Pakos Emilios E, Ioannidis John P A
Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece.
Int J Radiat Oncol Biol Phys. 2004 Nov 1;60(3):888-95. doi: 10.1016/j.ijrobp.2003.11.015.
To evaluate the efficacy of radiotherapy (RT) vs. nonsteroidal anti-inflammatory drugs (NSAIDs) in the prevention of heterotopic ossification (HO) after major hip procedures.
We conducted a meta-analysis of 7 randomized studies (n = 1143) comparing RT with NSAIDs. Data were combined across studies using fixed and random effects models. We conducted separate analyses for clinically significant HO (Brooker Grade 3 and 4) and for any HO (any Brooker grade).
Overall RT tended to be more effective than NSAIDs in preventing Brooker 3 or 4 HO (risk ratio, 0.42; 95% confidence interval [CI], 0.18-0.97) or any HO (risk ratio, 0.75; 95% CI, 0.37-1.71), but with significant between-study heterogeneity for the second analysis. The overall absolute risk difference for Brooker 3 or 4 HO was small (-1.18%; 95% CI, -2.45% to 0.09%). Subgroup analyses showed that early preoperative RT (16-20 hours before surgery) and acetylsalicylic acid were less effective. For postoperative RT, there was a significant dose-response relationship (p = 0.008): 6 Gy of RT was equally effective as NSAIDs, whereas increasing radiation doses were more effective.
Although absolute differences may be small, postoperative RT is on average more effective than NSAIDs in preventing HO after major hip procedures, and its efficacy is dose dependent.
评估放射治疗（RT）与非甾体抗炎药（NSAIDs）在预防大髋关节手术后异位骨化（HO）方面的疗效。
我们对7项比较RT与NSAIDs的随机研究（n = 1143）进行了荟萃分析。使用固定效应模型和随机效应模型对各研究的数据进行合并。我们分别对具有临床意义的HO（布鲁克3级和4级）以及任何HO（任何布鲁克等级）进行了分析。
总体而言，在预防布鲁克3级或4级HO（风险比，0.42；95%置信区间[CI]，0.18 - 0.97）或任何HO（风险比，0.75；95%CI，0.37 - 1.71）方面，RT往往比NSAIDs更有效，但在第二项分析中存在显著的研究间异质性。布鲁克3级或4级HO的总体绝对风险差异较小（-1.18%；95%CI，-2.45%至0.09%）。亚组分析表明，术前早期RT（手术前16 - 20小时）和乙酰水杨酸效果较差。对于术后RT，存在显著的剂量反应关系（p = 0.008）：6 Gy的RT与NSAIDs效果相当，而增加辐射剂量则更有效。
虽然绝对差异可能较小，但术后RT在预防大髋关节手术后的HO方面平均比NSAIDs更有效，且其疗效具有剂量依赖性。
