吲哚美辛预防髋臼骨折术后异位骨化的疗效分析

Prevention effect of indomethacin on heterotopic ossification after acetabular fracture surgery

[目的]探讨吲哚美辛在预防髋臼骨折术后异位骨化中的作用。[方法]回顾性分析本院自2009年1月~2012年1月收治的120例采用Kocher-Langenbeck入路治疗的髋臼骨折病例,将上述患者随机分为两组,无药物组患者60例,术后无任何药物干预,吲哚美辛组患者60例,术后1d开始口服吲哚美辛,25 mg/次,3次/d,持续4周;术后门诊随访X线片并记录异位骨化发生情况,随访时间最短6个月,最长18个月。[结果]在所有的患者中,异位骨化发生率为49%,其中Brooker Ⅰ级16例,Ⅱ级18例,Ⅲ级15例,Ⅳ级10例,18例患者有症状,4例需要再次手术。吲哚美辛组与无药物组相比,轻度异位骨化发生率明显降低,但重度异位骨化的发生率无明显差异。[结论]髋臼骨折术后应用吲哚美辛并不能有效预防重度异位骨化的发生,应提高医生手术技巧,降低发生率。

[Objective] To investigate the effect of indomethacin on prevention of heterotopic ossification （HO） after surgical treatment of acetabular fracture. [Methods] A total of 120 patients with acetabular fractures treated with a Kocher-Langenbeck approach in our hospital were reviewed in this study. Of them, 60 patients were divided into the trial group with indomethacin 25 mg each time, 3 times per day for 4 weeks, while the remaining 60 patients enrolled into the control group without interference of the drug after surgery. Symptoms and reoperations, as well as sign of HO on radiographies were documented and compared between the two groups, [Results] The patients were followed up from 6 months to 18 months. The overall incidence of radiographic HO was 49%, including 16 in Brocker I, 18 in Brooker II, 15 in Brooker III and 10 patients in Brooker IV. Eighteen patients presented symptoms, 4 patients of them underwent reoperations for excision of HO. Compared with the control group, the incidence of mild HO in the trial group decreased with significant differences （P〈0.05） . However, there was no significant difference in incidence of severe HO between the two groups （P〉0.05） . [Conclusions] Indomethacin cannot prevent severe HO effectively, so improved surgical technique is still need for surgeons to minimize damage in operation.