Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China.
Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China.
Med Dosim. 2021;46(1):65-73. doi: 10.1016/j.meddos.2020.07.010. Epub 2020 Sep 11.
Heterotopic ossification (HO) refers to the formation of lamellar bone in soft tissues and is a significant complication after total hip arthroplasty (THA). Radiotherapy has been proven as an effective prophylaxis especially for those patients with high risk of HO after THA. However the dose, timing, and frequency of radiation have yet to be determined. To compare HO progressions with different radiotherapy strategies and explore an optimal radiation option. We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trails (through December 1, 2019; no language restrictions) collecting patients who accepted prophylaxis radiation for whom HO progression outcomes were reported. Of 87 identified studies, 10 randomized controlled trails including 1203 patients and 1268 hips were taken to this analysis. Compared with the low biologically effective radiation dose group (biologically effective dose [BED] < 20 Gy), the medium biologically effective radiation dose group (20 Gy ≤ BED ≤ 24 Gy) had statistically significant difference on the prophylaxis of HO (p = 0.003). But for overall incidence of HO, there was no statistically significant difference between low BED group and high BED group (BED > 24, p = 0.21). There was statistically significant reduction in the prophylaxis of HO progression with multiple fractions as opposed to single fraction radiotherapy (p = 0.04). Hips with preoperative radiation were no more likely to observe HO progression than those with postoperative radiotherapy (p = 0.43). Radiotherapy with medium dose (20 Gy ≤ BED ≤ 24 Gy) after THA is an effective dose for preventing HO. In the prophylaxis of HO, multiple fractions seem to be more effective than single fraction radiation. Preoperative radiotherapy could prevent HO progression with the same efficacy postoperative.
异位骨化（HO）是指在软组织中形成板层骨，是全髋关节置换术（THA）后严重的并发症。放射治疗已被证实是一种有效的预防措施，尤其适用于 THA 后有高 HO 风险的患者。然而，放射剂量、时间和频率尚未确定。为了比较不同放射治疗策略的 HO 进展情况，并探索最佳的放射治疗选择。我们系统地检索了 PubMed、Embase 和 Cochrane Library 中的随机对照试验（截至 2019 年 12 月 1 日；无语言限制），收集接受预防照射且报告 HO 进展结果的患者。在 87 项确定的研究中，有 10 项随机对照试验纳入了 1203 名患者和 1268 髋接受分析。与低生物有效剂量组（生物有效剂量[BED]＜20 Gy）相比，中生物有效剂量组（20 Gy≤BED≤24 Gy）在预防 HO 方面有统计学意义（p=0.003）。但在 HO 的总发生率方面，低 BED 组和高 BED 组之间无统计学差异（BED＞24，p=0.21）。与单次分割放疗相比，多次分割放疗在预防 HO 进展方面具有统计学意义（p=0.04）。与术后放疗相比，术前放疗的髋关节发生 HO 进展的可能性更小（p=0.43）。THA 后给予中剂量（20 Gy≤BED≤24 Gy）放疗是预防 HO 的有效剂量。在预防 HO 方面，多次分割放疗比单次分割放疗更有效。术前放疗与术后放疗同样可以预防 HO 进展。
