District, call Q: Two months ago, I accidentally tripped in a soccer Tournament, resulting in dislocation of the right elbow. At that time, the hospital conducted a manual reduction, cast immobilization. After removal of plaster, I think the right elbow joint activities are not freely, according to doctors diagnosed a week of functional exercise, but still have not changed much. Later, I found a doctor, a massage treatment, he said I could touch the elbow in front of an obvious lump, that is inside the elbow muscles in front of long bones, may I ask how this phenomenon is going on? How is it treated?
Shenzhen Ping Le Hospital trauma orthopedic bone Ke Jia Bin, deputy director of Physicians A: According to Li Ping situation described by the students, this "inside the muscles of the elbow in front of long bones", and modern medicine is called bone Myositis, This is because you anxious, numerous experiences of finding strong traction massage medical consequences.
What is myositis ossificans elbow formed? According to statistics, myositis ossificans of the elbow joint elbow fracture, dislocation, and the incidence of injury while not high, but the incidence of cases, more than 90% of the patients had at least 5 times violent passive pull elbow Pull history. Some scholars have also pointed out that the foreign, myositis ossificans elbow elbow injury is the result of a strong massage. Elbow fracture and dislocation of violence by repeatedly reset, or by the injury after elbow injury in a fixed limited joint function due to the strong passive stretch massage, the easily lead to elbow muscle strain, hematoma formation in muscle. The hematoma is not absorbed, but through various mechanisms of bone induction, there hematoma fibrosis, and ultimately into lumps of bone, thus impeding the activities of the elbow joint initiative, Li Ping This clinical symptoms appear.
In order to prevent the occurrence of myositis ossificans elbow, should pay attention to the following aspects: 1, if accidentally injured elbow, should be immediately to the hospital, the right elbow after treatment can reduce bleeding, to prevent the elbow hematoma formation; 2, elbow fracture and dislocation of the function will be fixed for a long time is limited, this time, patients do not worry, as long as the tolerance for active cases, the function step by step exercises, in conjunction with herbal fumigation elbow, After a period of treatment, its function can be fully restored; 3, must not be anxious for the strong pressure of the passive pull the elbow, the elbow because it is easily induced myositis ossificans.
If myositis ossificans is the formation of the elbow, the early patients, such as local swelling, tenderness and fever, etc., then it should not exercise activities, should be obvious symptoms and pain when the tolerable range of motion under the Initiative. If the organization has matured to late ossification, X-ray showed ossification of the organization in a narrow and limited area, this time, patients should choose surgery, excision of the ossification of the elbow in order to improve the function, postoperative need for radiation therapy to prevent recurrence.
"Egg inside the bones," we are very familiar with this proverb. Inside the long bones, muscles, sounds like you think it is a joke, but it does exist in real life.
Li Ping is the junior class football in the Tournament the previous two months, inadvertently fall, caused the right elbow dislocation, in the hospital for a manual reduction, cast immobilization. 3 weeks after the removal of the right elbow plaster appears limited mobility, the doctor told him that he himself can live with active elbow function under the premise of doing exercise. Li Ping keep practicing a week later, the activity of the elbow felt not changed much and felt very anxious, listening to people say that a good massage treatment, doctors will find a massage treatment. Massage is the elbow limited mobility to see a doctor to confidently said to him: "Massage therapy is limited joint function after injury good effect, and a week later your elbow certainly a significant improvement in activity." But stressed that he must first be hold back the pain, so little done for Li Ping, "warm up", the hand grabbed his upper arm, forearm and grabbed his hand and began his elbow flexion strength. Li Ping bellowed in pain shouting, but seeing the gradual increase in the elbow joint activity, heart and seemed to see hope of recovery. Persist for a week this way, the joint activity is indeed increasing day by day, Li Ping and felt very happy, grateful to the doctors massage.
Can not last, did not think a week after elbow swelling, pain, accompanied by local heating. Massage doctor said the reason was excessive exercise, take some time off just fine, so he stopped the massage therapy. Local pain and fever really disappeared, but the elbow of the activity but also reduced day by day, the swelling gradually become more and more hard parts, three weeks later only a small range of elbow flexion and extension activities, elbow Ahead an obvious lump palpable. Ping no longer dare to believe that the massage doctor, where I went to the hospital out-patient for treatment.
Just my day admissions. After listening to tell Li Ping, I gave him the elbow joint examination: elbow flexion and extension range of about 10 degrees, the front elbow and a palpable lump about the size of the egg. With more than ten years of clinical experience, I was already eight grasp, Li Ping is suffering from elbow myositis ossificans. X-ray photo shows ossification of the elbow in front of a cloudy shadow, which confirmed my diagnosis. Then said to him: "Your muscles inside the elbow in front of the long bones, and modern medicine known as myositis ossificans, which is entirely due to your quick success, numerous experiences of finding strong traction massage medical consequences . Fortunately, not yet completely ossified mass, otherwise you will inevitably suffer a knife. "Later, after my guidance, Li Ping, active elbow every day to do functional exercise, combined with herbal fumigation, two months after the lump slowly getting Soft disappeared, normal elbow function.
What is myositis ossificans elbow formed? According to medical statistics, myositis ossificans of the elbow joint elbow fracture, dislocation, and the incidence of injury while not high, but the incidence of cases, 90 % of patients had at least 5 times violent history of elbow passive stretch. Abroad as early as 1936, one scholar pointed out, myositis ossificans elbow elbow injury is the result of a strong massage. Elbow fracture and dislocation of violence by repeatedly reset, or elbow injuries and joint function due to limited fixed passive massage for a strong stretch, easily lead to elbow muscle strain, hematoma formation in muscle, hematoma does not absorb , but through a variety of mechanisms of bone induction, hematoma fibrosis, and ultimately ossification. Ossification of the elbow after the lump hindered the initiative activities, leading to the same clinical symptoms as Li Ping.
In order to prevent the occurrence of myositis ossificans elbow, should pay attention to the following aspects: â‘ If you accidentally elbow injury, immediately to the hospital, the right elbow after treatment can reduce bleeding, to prevent the elbow hematoma formation; â‘¡ elbow fracture and dislocation of functional limitation due to the fixed time, when patients do not worry, usually after a period of time, they can endure the pain to do active case of functional exercise, while the elbow with the herb fumigation step by step, its function can be fully restored; â‘¢ must not be so anxious to find or make their own strong massage pressure passive pull the elbow, the elbow will n
If myositis ossificans is the formation of the elbow, there is still early, such as local swelling, tenderness and fever, activity, and the pain got worse after the event, this time not over-exercise activities, should be the obvious symptoms of pain when the situation tolerable joint activities under the Initiative. If the organization has matured to late ossification, X-ray showed ossification of the organization in a narrow and limited area, this time should be surgical excision of the ossification, to improve the function of the elbow joint, but also for radiation therapy after surgery to prevent recurrence.
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