Postoperative Low Dose Single Fraction Irradiation for Prevention of Heterotopic Bone Formation after Hip Surgery

利用手術後單劑量照射預防髖關節異位骨化

吳樂榮(Le-Jung Wu) ； 顏上惠(Sang-Hue Yen) ； 陳天雄(Tain-Hsiung Chen) ； 王令瑋(Ling-Wei Wang) ； 季匡華(Kwan-Hwa Chi) ； 陳光耀(Kuang Y. Chen)

《放射治療與腫瘤學》 2卷3期 (1995/09) Pp. 209-215

https://doi.org/10.6316/TRO/199502(3)209

摘要

髖關節異位骨化是髖關節手術後常見之幷發症，而有高危險因子的病患發生的比率更高，可高達50%。所謂高危險因子包括僵直性脊椎炎、骨關節炎、髖關節骨折、髖關節多次手術，異位骨化之既往歷。而預防高危險群病患手術後發生髖關節異位骨化的方法有手術改良，藥物治療及放射治療等三種方式。手術改良尚未證實有效，藥物治療雖然有效但需長期服用且易産生副作用，然而放射治療不僅有效且耗時短而爲臨床上常用之方式。從1989年至1994年，臺北榮總共治療了15位病人（18處髖關節），這些病人包括了僵直性脊椎炎（12例）、骨關節炎（1例）、髖部骨折（2例）、髖關節多次手術（3例），有異位骨化之既往歷（1例），有3例危險因子超過2個以上。這15例均為男性，年齡分佈從24至70歲，所作之手術包括全關節置換（14處關節）、人工關節修補（3處關節）、骨折接合術（1處關節）、放射治療則在手術後6天內實施。利用加馬線及一千萬伏特X光以前後對稱照野施以單次照射，照射範圍包括髖臼，股骨頭上半部及周圍軟組織，照射劑量是5或7格雷。治療後迫蹤4到66個月，期間有2處髖關節發生異位骨化，另有1處已發生異位骨化之關節則未繼續惡化。此外無1例發生幷發症及異位骨化引起之功能不良。我們之經驗顯示手術後單劑量照射對預防髖關節異位骨化是有效而安全的治療。

關鍵字

髖關節 ； 異位骨化 ； 放射治療

並列摘要

Purpose: To investigate retrospectively the effects of postoperative low-dose single fraction irradiation in prevention of ectopic bone formation after hip surgery in high-risk patients.
Materials and Methods: From 1989 to 1994 fifteen patients (18 hips) were treated with single-dose irradiation to hip joints after hip surgery in an attempt to prevent heterotopic bone formation. Of these patients, there were 12 patients with ankylosing spondilitis, 1 patient with osteoarthritis, 2 patients with bony fractures, 3 patients post multiple surgical procedures, and 1 patient with past history of ectopic bone formation. These patients received surgical procedures of primary total-hip arthroplasty (14 hips), revision of arthroplasty (3 hips), or open reduction of acetabular fracture (1 hip). Radiotherapy was delivered with either Cobalt-60 gamma ray (4 patients) or 10 MV X-ray (11 patients) at midplane doses of 5 or 7 Gy several hours to 6 days after operation.
Results: New ectopic bone formation was found in 2 patients (2 hips), while 1 patient (1 hip) has stable disease, with a follow-up time from 4 to 66 months (median=31 months). Neither functional disability nor complication related to heterotopic ossification and irradiation developed.
Conclusion: Postoperative low-dose single fraction irradiation with 5 or 7 Gy is an effective and safe procedure to prevent heterotopic bone formation in high-risk patients after hip surgery.

並列關鍵字

Hip joints ； Heterotopic ossification ； Radiotherapy