Heterotope Ossifikationen

Heterotope Ossifikationen sind ein bekanntes Phänomen in Orthopädie und Unfallchirurgie und Gegenstand aktueller Forschung. Im Folgenden präsentieren wir den derzeitigen Kenntnisstand zu Pathophysiologie, Diagnostik, Therapie und Prävention mit zwei Fallbeispielen und abschließender Erfolgskontrolle.

Kernaussagen

• Heterotope Ossifikationen (HO) sind ein weiterhin aktuelles Krankheitsbild mit z. T. ausgeprägtem klinischem Charakter.

• Schonendere Operationstechniken und optimierte perioperative Abläufe haben zu sinkenden Inzidenzen geführt.

• Schwere Fälle von HO beobachten wir bei septischen Fällen.

• Ungeklärt sind derzeit noch die exakte Pathogenese und Pathomechanik, vor allem bei noch ausstehenden Kontrollstudien.

• In schweren Fällen mit ausgeprägter Bewegungseinschränkung des betroffenen Gelenks sollte eine chirurgische Exzision in Verbindung mit einer lokalen Bestrahlung im Sinne einer Sekundärprophylaxe erfolgen.

• Der OP-Zeitpunkt zur HO-Abtragung sollte so gewählt werden, dass die aktive Verknöcherung abgeschlossen ist.

• Zur Beurteilung können eine Szintigrafie und Laborparameter herangezogen werden.

• Die Bestrahlung kann bis zu 24 h prä- und 96 h postoperativ erfolgen. Als Strahlendosis sollten minimal 6 Gy bis maximal 12 Gy gewählt werden.

• Es kann eine postoperative Ossifikationsprophylaxe für mindestens 14 Tage erfolgen.

• Bei neurogener HO können sonografische Screeninguntersuchungen zu einer frühzeitigen Erkennung und Behandlung des Krankheitsbildes führen.

Schlüsselwörter

Myositis ossificans - NSAID - Verknöcherung - Hüft-TEP - Bewegungsumfang

Publikationsverlauf

Artikel online veröffentlicht:
04. Juni 2023

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