Heterotope Ossifikation – Komplikation oder Chance?

Zusammenfassung

Bislang gibt es keine eindeutigen Erklärungen der pathophysiologischen Zusammenhänge in der Entstehung der heterotopen Ossifikation (HO). Es gibt nur wenig experimentelle Daten, die sich mit der posttraumatischen Entzündungsreaktion in Bezug auf die Balance zwischen der Reparatur beschädigter Muskelzellen und der entgegengesetzten Reaktion bei ihrer Entstehung beschäftigen. Es gibt zahlreiche Hinweise in Bezug auf mögliche prädisponierende Faktoren wie das Vorliegen einer Hypoxie im umgebenden Gewebe oder die Funktion von proangiogenen (z. B. VEGF) und osteoinduktiven (z. B. BMP) Faktoren. Diese verschiedenen wissenschaftlichen Ansätze bieten die Möglichkeit, klinisch zu interventionieren. Aus unserer Sicht erscheint das frühe Eingreifen im Hinblick auf die Effektivität sowie das Wiederkehren der HO am sinnvollsten. Ein wichtiger Pathomechanismus scheint die chronische Inflammation zu sein. Derzeit sind die nicht steroidalen Antiphlogistika die am häufigsten verschriebenen Medikamente zur Prophylaxe. Die Effektivität und Wirksamkeit der nicht steroidalen Antiphlogistika ist nicht zuletzt auch durch die zeitlich begrenzte Freisetzung und das Nebenwirkungspotenzial limitiert. Daher ist es interessant, einen Fokus der zukünftigen Forschung in Richtung des Zusammenspiels zwischen immunsuppressiver Herunterregulierung der inflammatorischen Antwort sowie deren Effekt auf die Balance zwischen Muskelregeneration und Entstehung der HO zu richten.

Schlüsselwörter

heterotope Ossifikation - Knochen - Frakturheilung - Nerven - Nervenläsionen

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