Pohl Fabian, Seufert Julia, Tauscher Annette, Lehmann Harald, Springorum Hans-Werner, Flentje Michael, Koelbl Oliver
Department of Radiotherapy, University of Wuerzburg, Germany.
Strahlenther Onkol. 2005 Aug;181(8):529-33. doi: 10.1007/s00066-005-1352-4.
The functional failure induced by heterotopic ossification (HO) following total hip arthroplasty (THA) was analyzed and correlated to the radiologic failure.
From July 1997 to July 2001, 315 patients (345 hips) received THA indicated by a hypertrophic osteoarthritis of higher degree (Kellgren grade III, IV). All patients were irradiated prophylactically for prevention of HO on the evening before surgery with a 7-Gy single fraction. The patients' median age was 66.3 years. Radiologic failure was assessed by comparison of pre- and postoperative hip X-rays (immediately and 6 months after surgery). Analysis of radiographs was performed according to the Brooker Score. Clinical failure was appraised by measurement of passive range of motion (ROM) of the hip joint with a standard goniometer. The t-test was used for statistical analysis.
281 patients (81.5%) did not develop HO. HO of Brooker grade I or II was found in 58 patients (16.8%). Six patients (1.7%) developed HO Brooker grade III or IV. There was a significant negative correlation between the degree of radiologic and clinical failure. ROM differed significantly between patients with HO Brooker grade 0, I, II and patients with HO Brooker grade III, IV. Comparing the pre- and postoperative ROM, all patients with Brooker grade 0, I and II showed a significant improvement of flexion, internal and external rotation, abduction and adduction movement. Patients with HO Brooker grade III and IV showed no improvement of ROM in the postoperative follow-up.
The development of HO following THA influences the physical function of the hip joint dependent on the degree of ossification. HO of lower degree (Brooker I, II) does not influence the clinical outcome, whereas HO of higher degree (Brooker III, IV) reduces the function of hip arthroplasty. Therefore, the purpose of a prophylactic therapy must be to reduce HO of higher degree.
分析全髋关节置换术（THA）后异位骨化（HO）所致的功能障碍，并将其与放射学失败相关联。
1997年7月至2001年7月，315例患者（345髋）因重度肥厚性骨关节炎（凯尔格伦分级III、IV级）接受THA。所有患者在手术前一晚接受7 Gy单次剂量的预防性照射以预防HO。患者的中位年龄为66.3岁。通过比较术前和术后（术后即刻及术后6个月）的髋关节X线片评估放射学失败情况。根据布鲁克评分对X线片进行分析。通过使用标准测角计测量髋关节的被动活动范围（ROM）来评估临床失败情况。采用t检验进行统计学分析。
281例患者（81.5%）未发生HO。58例患者（16.8%）出现布鲁克I级或II级HO。6例患者（1.7%）出现布鲁克III级或IV级HO。放射学失败程度与临床失败程度之间存在显著负相关。布鲁克0级、I级、II级HO患者与布鲁克III级、IV级HO患者之间的ROM差异显著。比较术前和术后的ROM，所有布鲁克0级、I级和II级患者的屈曲、内旋、外旋、外展和内收运动均有显著改善。布鲁克III级和IV级HO患者在术后随访中ROM无改善。
THA后HO的发生根据骨化程度影响髋关节的物理功能。低度HO（布鲁克I级、II级）不影响临床结果，而高度HO（布鲁克III级、IV级）会降低髋关节置换术的功能。因此，预防性治疗的目的必须是减少高度HO。
