肘关节松解术前放射治疗预防异位骨化形成

Prophylaxis of heterotopic ossification:preoperative radiation therapy of elbow arthrolysis

目的探讨术前1～4h内单次放疗预防既往有肘关节异位骨化(HO)形成史的病人肘关节HO形成的效果及不良反应。方法回顾性分析了32例肘关节HO病人采用肘关节松解术前1～4h内单次放疗预防术后HO形成的研究结果,其中31例病人术前1～4h内单次放疗剂量总量(DT)7～8Gy;1例病人术前1～4h内单次放疗DT8Gy,术后第6天因出现部分关节功能障碍单次加量DT4Gy。3例病人放疗后短期服用NSAIDS类药物。对治疗前及末次随访时的肘关节功能进行分级,同时对治疗前及末次随访时的肘关节功能评分进行统计学分析。结果中位随访时间28.25个月(12～38.5个月),7例(21.9%)病人X线片显示HO复发,4例(12.5%)发展为临床型HO,有不同程度关节活动障碍。19例(59.4%)关节活动完全恢复正常。1例病人骨折不愈合,其他病人未观察到明显短期或长期放疗反应。治疗前及末次随访时的肘关节功能分为4级,2组间差异具有统计学意义(Z=4.198,P<0.01)。结论术前1～4h单次DT7～8Gy的放射治疗预防肘关节HO安全有效。

Objective To assess the efficacy and side-effect of preoperative radiation therapy with 7-8 Gy in patients receiving elbow arthrolysis. Methods Thirty-two patients with heterotopic ossification （HO） history at elbow were studied. Radiation therapy was given in 1 fraction of 7-8 Gy in 31 patients within 1-4 h before operation, and 2 fractions of 12 Gy in 1 patient （1 fraction of 8 Gy within 1-4 h before operation and 1 fraction of 4 Gy on the 6th day after operation）. Three eases took NSAIDS for a short time after operation. The elbow HO classification at baseline and last follow-up were analyzed. Results Median follow up was 28.25 months （range： 12-38.5 months）. X-ray films showed that 7 （21.9%） patients developed new HO. Four （12.5%） developed into clinical HO with function failure. The elbow function of 19 （59.4%） eases became normal. All eases had no side effect but one had bony nonunion. The Graham and Hastings HO classification scores were significantly different between pre-operation and last follow-up （Z= 4.198 ,P〈0.01）. Conclusions Preoperative radiation therapy of 7-8 Gy within 1-4 h of elbow arthrolysis is safe and effective.