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Prophylactic Radiotherapy to Prevent the Recurrence of Heterotopic Ossification after Surgical Intervention of the Elbow
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±èÇÐÀç ( Kim Hak-Jae )
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Á¤¹®»ó ( Chung Moon-Sang )
¼¿ï´ëÇб³ ÀÇ°ú´ëÇÐ Á¤Çü¿Ü°úÇб³½Ç
±èÀÏÇÑ ( Kim Il-Han )
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ÃÖÀÚ¿µ ( Choi Ja-Young )
¼¿ï´ëÇб³ ÀÇ°ú´ëÇÐ ¿µ»óÀÇÇаú
±è±Ôº¸ ( Kim Kyu-Bo )
¼¿ï´ëÇб³ ÀÇ°ú´ëÇÐ ¹æ»ç¼±Á¾¾çÇб³½Ç
±èÁøÈ£ ( Kim Jin-Ho )
¼¿ï´ëÇб³ ÀÇ°ú´ëÇÐ ¹æ»ç¼±Á¾¾çÇб³½Ç
KMID : 0859320070250040206
Abstract
¸ñ Àû: ÁÖ°üÀýÀÇ À̼Ҽº °ñÇü¼ºÀº ¼ö¼úÀ̳ª ¿Ü»ó ÈÄ¿¡ ¹ß»ýÇÏ´Â ÈçÇÑ ÇÕº´ÁõÀ¸·Î ¾Ë·ÁÁ® ÀÖ´Ù. º» ¿¬±¸´Â ÁÖ°üÀý¿¡¼ ¹ß»ýÇÏ´Â À̼Ҽº °ñÇü¼ºÀÇ Àç¹ß ¹æÁö¸¦ À§ÇØ ¿¹¹æÀû ¹æ»ç¼± Ä¡·á¸¦ ½ÃÇàÇÑ È¯ÀÚµéÀ» ´ë»óÀ¸·Î ÈÄÇâÀû ºÐ¼®À» ½ÃÇàÇÏ¿´´Ù.
´ë»ó ¹× ¹æ¹ý: ÁÖ°üÀý¿¡ À̼Ҽº °ñÇü¼ºÀ¸·Î Áø´ÜµÈ 45¸íÀÇ È¯ÀÚ°¡ ¼ö¼ú ÈÄ ¹æ»ç¼± Ä¡·á¸¦ ½ÃÇà ¹Þ¾Ò´Ù. À̼Ҽº °ñÇü¼ºÀÇ ÁÖµÈ ¿øÀÎÀº °ñÀý°ú ¿Ü»óÀ̾ú°í ¼ö¼ú Àü ÁÖµÈ Áõ»óÀº °¡µ¿°üÀý¹üÀ§ÀÇ Á¦ÇÑÀ̾ú´Ù. ¹æ»ç¼± Ä¡·á´Â ´ëºÎºÐÀÇ È¯ÀÚ¿¡¼ ¼ö¼ú ÈÄ 2ÀÏ ¾È¿¡ ½ÃÀÛÇÏ¿´°í 1ÀÏ Á¶»ç¼±·®À» 4 Gy¾¿ 2ȸ¿¡ °ÉÃÄ ÃÑ 8 Gy¸¦ Á¶»çÇÏ¿´´Ù. 29¸íÀÇ È¯ÀÚ¿¡¼ 1¡8°³¿ù µ¿¾È NSAID¸¦ Åõ¾à ¹Þ¾Ò´Ù.
°á °ú: Ä¡·á ÈÄ(60¡145o) ÃøÁ¤ÇÑ °¡µ¿°üÀý¹üÀ§¿¡¼ Ä¡·á Àü(0¡135o)º¸´Ù Åë°èÀûÀ¸·Î À¯ÀÇÇÑ Çâ»óÀ» º¸¿´°í(p=0.028), MEPI¸¦ ÀÌ¿ëÇÑ ±â´ÉÁö¼ö Æò°¡¿¡¼µµ Ä¡·á Àü(15¡90)º¸´Ù Ä¡·á ÈÄ(80¡100)¿¡¼ Åë°èÀûÀ¸·Î À¯ÀÇÇÏ°Ô Áõ°¡ÇÏ¿´´Ù. ÃßÀû °üÂû ½Ã ¹æ»ç¼± »çÁøÀÇ Æǵ¶ÀÌ °¡´ÉÇß´ø 34¸íÀÇ È¯ÀÚ Áß 2¸í¿¡¼ °æ¹ÌÇÑ À̼Ҽº °ñÇü¼ºÀÇ Àç¹ßÀÌ Àִ°ÍÀ¸·Î ³ªÅ¸³µ´Ù. Ä¡·á ÈÄ ÇÕº´ÁõÀº °üÂûµÇÁö ¾Ê¾Ò´Ù.
°á ·Ð: ÁÖ°üÀýÀÇ À̼Ҽº °ñÇü¼ºÀÇ °æ¿ì ¼ö¼ú ÈÄ ¿¹¹æÀû ¹æ»ç¼± Ä¡·á¸¦ ½ÃÇàÇÏ´Â °ÍÀº Àç¹ß ¹æÁö¸¦ À§ÇØ À¯¿ëÇÑ Ä¡·á·Î ¼±ÅÃµÉ ¼ö ÀÖ°í, ÇâÈÄ ´õ ¸¹Àº ȯÀÚ¸¦ ´ë»óÀ¸·Î ¿¬±¸°¡ ÁøÇàµÇ¾î¾ß ÇÒ °ÍÀ¸·Î »ý°¢µÈ´Ù.
Purpose: Heterotopic ossification is a well-known postoperative and post-traumatic complication of the elbow. We reviewed the treatment outcome for the use of low-dose radiation after surgical intervention of the elbow to prevent recurrence of heterotopic ossification (HO).
Materials and Methods: Forty-five patients with HO underwent surgical intervention and postoperative radiotherapy of the elbow. The median age of the patients was 29 years (16¡75 years), and 27 of the patients were men and 18 were women. The occurrence of HO was mainly due to surgery after fracture (24/45) and traumatic injury (21/45). Limitation of the range of motion (ROM) was the most common symptom of the patients. Thirty-four patients received postoperative radiotherapy with a dose of 8 Gy in 2 fractions; 5 patients received a dose of 10 Gy in 5 fractions and 6 patients received a dose of 7 Gy in 1 fraction. Postoperative radiotherapy was given on the first two postoperative days for most of the patients. Sixteen patients were not given anti-inflammatory medication and 29 patients were given NSAIDs for 1¡8 months.
Results: After a median follow-up period of 18 months (range 6¡72 months), 41 patients showed clinical improvement and two patients did not show improvement. Assessment of the ROM showed a mean improvement from 0¡135o to 60¡145o (p=0.028), and assessment of the functional outcome according to MEPI was from (15¡95) to (80¡100) (p£¼0.0001). Two of the 34 patients that were followed-up with radiography had mild radiological recurrence of heterotopic ossification. No complications were observed after the radiotherapy.
Conclusion: These results suggested that low-dose radiation administered after surgical intervention is safe and effective to prevent the recurrence of HO in the elbow
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À̼Ҽº °ñÇü¼º;ÁÖ°üÀý; ¹æ»ç¼± Ä¡·á
Heterotopic ossification;Elbow;Radiotherapy
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