Matteo Olivero, Ankit Kumar Garg, Miguel Cañones, Fernando Oñorbe San Francisco, Javier Montoya Adarraga, Anuj Chawla, Jorge Lopez-Subias, Ricardo Larrainzar Garijo, Oliver Marín-Peña
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引用次数: 0
摘要
目的 研究手术方式和术后预防措施对全髋关节置换术(THA)后异位骨化(HO)发生的影响。方法 对 2009 年 1 月至 2016 年 4 月间接受全髋关节置换术的 312 例患者进行回顾性分析。根据手术方式(直接外侧或后外侧)、假体类型和术后预防措施(每天服用60毫克依托考昔,连续两周)对患者进行分类。两名矫形外科医生以连续的时间间隔对X光片进行独立评估,并根据Brooker分类法对HO进行分级。为了评估不同变量之间的关联和混杂效应,研究人员进行了双变量分析和回归建模。结果双变量分析发现了与HO发生率较高相关的因素:未采取预防措施、年龄较大、症状演变时间较长以及手术前体力活动较少。回归模型显示,直侧入路、术后预防、症状演变和较高的 HO 发生率之间存在相关性。虽然直接侧方入路的 HO 发生率更高,但差异并不显著。在 THA 术后每天服用 60 毫克 Etoricoxib 的两周预防方案可有效减少 HO 的形成。药物预防应根据患者的特征和风险因素逐个进行评估。
Heterotopic ossification following total hip arthroplasty. Which is the predominant risk factor: surgical approach or post-operative prophylaxis?
Purpose
To investigate the impact of surgical approach and post-operative prophylaxis on heterotopic ossification (HO) development after total hip arthroplasty (THA).
Methods
A retrospective analysis of 312 patients who underwent THA between January 2009 and April 2016. Patients were categorized by surgical approach (direct lateral or posterolateral), prosthesis type, and post-operative prophylaxis (Etoricoxib 60 mg daily for two weeks). Two orthopaedic surgeons independently assessed radiographs at serial intervals, and HO was graded as per Brooker classification. Bivariate analysis and regression modelling were performed to assess the associations and confounding effects of different variables,
Results
Bivariate analysis identified factors correlated with higher HO incidence: absence of prophylaxis, older age, longer symptom evolution, and lower pre-surgery physical activity. Regression modelling showed a correlation between the direct-lateral approach, post-operative prophylaxis, symptom evolution, and higher HO incidence.
Conclusion
Patients with longer symptom evolution before surgery and without post-operative prophylaxis are at higher risk of developing HO. While the direct lateral approach showed higher HO rates, the difference was insignificant. A two-week prophylactic regimen of Etoricoxib 60 mg daily after THA effectively reduced HO formation. Pharmacological prophylaxis should be evaluated case-by-case, considering patient characteristics and risk factors.
期刊介绍:
International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters.
Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable.
The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.