Heterotopic Ossification – Complication or Chance?

Philip Peter Roessler; Rahel Bornemann; Cornelius Jacobs; Robert Pflugmacher; Matthias Trost; Stefanie Hölscher-Doht; Hendrik Jansen; Sönke Percy Frey

doi:10.1055/a-0732-5946

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2019; 157(03): 301-307
DOI: 10.1055/a-0732-5946

Review/Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Heterotope Ossifikation – Komplikation oder Chance?

Article in several languages: English | deutsch

Philip Peter Roessler

¹Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn

,

Rahel Bornemann

¹Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn

,

Cornelius Jacobs

¹Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn

,

Robert Pflugmacher

¹Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn

,

Matthias Trost

²Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik der Ruhr-Universität Bochum am St. Josef-Hospital Bochum, Katholisches Klinikum Bochum

,

Stefanie Hölscher-Doht

³Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederstellungschirurgie, Universitätsklinikum Würzburg

,

Hendrik Jansen

³Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederstellungschirurgie, Universitätsklinikum Würzburg

,

Sönke Percy Frey

²Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik der Ruhr-Universität Bochum am St. Josef-Hospital Bochum, Katholisches Klinikum Bochum

› Author Affiliations

Abstract

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

Full Text

References

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