Kienapfel H, Koller M, Wüst A, Sprey C, Merte H, Engenhart-Cabillic R, Griss P
Department of Orthopaedic Surgery, Philipps University, Baldingerstrasse, D-35033 Marburg, Germany.
Arch Orthop Trauma Surg. 1999;119(5-6):296-302. doi: 10.1007/s004020050414.
Heterotopic ossification (HO) after total hip arthroplasty is known to be a major complication with an impact on the functional outcome. Efforts have been made to prevent the occurrence of HO by means of either radiation therapy or pharmacotherapy. To date, there are no data available regarding the relative benefit of radiation versus medication with non-steroidal anti-inflammatory drugs. The objective of this study was to compare single-dose 600-cGy radiation therapy with indomethacin medication for their effect on the prevention of heterotopic bone formation after total hip arthroplasty. In all, 154 patients were included in the study. All patients underwent primary total hip arthroplasty due to osteoarthritis. Patients were randomly assigned to three different therapeutic groups. (a) The radiation group received a single radiation dose of 600 cGy between the 2nd and 4th postoperative day. (b) The indomethacin group received an oral application of indomethacin 2 x 50 mg per day from the 1st to 42nd postoperative day. (c) The control group received neither radiation nor indomethacin medication. There were significant group differences (P < 0.001). A least significant difference test (LSD) revealed that the mean of the control group was significantly different from that of the radiation and indomethacin groups. The 13 patients (8.4%) classified Brooker 3 or 4 were all in the control group. Again, this effect was statistically significant (chi-square, P < 0.001). In conclusion, this study demonstrated that both radiation and indomethacin therapy are effective in the prevention of postoperative HO. The choice for either one of the treatments has to be based on availability, contraindications, side-effects, practicability, standardisation and cost. Based on these considerations together with the results of this study, we currently use postoperative radiation with 600 cGy for all patients undergoing primary total hip arthroplasty.
全髋关节置换术后的异位骨化（HO）是一种已知会影响功能结局的主要并发症。人们已通过放射治疗或药物治疗来努力预防HO的发生。迄今为止，尚无关于放射治疗与使用非甾体抗炎药药物治疗的相对益处的数据。本研究的目的是比较单剂量600 cGy放射治疗与吲哚美辛药物治疗对预防全髋关节置换术后异位骨形成的效果。该研究共纳入154例患者。所有患者均因骨关节炎接受初次全髋关节置换术。患者被随机分配到三个不同的治疗组。（a）放射组在术后第2天至第4天接受单次600 cGy的放射剂量。（b）吲哚美辛组从术后第1天至第42天每天口服2×50 mg吲哚美辛。（c）对照组既未接受放射治疗也未接受吲哚美辛药物治疗。组间存在显著差异（P < 0.001）。最小显著差异检验（LSD）显示，对照组的均值与放射组和吲哚美辛组的均值存在显著差异。13例（8.4%）被归类为布鲁克3级或4级的患者均在对照组。同样，这种效应具有统计学意义（卡方检验，P < 0.001）。总之，本研究表明放射治疗和吲哚美辛治疗在预防术后HO方面均有效。选择其中任何一种治疗方法都必须基于可用性、禁忌症、副作用、实用性、标准化和成本。基于这些考虑以及本研究的结果，我们目前对所有接受初次全髋关节置换术的患者使用600 cGy的术后放射治疗。
