吲哚美辛联合局部放疗预防髋臼骨折异位骨化切除术后复发

Indomethacin combined with local radiation to prevent recurrence following surgical resection of het-erotopic ossification in patients with acetabular fracture

目的 探讨吲哚美辛联合局部放疗预防髋臼骨折异位骨化切除术后复发的效果. 方法 回顾性分析2005年10月至2010年11月期间因髋臼骨折术后重度异位骨化（Brooker分级为Ⅲ、Ⅳ级）和髋关节活动明显受限而行异位骨化切除的18例患者资料,男17例,女l例;骨化切除时平均年龄为36.8岁（22 ～ 54岁）.骨化切除至髋臼骨折手术时间平均为9.9个月（3～ 30个月）.所有患者均联合应用吲哚美辛和局部放疗以预防骨化复发.吲哚美辛为口服,25 mg/次,3次/d,持续6周.放疗为局部单次,剂量为7～8 Gy. 结果 18例患者术后获平均4.5年（2.1～7.8年）随访.6例患者异位骨化复发,均为轻度（Brooker分级为Ⅰ、Ⅱ级）.在髋臼骨折术后6个月内行异位骨化切除的7例患者中,2例患者复发;在髋臼骨折术后超过6个月行异位骨化切除的11例患者中,4例患者复发.末次随访时按髋关节Harris评分标准评定疗效：优9例,良3例,可4例,差2例.髋关节活动度平均为194°（90°～260°）.并发症包括：异位骨化切除术中股骨颈骨折l例,医源性坐骨神经损伤l例,股骨头坏死2例.无一例患者发生切口感染、深静脉血栓形成及肺栓塞.未发现与吲哚美辛和局部放疗相关的并发症. 结论 联合应用吲哚美辛和局部放疗可以有效预防髋臼骨折患者异位骨化切除术后复发,早期切除可能并不会增加异位骨化复发的风险.

Objective To evaluate the effect of indomethacin combined with local radiation on prevention of recurrence of heterotopic ossification （HO） in patients with acetabular fracture after surgical resection.Methods Between October 2005 and November 2010,18 patients were operated on for severe HO （Brooker grades Ⅲ-Ⅳ） and limited hip joint motion after surgery for acetabular fractures.There were 17 males and one female.The average age was 36.8 years （range,22 to 54 years） when HO resection was performed.The average interval between HO resection and acetabular fracture operation was 9.9 months （range,3 to 30 months）.All of them received indomethacin （25 mg/tid for 6 weeks） combined with local radiation （single dosage 7 to 8 Gy） for prevention of HO recurrence.Results The average follow-up was 4.5 years （range,2.1 to 7.8 years）.Six patients had mild HO recurrence （Brooker grades Ⅰ-Ⅱ）.Of the 7 patients who had HO resected within 6 months,recurrence was found in 2.Of the other 1 1 patients who had HO resected beyond 6 months,recurrence was observed in 4.According to Harris hip score at the last follow-up,9 cases were excellent,3 good,4 fair and 2 poor.The range of hip motion averaged 194＆#176; （range,90＆#176; to 260＆#176;）.Other complications included intra-operative femoral neck fracture in one patient,iatrogenic sciatic nerve injury in one and avascular necrosis of the femoral head in 2.There was no wound infection,deep venous thrombosis,pulmonary embolism,or complications related to indomethacin or radiation.Conclusions Indomethacin combined with local radiation can be effective in prevention of HO recurrence after surgical resection in patients with acetabular fracture.Early resection may not increase the recurrence risk.