非甾体类抗炎药联合放疗预防全髋关节置换术后异位骨化
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作者Author单位AddressE-Mail
吴锋锋 WU Feng-feng 湖州市中心医院骨科, 浙江 湖州 313000 Department of Orthopaedics, the Central Hospital of Huzhou, Huzhou 313000, Zhejiang, China  
高宏梁 GAO Hong-liang 湖州市中心医院骨科, 浙江 湖州 313000 Department of Orthopaedics, the Central Hospital of Huzhou, Huzhou 313000, Zhejiang, China bonemanzju@126.com 
黄胜 HUANG Sheng 湖州市中心医院骨科, 浙江 湖州 313000 Department of Orthopaedics, the Central Hospital of Huzhou, Huzhou 313000, Zhejiang, China  
王国荣 WANG Guo-rong 湖州市中心医院骨科, 浙江 湖州 313000 Department of Orthopaedics, the Central Hospital of Huzhou, Huzhou 313000, Zhejiang, China  
蒋雪生 JIANG Xue-sheng 湖州市中心医院骨科, 浙江 湖州 313000 Department of Orthopaedics, the Central Hospital of Huzhou, Huzhou 313000, Zhejiang, China  
李建有 LI Jian-you 湖州市中心医院骨科, 浙江 湖州 313000 Department of Orthopaedics, the Central Hospital of Huzhou, Huzhou 313000, Zhejiang, China  
寿志强 SHOU Zhi-qiang 湖州市中心医院骨科, 浙江 湖州 313000 Department of Orthopaedics, the Central Hospital of Huzhou, Huzhou 313000, Zhejiang, China  
期刊信息:《中国骨伤》2018年,第31卷,第6期,第538-542页
DOI:10.3969/j.issn.1003-0034.2018.06.011
基金项目:浙江省科技厅公益项目(编号:2017C33222);浙江省湖州市科技局公益一般项目(编号:2015GY18)
中文摘要:

目的:探讨非甾体类抗炎药(NSAIDs)联合放疗、NSAIDs、放疗3种方式对全髋关节置换术后异位骨化的预防效果及差异。

方法:将2015年2月至2016年7月因髋关节骨性关节炎而接受初次全髋关节置换术的168髋分为A、B、C组(A组随访54髋,B组随访55髋,C组随访54髋)。A组原发性骨关节炎5髋,股骨头缺血坏死继发骨关节炎37髋,髋臼发育不良继发骨关节炎12髋,术后口服塞来昔布(0.2 g,每天2次)2周;B组原发性骨关节炎6髋,股骨头缺血坏死继发骨关节炎32髋,髋臼发育不良继发骨关节炎17髋,给予术前单次7 Gy放疗;C组原发性骨关节炎5髋,股骨头缺血坏死继发骨关节炎35髋,髋臼发育不良继发骨关节炎14髋,术前放疗并予术后塞来昔布口服。术后观察各组胃肠道反应等不良反应情况,并应用骨盆前后位X线片评定异位骨化情况(采用Brooker分级)。

结果:各组平均随访21个月,A组成功随访54髋,出现异位骨化7髋,BrookerⅠ型5髋,BrookerⅡ型2髋;B组成功随访55髋,出现异位骨化8髋,BrookerⅠ型6髋,BrookerⅡ型2髋;C组成功随访54髋,出现异位骨化5髋,BrookerⅠ型4髋,BrookerⅡ型1髋。3组均无Brooker Ⅲ、Ⅳ型发生,3组异位骨化率差异无统计学意义(χ2=0.743,P=0.690)。A、B、C组出现不良反应分别为6例、6例、7例,差异无统计学意义(χ2=0.135,P=0.935)。

结论:在预防全髋关节置换术后异位骨化时,首推NSAIDs。
【关键词】关节成形术,置换,髋  放疗  骨化,异位性  副反应
 
NSAIDs combined with radiotherapy to prevent heterotopic ossification after total hip arthroplasty
ABSTRACT  

Objective: To investigate the preventive effects and differences of NSAIDs combined with radiotherapy,NSAIDs and radiotherapy for heterotopic ossification(HO) after total hip arthroplasty(THA).

Methods: From February 2015 to July 2016,168 hips undergoing primary THA were divided into group A,B and C,and 163 patients were followed up (54 cases and 54 hips in group A,55 cases and 55 hips in group B,54 cases and 54 hips in group C). Among group A,5 hips were primary osteoarthritis,37 hips were secondary osteoarthritis due to avascular necrosis of the femoral head,12 hips were secondary osteoarthritis due to acetabular dysplasia. Patients in group A received oral celecoxib (0.2 g,2 times a day) for 2 weeks after operation. Among group B,6 hips were primary osteoarthritis,32 hips were secondary osteoarthritis due to avascular necrosis of the femoral head,17 hips were secondary osteoarthritis due to acetabular dysplasia,all of which in group B were treated with preoperative single 7 Gy radiotherapy. Among group C,5 hips were primary osteoarthritis,35 hips were secondary osteoarthritis due to avascular necrosis of the femoral head,14 hips were secondary osteoarthritis due to acetabular dysplasia. Patients in group C were treated with preoperative radiotherapy and celecoxib after operation. The side effects of gastrointestinal reactions were observed after operation,and the heterotopic ossification was evaluated by pelvic anterior and posterior X-ray (Brooker grading).

Results: The mean clinical and radiological follow-up was 21 months(12 to 30 months). In group A,54 hips were followed up with 7 hips with heterotopic ossification,including 5 hips of BrookerⅠand 2 hips of BrookerⅡ. In group B,55 hips were successfully followed up,with 8 hips of heterotopic ossification occurred,including 6 hips of BrookerⅠ,2 hips of BrookerⅡ. In group C,54 hips were successfully followed up,with 5 hips of heterotopic ossification occurred,including 4 hips of BrookerⅠ,1 hip of BrookerⅡ. There was no significant difference in efficacy among 3 groups (χ2=0.743,P=0.690) by chi-square test. The prevalence of side effects were as following:in group A,there were 6 hips with side effects;in group B,there were 6 hips with side effects;in group C,there were 7 hips with side effects. There was also no significant difference in side effects among 3 groups (χ2=0.135,P=0.935).

Conclusion: The combined-therapy group has lower prevalence of HO than the NSAIDs group or radiotherapy group,but the statistical difference between them is not significant. NSAIDs is still the first choice to prevent HO after THA.
KEY WORDS  Arthroplasty,replacement,hip  Radiotherapy  Ossification,heterotopic  Side effect
 
引用本文,请按以下格式著录参考文献:
中文格式:吴锋锋,高宏梁,黄胜,王国荣,蒋雪生,李建有,寿志强.非甾体类抗炎药联合放疗预防全髋关节置换术后异位骨化[J].中国骨伤,2018,31(6):538~542
英文格式:WU Feng-feng,GAO Hong-liang,HUANG Sheng,WANG Guo-rong,JIANG Xue-sheng,LI Jian-you,SHOU Zhi-qiang.NSAIDs combined with radiotherapy to prevent heterotopic ossification after total hip arthroplasty[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(6):538~542
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