Burd T A, Hughes M S, Anglen J O
Department of Orthopaedic Surgery, The University of Missouri Hospital and Clinics, University of Missouri, Columbia 65212, USA.
J Bone Joint Surg Br. 2003 Jul;85(5):700-5.
Indomethacin is commonly administered for the prophylaxis of heterotopic ossification (HO) after the surgical treatment of acetabular fractures. Non-steroidal anti-inflammatory drugs such as indomethacin, have been associated with delayed healing of fractures and mechanically weaker callus. Our aim was to determine if patients with an acetabular fracture, who received indomethacin for prophylaxis against HO, were at risk of delayed healing or nonunion of any associated fractures of long bones. We reviewed 282 patients who had had open reduction and internal fixation of an acetabular fracture. Patients at risk of HO were randomised to receive either radiation therapy (XRT) or indomethacin. Of these patients, 112 had sustained at least one concomitant fracture of a long bone; 36 needed no prophylaxis, 38 received focal radiation and 38 received indomethacin. Fifteen patients developed 16 nonunions. When comparing patients who received indomethacin with those who did not, a significant difference was noted in the rate of nonunion (26% v 7%; p = 0.004). Patients with concurrent fractures of the acetabulum and long bones who receive indomethacin have a significantly greater risk of nonunion of the fractures of the long bones when compared with those who receive XRT or no prophylaxis.
吲哚美辛常用于髋臼骨折手术治疗后预防异位骨化（HO）。非甾体类抗炎药如吲哚美辛，与骨折愈合延迟及骨痂机械强度减弱有关。我们的目的是确定接受吲哚美辛预防HO的髋臼骨折患者是否存在长骨相关骨折愈合延迟或不愈合的风险。我们回顾了282例行髋臼骨折切开复位内固定术的患者。有HO风险的患者被随机分为接受放射治疗（XRT）或吲哚美辛治疗。在这些患者中，112例至少合并一处长骨骨折；36例无需预防，38例接受局部放疗，38例接受吲哚美辛治疗。15例患者出现16处骨折不愈合。将接受吲哚美辛治疗的患者与未接受该治疗的患者进行比较时，骨折不愈合率存在显著差异（26%对7%；p = 0.004）。与接受XRT或未进行预防的患者相比，髋臼和长骨同时骨折且接受吲哚美辛治疗的患者长骨骨折不愈合的风险显著更高。
