CAJ | 학술논문

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.
목적 탐토신타미신연합국부방료예방관구골절이위골화절제술후복발적효과. 방법 회고성분석2005년10월지2010년11월기간인관구골절술후중도이위골화(Brooker분급위Ⅲ、Ⅳ급)화관관절활동명현수한이행이위골화절제적18례환자자료,남17례,녀l례;골화절제시평균년령위36.8세(22 ～ 54세).골화절제지관구골절수술시간평균위9.9개월(3～ 30개월).소유환자균연합응용신타미신화국부방료이예방골화복발.신타미신위구복,25 mg/차,3차/d,지속6주.방료위국부단차,제량위7～8 Gy. 결과 18례환자술후획평균4.5년(2.1～7.8년)수방.6례환자이위골화복발,균위경도(Brooker분급위Ⅰ、Ⅱ급).재관구골절술후6개월내행이위골화절제적7례환자중,2례환자복발;재관구골절술후초과6개월행이위골화절제적11례환자중,4례환자복발.말차수방시안관관절Harris평분표준평정료효:우9례,량3례,가4례,차2례.관관절활동도평균위194°(90°～260°).병발증포괄:이위골화절제술중고골경골절l례,의원성좌골신경손상l례,고골두배사2례.무일례환자발생절구감염、심정맥혈전형성급폐전새.미발현여신타미신화국부방료상관적병발증. 결론 연합응용신타미신화국부방료가이유효예방관구골절환자이위골화절제술후복발,조기절제가능병불회증가이위골화복발적풍험.
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° (range,90° to 260°).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.