吲哚美辛预防髋臼骨折术后异位骨化的临床研究

目的通过服用吲哚美辛预防髋臼骨折术后异位骨化(HO)的发生以了解非甾体类抗炎药抑制HO形成的效果。方法对2001年2月～2003年8月采用Kocher-Langenbeck(K-L)入路治疗并在术后服用吲哚美辛的50例髋臼骨折患者进行随访研究(用药组),其结果与1993年3月～1998年5月采用相同后入路治疗而在术后未服用吲哚美辛的40例髋臼骨折患者进行对照研究(对照组)。用药组患者从术后第1天开始口服吲哚美辛,25 mg/次,3次/d,应用4周。术后定期对患者进行复杏。随访术后HO的发生情况,并对所有患者进行临床功能评价。结果用药组48例患者获完整资料随访,平均随访时间为22．8个月(6～39个月)。8例患者发生HO,据Brooker分型：Ⅰ度5例,Ⅱ度3例,尤严重HO(Ⅲ、Ⅳ度)发生；HO的发生率为16．7。对照组40例患者获平均26．4个月(4～58个月)随访。14例患者发生HO,HO发生率为35．0%,其中4例为严重HO。两组患者HO和严重HO的发生率差异均有显著性意义(P＜0．05)。结论吲哚美辛对髋臼骨折术后HO形成有一定的预防作用。     

全髋关节置换术后双下肢不等长对功能和满意度影响的研究

目的：研究全髋关节置换术后下肢不等长与患者功能的关系。方法：随诊80例（其中男38例,女42例;年龄56～86岁,平均72.3岁）2004年6月至2007年6月行初次单侧全髋关节置换术的患者,术后拍摄双髋正位X线片,测量出双下肢长度差;术后3个月及1年分别对患者随访,用牛津髋关节功能评分（OHS）评估患者术后功能及满意度。结果：①下肢长度。术后患肢延长者52例,平均延长（9.2±3.2）mm,其中延长1～10mm者29例,平均4.9mm;延长11～22mm者23例,平均14.6mm。缩短者13例,平均缩短（6.4±2.1）mm;等长者15例。②牛津髋关节功能评分。术后3个月OHS评分结果显示下肢延长者,延长1～10mm组与延长11～22mm组之间OHS评分差异无统计学意义（P=0.766）;下肢延长者（两组）比缩短者及等长者OHS评分差;缩短者与等长者之间OHS评分差异无统计学意义（P=0.437）。术后1年OHS评分结果显示下肢延长11～22mm者比缩短者、等长者及下肢延长1～10mm者OHS评分差;缩短者、等长者及下肢延长1～10mm者之间OHS评分差异无统计学意义（P=0.657）。肢体延长11～22mm者、肢体等长者、肢体缩短者的术后3个月与术后1年OHS评分相比差异均无统计学意义;肢体延长1～10mm者的术后3个月与术后1年OHS评分差异有统计学意义（P〈0.05）。结论：全髋置换术后下肢不等长,尤其是患肢延长11～22mm对术后功能有很大的影响,且不会随时间推移而减轻。因此,术前、术中应尽量采取措施避免下肢不等长的产生,术后则应积极对下肢不等长进行处理。     

系统手术松解疗法治疗创伤后肘关节僵硬

目的回顾性探讨采用系统手术松解疗法治疗创伤后肘关节僵硬的疗效。方法自1996-04—2010—05采用手术松解治疗来自香港大学玛丽医院的26例创伤后肘关节僵硬．平均初次受伤后12个月进行手术松解。术中完全清除关节囊内、外的粘连。所有患者术后均使用支具固定,并在服用吲哚美辛下进行复康治疗6周。平均随访25．6个月。通过比较手术前后关节活动范围及Mayo肘关节功能评分评定疗效。结果所有患者关节活动平均幅度由术前48°（0～80°）改善至末次随访时104°（40～130°）。末次随访平均Mayo评分为87分。1例出现外侧肘韧带松弛并导致肘关节半脱位。结论采用系统手术松解治疗创伤后肘关节僵硬可有效改善关节活动度及整体肘关节功能。     

吲哚美辛联合生长抑素预防ERCP术后胰腺炎

目的 探讨生长抑素联合吲哚美辛预防性治疗内镜逆行胰胆管造影（ERCP）术后胰腺炎的效果及对血清淀粉酶水平的影响。方法 选择2017年5月至2018年5月佛山市第一人民医院胆道外科204例行ERCP术的患者为研究对象,随机分为3组,每组68例。A组基础性治疗+安慰剂塞肛,B组基础治疗+术前半小时100 mg吲哚美辛塞肛,C组基础治疗+术前半小时100 mg吲哚美辛塞肛+术中250 μg/h生长抑素泵入11 h。比较各组患者术后胰腺炎发生率,ERCP术后6、12、24及48 h血清淀粉酶变化和临床症状体征评分变化。结果 3组患者年龄、性别、病因、胆总管直径、术中Oddi括约肌切开等基本资料比较无统计学差异（P>0.05）。B组和C组术后胰腺炎发生率显著低于A组（P<0.05）。术后6、12、24及48 h B组和C组血清淀粉酶水平、临床症状与体征评分均明显低于A组（P<0.05）。进一步分析显示,C组术后胰腺炎发生率,术后12、24及48 h血清淀粉酶水平及临床症状与体征评分均低于B组（P<0.05）。结论 生长抑素联合吲哚美辛能够有效预防ERCP术后胰腺炎发生,同时有效降低血清淀粉酶水平,改善患者临床症状,疗效优于单独给予吲哚美辛治疗,值得临床推广应用。     

序贯应用地塞米松及吲哚美辛栓剂防治Wilson病脾切除术后发热

目的 观察地塞米松联合吲哚美辛栓剂序贯用药防治肝豆状核变性合并脾功能亢进(脾亢)病人术后发热的疗效及并发症.方法 分析1995年1月至2007年1月,小剂量地塞米松联合吲哚美辛栓剂序贯用药,防治45例肝豆状核变性病人脾切除术后发热,并与对照组42例进行比较.结果 治疗组术后1周内体温恢复正常者42例(93.3%),术后2周内体温全部恢复正常(100%),发生各种并发症5例(11.1%);对照组术后1周内体温恢复正常者26例(61.9%),术后2周内共32例(76.2%),发生各种并发症12例(28.6%).结论 肝豆脾切除术后序贯应用地塞米松及吲哚美辛栓剂防治发热疗效确切(P＜0.01)且能显著降低术后并发症(P＜0.01).     

吲哚美辛对门静脉高压症术后免疫功能影响的临床研究

目的：探讨吲哚美辛（消炎痛）栓剂对门静脉高压症术后病人免疫功能的影响。方法：观测14例应用吲哚美辛的门静脉高压症（A组）和13例对照组病人（B组）手术前后IgG,IgM,C3,C4,T细胞亚群,NK细胞,PGE2（前列腺素E2）,TXB2（血栓素B2）,6－K－PGF1α（6酮前列腺素F1α）的变化及吲哚美辛的毒副作用。结果：术后A组PGE2,TXB2,6－K－PGF1α均显性低于B组,CD4,NK细胞均显性高于B组,未见明显的毒副作用。结论：吲哚美辛有助于改善门静脉高压症病人术后的免疫功能,短期经直肠给药,不会引起不良反应。     

吲哚美辛对ERCP术后高淀粉酶血症及胰腺炎的预防作用

目的观察常规直肠应用吲哚美辛栓剂对内镜下逆行胰胆管造影术(endoscopic rectrograde cholangiopancreatography,ERCP)术后高淀粉酶血症、胰腺炎的预防作用。方法回顾性分析2009年1月至2014年12月,池州市人民医院消化内镜中心行ERCP治疗的166例临床患者资料,其中术前预防性使用吲哚美辛栓纳肛的病例94例,未使用吲哚美辛72例,比较两组ERCP术前、术后3 h、术后24 h血清淀粉酶水平及术后高淀粉酶血症、胰腺炎的发生率。结果 2组患者术前血淀粉酶无统计学差异(78.0±6.9 vs 87.8±7.8,P0.05),但吲哚美辛组术后3 h血淀粉酶水平显著低于对照组(175.6±67.7 vs438.6±77.4,P0.01),24 h血淀粉酶也低于对照组(227.8±37.3 vs 239.8±38.1,F=19.93,P0.01)。吲哚美辛纳肛组ERCP术后高淀粉酶血症发生率低于对照组(3.2%vs 5.6%,P0.01),吲哚美辛纳肛组ERCP术后胰腺炎发生率也低于对照组(7.4%vs 12.5%,P0.01)。结论 ERCP术前使用吲哚美辛可以预防ERCP术后高淀粉酶血症及术后急性胰腺炎的发生,可以作为常规预防手段使用。     

氯美扎酮联合吲哚美辛栓治疗慢性非细菌性前列腺炎／慢性盆腔疼痛综合征的研究

目的评价氯美扎酮联合吲哚美辛栓治疗以疼痛为主诉的慢性非细菌性前列腺炎／慢性盆腔疼痛综合征（CP／CPPS）的疗效。方法对符合CP／CPPS标准的180例患者随机分为吲哚美辛栓组、氯美扎酮联合吲哚美辛栓组及特拉唑嗪组,疗程4周。在治疗结束时进行疗效判定,疗效评价标准采用视觉模拟评分方法。结果中途退出7例,173例患者进行了疗效评价,联合治疗组症状改善总有效率与吲哚美辛栓组（x^2=3．87,P〈0．05）和特拉唑嗪组（x^2=6．82,P〈0．01）相比疗效差异有统计学意义。治疗过程中无严重不良反应发生。结论氯美扎酮联合吲哚美辛栓可作为CP／CPPS疼痛患者的一种有效治疗手段。     

托特罗定联合吲哚美辛栓剂治疗前列腺术后膀胱痉挛临床观察

目的观察托特罗定联合吲哚美辛栓剂治疗前列腺术后膀胱痉挛临床疗效。方法回顾性分析,将89例前列腺增生术后膀胱痉挛患者随机分为对照组和实验组,对照组患者手术当日口服托特罗定2 mg,2次/d,于拔除导尿管前1 d停药;实验组患者手术当日口服托特罗定2 mg,2次/d,加上吲哚美辛直肠栓剂50 mg纳肛,2次/d,于拔除导尿管前1 d停药。结果实验组在术后72h内膀胱痉挛的发作次数,膀胱痉挛持续时间、膀胱冲洗时间、膀胱冲洗液转清时间均明显优于对照组。结论托特罗定联合吲哚美辛栓剂治疗前列腺术后膀胱痉挛的疗效显著,优于单独应用托特罗定治疗膀胱痉挛的效果。     

新型短柄全髋关节置换手术技术及近期疗效观察

目的介绍新型短柄全髋关节置换手术技术及评价其治疗髋关节疾病的近期临床疗效。方法首次接受陶瓷对陶瓷短柄人工全髋关节置换术患者12例（16髋）,均采用后外侧入路。结果 12例均获随访,时间8～14（12±1.08）个月。术后髋关节疼痛均明显好转,随访期内无严重并发症发生。Harris评分：术前38～55（49±5.27）分,术后为87～97（93±6.37）分,优11髋,良4髋,可1髋,优良率为93.8%。结论新型短柄全髋关节置换术治疗年轻患者和对关节功能要求较高的中年患者近期疗效满意,术后髋关节疼痛和髋关节功能明显改善。     

Prevention of heterotopic bone formation in high risk patients post-total hip arthroplasty

A retrospective study was carried out to evaluate prophylaxis for heterotopic ossification (HO) about the hip joint post total hip arthroplasty (THA). Between 1990 and 1996, 20 patients with known risk for developing HO were treated prophylactically to prevent this complication. Patients at risk were divided into 3 groups based on risk factors for HO formation (previous ipsilateral hip HO formation, previous contralateral hip HO formation and bilateral hypertrophic osteoarthritis) Single fraction radiotherapy of 600, 700 or 800 cGy was administered postoperatively to all patients. The aim was to irradiate all patients within 72 hours of THA. 12 (60%) patients received in addition a short course of postoperative indomethacin for less than 13 days. Patients in this study were investigated for the following treatment variables: relative risk for forming HO, radiotherapy doses administered, time delays between surgery and irradiation, combined radiotherapy and indomethacin treatment versus radiotherapy alone, and surgical approach used for THA. Heterotopic ossification in patients was measured radiographically by use of the Brooker grading sytem, and was assessed clinically by use of the Harris Hip Score (HHS). A significant difference was found between relative risk groups (p = 0.02). Patients with previous HO formation in the ipsilateral hip joint were at greater risk of developing HO than those with previous contralateral HO formation. Moreover both of these groups were at greater risk than those with advanced bilateral hypertrophic osteoarthritis. Other variables studied showed differences that were not significant due to small sample numbers. This study, though limited by sample number, addresses questions regarding effective radiotherapy dosage, time delays acceptable before irradiation postoperatively, usefulness of short course postoperative indomethacin, and preferred operative approaches to minimise HO.     

Preventive effects of ibuprofen on periarticular heterotopic ossification after total hip arthroplasty: A randomized double-blind prospective study of treatment time

We determined the efficacy and the minimum treatment time necessary for prophylaxis with nonsteroidal anti-inflammatory drugs (NSAIDs) for periarticular heterotopic ossification (HO) after total hip arthroplasty (THA). Using a double-blind placebo controlled design, 144 patients operated on with total hip arthroplasty for primary arthrosis were treated postoperatively with (1) ibuprofen for 3 weeks, (2) ibuprofen for 1 week and placebo for the next 2 weeks or (3) placebo for 3 weeks. Radiographic occurrence of periarticular heterotopic ossification and complications of the treatment were recorded for the first year.

Both ibuprofen-treated groups showed significantly less HO than the placebo-treated group. There was no difference in HO between the patients treated for 8 or 21 days postoperatively. Both 8 and 21 days of treatment with ibuprofen following THA effectively prevents clinically significant degrees of HO. No serious short-term complications of the treatment were noted.     

Total hip arthroplasty for ankylosed hip secondary to heterotopic ossification

Heterotopic ossification (HO) secondary to traumatic brain injury occurs at various sites and most commonly at the elbow, shoulder, and hip. There are few published reports on the assessment and surgical resection techniques of HO. A complete preoperative physical examination and radiologic assessment with a computed tomographic scan are important for the thorough evaluation of a patient. We describe a patient with neurogenic HO of the hip secondary to traumatic brain injury who underwent a total hip arthroplasty (THA). In selected patients with hip HO, THA supplemented with postoperative radiotherapy and indomethacin prophylaxis can facilitate progressive functional movements of the hip. To our knowledge, there is no report in the English literature of a THA being preformed for HO.     

Spinal cord insults and heterotopic ossification in the pediatric population

Fifteen of 152 pediatric patients with spinal cord insults (10%) developed heterotopic ossification (HO) at 19 locations. The average age of the patient was eight and one-half years. The spinal cord levels were 13 thoracic and two cervical. The average time to detection of the HO from spinal insult was six and one-half years. The hip was involved in 15 of 19 HO lesions. Decreased range of motion of the affected extremity was the most common sign of occurrence. Alkaline phosphatase was elevated in five of eight patients at the time of detection. Three patients had some resorption of the HO, and one had nearly complete resorption. Five patients (3.3%) with HO had no other etiologic agent other than the neurologic insult, and their average age at time of injury was 13 and one-half years. The hip was involved in six of seven instances. The average time to diagnose this HO was 14 months after injury. Ten patients had late concurrent etiologic factors such as surgery, decubitus ulcers, late neurogenic hip dislocation, and late acute local trauma influencing HO formation. Pediatric patients who developed HO appeared to have a lower incidence, delayed onset, and fewer associated signs and symptoms compared with their adult counterparts with spinal cord injury. Patterns of ossification about the hip differ from adults. The HO lesion has the potential to resorb. HO may be initiated years after the spinal injury by an incidental insult.     

External beam radiation helps prevent heterotopic bone formation in patients with a history of heterotopic ossification

The aim of this study was to determine if radiation prevents heterotopic ossification (HO) in HO-forming patients after total hip arthroplasty (THA) or HO excision alone. Patients with HO in the ipsilateral hip (63 treated with THA revision and 25 treated with HO excision alone) and HO in the contralateral hip (36 treated with primary THA) were termed HO-forming patients. They underwent radiation to prevent HO. After excluding patients with inadequate follow-up, 84 patients were studied to determine if radiation prevents significant HO (Brooker Grade 3-4). For patients with ipsilateral hip HO, 12.3% developed significant HO. In patients with contralateral hip HO, 10.5% developed significant HO after THA. Sixty percent who received 6 Gy in 3 fractions after excision of ipsilateral HO developed significant HO, which was higher than for all dose-fractionation schemes combined (P = .01). In contrast, patients who received 7 Gy in 1 fraction developed significant HO 13.8% of the time, which was equivalent to all dose-fractionation schemes combined (P = not significant). Radiation prevents HO in HO-forming patients.     

Total hip arthroplasty. The role of antiinflammatory medications in the prevention of heterotopic ossification

Postoperative prophylaxis with antiinflammatory medications, primarily indomethacin, is extremely effective in preventing the severest degrees of heterotopic ossification (HO) after a total hip arthroplasty (THA) and the recurrence of excised HO developed after a previous hip surgery. Prophylaxis with indomethacin should be given in 25-mg doses three times daily for at least three weeks, starting on the first postoperative morning. However, a shorter treatment period may be equally effective in preventing the severest degrees of HO, and a postoperative delay of five days before the initiation of prophylaxis does not seem to be followed by the development of severe HO. As evaluated one year after surgery, treatment with antiinflammatory medications in the immediate postoperative weeks did not increase the incidence of implant-bone interface radiolucencies, aseptic loosening, or revisions in cemented or cementless THAs when compared with cases that did not have postoperative treatment. However, although no major complications have been reported regarding the use of antiinflammatory medications in the prevention of HO after THA, orthopedic surgeons prescribing such treatment should be aware of their contraindications as well as early and late side effects. Since several antiinflammatory agents are reported to be effective in preventing HO, future reports dealing with HO after THA should always include information about the postoperative antiinflammatory treatment used.     

Short-term treatment with nonsteroidal antiinflammatory medications to prevent heterotopic bone formation after total hip arthroplasty. A preliminary report.

The effect of short-term postoperative treatment with nonsteroidal antiinflammatory medication to prevent the formation of heterotopic ossification (HO) after total hip arthroplasty (THA) was studied in two groups of patients. Group A included 46 noncemented THAs in 40 men. Eight patients (13 hips) received prophylaxis with 25 mg of indomethacin three times daily for 14 days, and 32 patients (33 hips) received prophylaxis of 650 mg of aspirin twice daily for six weeks. Six to 12 months after surgery, only one hip (aspirin treated) developed HO, this being Grade I. In group B, 17 hips in 17 patients with cemented THA received prophylaxis of 25 mg of indomethacin three times daily. Of these, 12 patients were given indomethacin from one to nine days. One year after surgery, five hips had no HO and seven hips showed a Grade I or Grade II lesion. The remaining five patients in Group B received indomethacin from 19 to 26 days; one developed HO. This study demonstrated that treatment with either 650 mg of aspirin twice daily for six weeks or 25 mg of indomethacin three times daily for the first 14 postoperative days is sufficient to prevent the formation of severe HO after THA.     

Heterotopic ossification following hip osteotomies in cerebral palsy: incidence and risk factors

The aims of this study are, first, to determine the incidence of heterotopic ossification (HO) in patients with cerebral palsy (CP) who have undergone pelvic and/or proximal femoral osteotomies and, second, to identify any risk factors that may contribute to its development in this patient population. The radiographs of 219 consecutive patients with CP who underwent proximal femoral osteotomies with or without pelvic osteotomies were reviewed. Risk factors including gender, age, and degree of involvement, ambulatory status, previous hip operations, bilateral hip surgery, capsular release, concomitant pelvic osteotomy, infection, and history of exuberant callus were evaluated. Thirty-five (16%) patients were diagnosed with HO and the 5 factors that cause HO were identified, which are degree of involvement (quadriplegic), ambulatory status, capsular release, infection, and previous hip operations. Based on logistic regression analysis, if a patient had quadriplegic type of CP, then they have 17.5 times more risk for HO than a patient with hemiplegic type, and capsular release increases the risk 237 times. Although HO occurred in 16% of patients treated with bony procedures in the hip, in a small group (2%) of children it had a clinically significant limitation requiring surgical resection. In this study, clear risk factors were presented for the development of HO; however, none of these risk factors can be altered in ways that will reduce the risk for HO. These risk factors might be used to define a high-risk group in whom attempts at prophylactic treatment for prevention of HO could be initiated.     

Refractory heterotopic ossification with complications

BACKGROUND: Heterotopic ossification (HO) following spinal cord injury can lead to various complications, including venous thrombosis, autonomic dysreflexia, and pressure ulcers. We report refractory, complicated HO in a 19-year-old man with C8 incomplete tetraplegia. He first presented at 9 weeks postinjury with fever and swelling of his right leg. Ultrasound indicated a deep venous thrombosis (DVT). Persistent symptoms prompted triple-phase bone scan and magnetic resonance imaging (MRI), which revealed HO compressing the right external iliac vein and no evidence of DVT. The HO was complicated by hypercoagulability. CLINICAL COURSE: The HO was refractory to oral indomethacin and etidronate; therefore, intravenous etidronate was instituted, resulting in only a transient decrease in alkaline phosphatase. Local irradiation of the right hip did not decrease the activity of HO. The patient was discharged on oral etidronate, indomethacin, and warfarin. This complicated case raises issues regarding early diagnosis and aggressive treatment of HO, as well as treatment of associated hypercoagulability.