DeFlitch C J, Stryker J A
Department of Radiology, College of Medicine, University Hospital, Milton S. Hershey Medical Center of the Pennsylvania State University, Hershey 17033.
Radiology. 1993 Jul;188(1):265-70. doi: 10.1148/radiology.188.1.8511309.
Over 4 years, 33 patients (mean age, 52 years) underwent hip surgery followed by single-fraction 700-cGy radiation therapy (RT). Records, port films, and plain radiographs were reviewed to assign Brooker classification levels for severity of heterotopic ossification (HO) and assess the amount of new HO developing after surgery. Nineteen patients (58%) developed radiographic evidence of new HO after surgery. All five patients with three or more risk factors and none of 12 with postoperative Brooker level 0 (no radiographic HO) developed new HO. Ten of 16 treated on postoperative day 1, six of 10 on postoperative day 2, none of three on day 3, two of three on day 4, and one of one on day 5 developed new HO. New HO developed outside the irradiated volume in 11 patients. Surgeons should remove all heterotopic bone whenever possible; RT should be administered within 3 days after surgery; portals should cover all potentially involved soft tissue; and future studies should evaluate larger single fractions (900-1,000 cGy) for prevention of HO in patients with three or more risk factors and/or radiographic evidence of residual HO.
在4年期间，33例患者（平均年龄52岁）接受了髋关节手术后进行单次分割700 cGy的放射治疗（RT）。回顾病历、射野片和平片，以确定异位骨化（HO）严重程度的布鲁克分类水平，并评估手术后新发生的HO量。19例患者（58%）术后出现新HO的影像学证据。所有5例有三个或更多危险因素的患者以及12例术后布鲁克0级（无影像学HO）患者中均无新HO发生。术后第1天接受治疗的16例中有10例，术后第2天接受治疗的10例中有6例，第3天接受治疗的3例中无新HO发生，第4天接受治疗的3例中有2例，第5天接受治疗的1例中有1例出现新HO。11例患者新HO发生在照射野之外。外科医生应尽可能切除所有异位骨；RT应在术后3天内进行；射野应覆盖所有可能受累的软组织；未来研究应评估更大的单次分割剂量（900 - 1000 cGy）对有三个或更多危险因素和/或有残留HO影像学证据的患者预防HO的效果。
