Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Foundation for Orthopaedic Research, Care & Education (FORCE), Amphia Hospital, Breda, Netherlands.
Department of Orthopaedic and Trauma Surgery, Deventer Ziekenhuis, Deventer, Netherlands.
J Shoulder Elbow Surg. 2022 Oct;31(10):2157-2163. doi: 10.1016/j.jse.2022.06.002. Epub 2022 Jul 22.
The aim of this study was to assess the efficacy of 3 weeks of indomethacin, a nonselective nonsteroidal anti-inflammatory drug, in comparison to 1 week of meloxicam as prophylaxis for heterotopic ossifications (HOs) after distal biceps tendon repair.
A single-center retrospective study was performed on 78 patients undergoing distal biceps tendon repair between 2008 and 2019. From 2008 to 2016, patients received meloxicam 15 mg daily for the period of 1 week as usual care. From 2016 onward, the standard protocol was changed to indomethacin 25 mg 3 times daily for 3 weeks. All patients underwent a single-incision repair with a cortical button technique. The postoperative rehabilitation protocol was similar for all patients. The postoperative radiographs at 8-week follow-up were assessed blindly by 7 independent assessors. If HOs were present, it was classified according to the Ilahi-Gabel classification for size and according to the Gärtner-Heyer classification for density. Statistical analysis was performed to analyze the difference in HO between the patients who were treated with indomethacin and with meloxicam.
Seventy-eight patients, with a mean age of 48.8 years (range 30-72) were included. The mean follow-up after surgery was 12 months (range 2-45). Indomethacin (21 days, 25 mg 3 times per day) was prescribed to 26 (33%) patients. The 52 other patients (67%) were prescribed meloxicam 15 mg daily for 7 days. HOs were seen in 19 patients 8 weeks postoperatively. Five of 26 patients treated with indomethacin developed HO, and 14 of 52 patients treated with meloxicam developed HO (P = .5). Two patients had symptomatic HO with minor restrictions in movement; neither patient was treated with indomethacin. Significantly more HOs were seen in patients with a longer time from injury to surgery (P = .01) The intraclass correlation score for reliability between assessors for HO scoring on postoperative radiographs was good to excellent for both classifications.
In this study, HOs were seen in 24% of postoperative radiographs. Three weeks of indomethacin was not superior to meloxicam for 1 week for the prevention of HO after single-incision distal biceps tendon repair.
本研究旨在评估非选择性非甾体抗炎药吲哚美辛 3 周与美洛昔康 1 周预防肱二头肌远端肌腱修复后异位骨化（HO）的疗效。
对 2008 年至 2019 年间接受肱二头肌远端肌腱修复的 78 例患者进行单中心回顾性研究。2008 年至 2016 年，患者接受美洛昔康 15mg，每日 1 次，持续 1 周作为常规治疗。自 2016 年起，标准方案改为吲哚美辛 25mg，每日 3 次，共 3 周。所有患者均采用单切口修复和皮质纽扣技术。所有患者的术后康复方案相同。术后 8 周的 X 线片由 7 名独立评估者进行盲法评估。如果存在 HO，则根据 Ilahi-Gabel 分类评估大小，根据 Gärtner-Heyer 分类评估密度。统计分析用于分析接受吲哚美辛和接受美洛昔康治疗的患者之间 HO 的差异。
78 例患者，平均年龄 48.8 岁（范围 30-72）。术后平均随访时间为 12 个月（范围 2-45）。26 例（33%）患者服用吲哚美辛（21 天，每日 3 次，每次 25mg）。52 例（67%）患者服用美洛昔康 15mg，每日 1 次，共 7 天。术后 8 周有 19 例患者出现 HO。26 例接受吲哚美辛治疗的患者中有 5 例出现 HO，52 例接受美洛昔康治疗的患者中有 14 例出现 HO（P=0.5）。2 例有症状性 HO，运动受限较小；均未接受吲哚美辛治疗。从受伤到手术的时间较长的患者中，HO 明显更多（P=0.01）。评估者对术后 X 线片 HO 评分的组内相关系数评分在两种分类中均为良好至极好。
在这项研究中，术后 X 线片中有 24%的患者出现 HO。与美洛昔康 1 周相比，单切口肱二头肌远端肌腱修复术后 3 周使用吲哚美辛并不能更好地预防 HO。
