放疗联合吲哚美辛对髋关节异位骨化切除术的辅助治疗作用

Effect of Radiotherapy Combined with Indomethacin as an Adjunctive Therapy for Heterotopic Ossification at the Hip

目的探讨放疗联合吲哚美辛对髋关节异位骨化(heterotopic ossification,HO)切除术的辅助治疗效果。方法回顾分析2005年11月～2008年12月对有完整随访资料的15例高危髋关节HO形成(均为男性,中位年龄34岁)的临床资料。采用常规K-L入路关节松解术,放疗采用前后对穿照射,照射野包括整个手术区域,6MV-X,源轴距100 cm,剂量以髋关节中心平面计算,术前1～4 h内或术后24 h内单次放疗组织剂量(dose of tissue,DT)7～8 Gy。所有患者术后常规服用吲哚美辛4周(25 mg,tid)。结果 15例中位随访时间20.5月(5.5～42.5月),随访时牛津髋关节功能评分(Oxford hipscore,OHS)评分为(15.7±6.2)分,较治疗前OHS评分(33.5±10.8)分明显降低(t=6.259,P=0.000)。11例(73.3%)关节活动完全恢复正常,3例(20.0%)好转,1例(6.7%)加重。5例治疗前有关节疼痛者,随访时4例疼痛消失,1例明显减轻。未观察到毒副反应。2例(13.3%)分别在术后6、3个月X线片显示HO复发,其中1例无临床症状,另1例发展为临床型HO,关节活动障碍较前加重。结论放射治疗联合吲哚美辛辅助用于预防高危患者的髋关节术后HO可能具有一定的疗效。

ObjectiveTo investigate the effect and side effect of radiotherapy combined with indomethacin on preventing the recurrence of heterotopic ossification（HO） at the hip following surgical treatment.MethodsA retrospective analysis on 15 consecutive patients（all male,median age 34 years） with high risk for HO formation at the hip,who received treatment in our department from November 2005 to December 2008.Surgery was done through routine approach（K-L）.All RT was delivered by using 6 MV photons via an opposing field arrangement prescribed to midplane（SAD=100 cm） of the hip.The treatment volume included the soft tissue in the operation area.All the patients received 7-8 Gy within 1-4 hours preoperation or within 24 hours postoperation.All of them took indomethacin（25 mg,tid） for 4 weeks after the operation as a routine method.ResultsMedian follow-up was 20.5 months（range,5.5-42.5 months）.The postoperative Oxford hip score（OHS） decreased significantly compared to preoperation（15.7±6.2 vs.33.5±10.8,t=6.259,P=0.000）.The hip function of 11（73.3%） cases became normal,3（20.0%） cases reached a functional improvement compared to the preoperative status;only 1 deteriorated.4 of the 5 patients who had local pain had the symptom disappeared and the other one was improved.All the cases had no side effect caused by radiation.Two（13.3%） cases had radiological failure;one of them had no symptom but the other one developed clinical HO because of aggravated function failure.ConclusionThe combination of radiotherapy and NSAIDS（indomethacin） may prevent HO formation after surgical treatment for the hip with a high risk.