Kölbl O, Flentje M, Eulert J, Barthel T, Knelles D, Kraus U
Klinik und Poliklinik für Strahlentherapie der Universität Würzburg.
Strahlenther Onkol. 1997 Dec;173(12):677-82. doi: 10.1007/BF03038450.
Two prospective trials were undertaken to assess the comparative efficacy of early postoperative irradiation with different radiation doses versus the postoperative use of nonsteroidal antiinflammatory drugs (NSAID) for prevention of heterotopic ossification (HO) following prothetic total hip replacement (THP).
Between 1992 and 1994 585 patients received THP. These patients were randomed in two longitudinal studies each with 3 treatment arms comparing postoperative irradiation with 4 x 3 Gy (101 patients), 1 x 5 Gy (93 patients), 1 x 7 Gy (95 patients) and the postoperative use of the NSAID indometacin for 7 days (113 patients) respectively for 14 days (90 patients) und acetyl salicyl acid (ASS) for 14 days (93 patients). Heterotopic ossification was scored according to the Brooker grading system. One hundred patients receiving no prophylactic therapy after total hip arthroplasty between 1988 and 1992 were analysed and defined as historical control group.
Incidence of heterotopic ossification was 5% in the 4 x 3 Gy group (Brooker grade I 5%, grade II 0%, grade III 0%), 30.5% in the 1 x 5 Gy group (Brooker grade I 24.7%, grade II 4.1%, grade III 1.0%) and 10.5% in the 1 x 7 Gy group (Brooker grade I 10.5%, grade II 0%, grade III 0%). 15.9% of the indometacin-7 days-group developed heterotopic ossification (Brooker grade I 8%, grade II 6.2%, grade III 1.7%, grade IV 0%), 12.2% of the indometacin-14 days-group (Brooker grade I 8.9%, grade II 2.2%, grade III 1.1%) and 37.5% of the ASS-group (Brooker grade I 27.9%, grade II 4.3%, grade III 5.3%). The lowest incidence of heterotopic ossification was found for the 4 xx 3 Gy and the 1 x 7 Gy group, but no significant difference between these two different treatments was observed.
Prophylactic irradiation of the operative site after hip replacement is more effective than the use of NSAID. Because no significant difference between the fractionated ingle dose irradiation was found and the latter is more comfortable for patients and more economical, irradiation with single 7 Gy fraction should be preferred.
进行两项前瞻性试验，以评估术后早期不同辐射剂量的放疗与术后使用非甾体类抗炎药（NSAID）预防人工全髋关节置换术（THP）后异位骨化（HO）的相对疗效。
1992年至1994年间，585例患者接受了THP。这些患者被随机分为两项纵向研究，每项研究有3个治疗组，分别比较术后4×3 Gy放疗（101例患者）、1×5 Gy放疗（93例患者）、1×7 Gy放疗（95例患者）以及术后使用NSAID吲哚美辛7天（113例患者）、14天（90例患者）和乙酰水杨酸（ASS）14天（93例患者）的效果。根据布鲁克分级系统对异位骨化进行评分。对1988年至1992年间100例全髋关节置换术后未接受预防性治疗的患者进行分析，并将其定义为历史对照组。
4×3 Gy组异位骨化发生率为5%（布鲁克I级5%，II级0%，III级0%）；1×5 Gy组为30.5%（布鲁克I级24.7%，II级4.1%，III级1.0%）；1×7 Gy组为10.5%（布鲁克I级10.5%，II级0%，III级0%）。吲哚美辛7天组15.9%发生异位骨化（布鲁克I级8%，II级6.2%，III级1.7%，IV级0%）；吲哚美辛14天组为12.2%（布鲁克I级8.9%，II级2.2%，III级1.1%）；ASS组为37.5%（布鲁克I级27.9%，II级4.3%，III级5.3%）。4×3 Gy组和1×7 Gy组异位骨化发生率最低，但这两种不同治疗方法之间未观察到显著差异。
髋关节置换术后对手术部位进行预防性放疗比使用NSAID更有效。由于分次单次剂量放疗之间未发现显著差异，且后者对患者更舒适、更经济，因此应首选单次7 Gy剂量的放疗。
