Liu Hai-ping, Li Yu-ji, Wang Cheng-xiang, Li Sheng-hua, Zhao Zhen-wen, Wang Jun-hong
Department of Orthopaedics, Hospital of Traditional Chinese Medicine of Gansu Province, Lanzhou, Gansu, China.
Zhongguo Gu Shang. 2011 Oct;24(10):857-60.
To explore the therapeutic effects of Xiaozhong Zhitong mixture preventing heterotopic ossification (HO) after total hip arthroplasty.
From July 2006 to October 2009, 154 patients underwent total hip replacement surgery were randomly divided into sham group (group A, 50 cases), indomethacin group (group B, 55 cases) and Xiaozhong Zhitong mixture group (group C, 49 cases). Among 154 patients, 9 cases were primary osteoarthris, 34 cases osteoarthritis secondary to acetabular dysplasia, 98 cases osteoarthritis secondary to avascular necrosis of the femoral head, 2 cases rheumatoid arthritis, 5 cases femoral neck fracture, 6 cases other diseases. Modified Gibson approach was used during the operation. After operation, group A was no preventing treatment, group B was treated by indomethacin 50 mg every time, twice a day; group C was treated by Xiaozhong Zhitong mixture 50 ml every time, twice a day for 4 weeks. Eighteen months after operation was study termination point and X-ray (including the double hip anteroposterior,obturator oblique and iliac oblique film) was used to observe whether heterotopic ossification was formed (Brooker classification was used to evaluate ossification degree); Harris scoring was used to evaluate the function of hip joint,including PAHSS 80 scores and IAHSS 20 scores.
All the patients were followed up,with the average of duration of 21.2 months. The condition of heterotopic ossification: for group A,there were 27 cases with heterotopic ossification(54%) ,and Brooker I in 8 cases, II in 9 cases, III in 8 cases and IVin 2 cases; for group B, there were 12 cases heterotopic ossification (21.82%), and Brooker I in 10 cases, II in 2 cases; for group C, there were 11 cases heterotopic ossification(22.45%), and Brooker I in 9 cases, I in 2 cases. There was significant difference among three group in heterotopic ossification by rank test (P<0.05), but no difference between group B and C (P>0.05); there were no significant difference among three groups before treatment in Harris, PAHSS and IAHSS by analysis of variance (one-way ANOVA) (P>0.05), and has significant difference at 18 months after treatment (P<0.01). There were significant difference in Harris, PAHSS and IAHSS before and after treatment at 18 months (P<0.01). LSD-t was used to analyzed the scoring of Harris, PAHSS and IAHSS, there was significant difference among group A and group B and group C (P>0.05), but no difference between group B and C (P<0.01). There were gastrointestinal reaction in 5 of group A, 35 in group B and 4 in group C.
The effect of Xiaozhong Zhitong mixture on the prevention of heterotopic ossification after total hip arthroplasty is similar to indomethacin, but Xiaozhong Zhitong mixture has the advantages of less side effects and easily acceptance by patients.
探讨消肿止痛合剂预防全髋关节置换术后异位骨化（HO）的治疗效果。
2006年7月至2009年10月，将154例行全髋关节置换术的患者随机分为假手术组（A组，50例）、吲哚美辛组（B组，55例）和消肿止痛合剂组（C组，49例）。154例患者中，原发性骨关节炎9例，髋臼发育不良继发骨关节炎34例，股骨头缺血性坏死继发骨关节炎98例，类风湿关节炎2例，股骨颈骨折5例，其他疾病6例。术中采用改良Gibson入路。术后，A组不进行预防治疗，B组每次给予吲哚美辛50mg，每日2次；C组每次给予消肿止痛合剂50ml，每日2次，共4周。术后18个月为研究终点，采用X线（包括双髋正位、闭孔斜位和髂骨斜位片）观察是否形成异位骨化（采用Brooker分级评估骨化程度）；采用Harris评分评估髋关节功能，包括疼痛（PAHSS）80分和关节活动度（IAHSS）20分。
所有患者均获随访，平均随访时间21.2个月。异位骨化情况：A组有27例发生异位骨化（54%），其中Brooker I级8例，II级9例，III级8例，IV级2例；B组有12例发生异位骨化（21.82%），其中Brooker I级10例，II级2例；C组有11例发生异位骨化（22.45%），其中Brooker I级9例，II级2例。三组异位骨化情况经秩和检验差异有统计学意义（P<0.05），但B组与C组差异无统计学意义（P>0.05）；治疗前三组Harris、PAHSS和IAHSS评分经方差分析（单因素方差分析）差异无统计学意义（P>0.05），治疗后18个月差异有统计学意义（P<0.01）。治疗后18个月Harris、PAHSS和IAHSS评分治疗前后差异有统计学意义（P<0.01）。采用LSD-t检验分析Harris、PAHSS和IAHSS评分，A组与B组、C组之间差异有统计学意义（P>0.05），但B组与C组之间差异无统计学意义（P<0.01）。A组有5例出现胃肠道反应，B组有35例，C组有4例。
消肿止痛合剂预防全髋关节置换术后异位骨化的效果与吲哚美辛相似，但消肿止痛合剂副作用少，患者易于接受。
