Haas M L, Kennedy A S, Copeland C C, Ames J W, Scarboro M, Slawson R G
Department of Radiation Oncology, University of Maryland Medical System, Baltimore 21201, USA.
Int J Radiat Oncol Biol Phys. 1999 Sep 1;45(2):461-6. doi: 10.1016/s0360-3016(99)00191-1.
Heterotopic ossification (HO) is a common problem following surgical repair of traumatic acetabular fracture (TAF), potentially causing severe pain and decreased range of motion. This report analyzes the role of radiation therapy for prevention of HO in TAF.
The charts of all patients who received RT to the hip following TAF repair between July 1988 and January 1998 were reviewed. Sixty-six patients were identified. RT was given in 5 fractions of 2 Gy in 45 patients, 1 fraction of 8 Gy in 17 patients, and other doses in 4 patients. Treatment fields encompassed periacetabular tissues at highest risk for HO. Time to RT was < or = 24 hours for 46 patients.
Radiographic follow-up at least 6 months following RT was available in 47/66 (71%) patients to permit Brooker classification, revealing 6 cases (13%) of Grade III HO, compared to historical incidence in this population of 50%. No Grade IV HO was found. Mean follow-up was 18 months. Four of the Grade III patients had received 10 Gy/5 fractions, and 2 received 8 Gy/1 fraction. Postoperative wound infection occurred in 6 patients, and osteonecrosis of the femoral head was found in 13.
RT following surgical repair of TAF provides effective prophylaxis against formation of clinically significant HO. We recommend a single fraction of 7-8 Gy within 24 hours of surgery to prevent HO formation and minimize patient discomfort.
异位骨化（HO）是创伤性髋臼骨折（TAF）手术修复后常见的问题，可能导致严重疼痛和活动范围减小。本报告分析放射治疗在预防TAF中HO的作用。
回顾了1988年7月至1998年1月期间TAF修复后接受髋关节放疗的所有患者的病历。共确定66例患者。45例患者接受5次分割、每次2 Gy的放疗，17例患者接受1次8 Gy的放疗，4例患者接受其他剂量的放疗。治疗野包括髋臼周围发生HO风险最高的组织。46例患者放疗时间≤24小时。
47/66（71%）例患者放疗后至少随访6个月，可进行布鲁克分类，显示6例（13%）III级HO，而该人群的历史发生率为50%。未发现IV级HO。平均随访18个月。III级患者中4例接受10 Gy/5次分割放疗，2例接受8 Gy/1次分割放疗。6例患者发生术后伤口感染，13例发现股骨头坏死。
TAF手术修复后放疗可有效预防具有临床意义的HO形成。我们建议在手术后24小时内单次给予7 - 8 Gy放疗，以预防HO形成并使患者不适降至最低。
