Ayers D C, Pellegrini V D, Evarts C M
Department of Orthopedic Surgery, SUNY, Syracuse 13202.
Clin Orthop Relat Res. 1991 Feb(263):87-93.
Heterotopic ossification (HO) is a frequent occurrence after cemented and cementless total hip arthroplasty (THA). Patients at risk for this complication include those with preexisting ipsilateral or contralateral HO, diffuse idiopathic skeletal hyperostosis, hypertrophic osteoarthrosis, posttraumatic arthritis, and ankylosing spondylitis. Low-dose radiation therapy effectively prevents HO in this high-risk group when treatment is begun early in the postoperative period. A prospective evaluation has established the efficacy of fractionated and single-dose radiation therapy protocols. Limited radiation portals are used in patients receiving cementless prostheses. A rectangular radiation portal obliquely oriented to the prosthesis enables radiation treatment of the periarticular soft tissues while avoiding exposure of the bone-prosthesis interface. Radiation therapy to this interface may inhibit or delay bony ingrowth. Radiation therapy is the only treatment used to prevent HO that is delivered locally and not systemically. Low-dose radiation therapy using a limited radiation portal is the treatment of choice to prevent HO in high-risk patients after cementless THA.
异位骨化（HO）在骨水泥型和非骨水泥型全髋关节置换术（THA）后经常出现。有这种并发症风险的患者包括那些先前存在同侧或对侧HO、弥漫性特发性骨肥厚、肥大性骨关节炎、创伤后关节炎和强直性脊柱炎的患者。当在术后早期开始治疗时，低剂量放射治疗可有效预防该高危组中的HO。一项前瞻性评估确定了分次和单剂量放射治疗方案的疗效。接受非骨水泥假体的患者使用有限的放射野。一个与假体倾斜定向的矩形放射野能够对关节周围软组织进行放射治疗，同时避免骨-假体界面暴露。对该界面进行放射治疗可能会抑制或延迟骨长入。放射治疗是唯一用于预防HO的局部而非全身治疗方法。使用有限放射野的低剂量放射治疗是预防非骨水泥型THA后高危患者HO的首选治疗方法。
