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Myositis ossificans circumscripta

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Book cover Orthopädie und Unfallchirurgie

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Zusammenfassung

Die Myositis ossificans circumscripta (MOC) wurde bereits im 19. Jahrhundert beschrieben, im Weiteren wurden ektope Knochenneubildungen nach endoprothetischer Versorgung des Hüftgelenks, nach Infektionen, Polytrauma, traumatischen Querschnittssyndromen und Gelenkverletzungen wie z. B. Acetabulumfrakturen beobachtet. Es existieren verschiedene Bezeichnungen, wie z. B. heterotope Ossifikation, ektope Knochenneubildung oder Paraosteoarthropathie. Die Pathophysiologie der MOC ist noch nicht vollständig aufgelöst, es konnte inzwischen unter anderem ein Einfluss des angeborenen und des erworbenen Immunsystems nachgewiesen werden. Die Patienten beklagen an betroffenen Gelenken eine eingeschränkte Beweglichkeit, Schwellungen oder zunehmende Gelenksteife, die häufig mit Schmerzen einhergehen. Die konventionelle Röntgendiagnostik ist weiterhin die primäre Standarddiagnostik, Schnittbildgebungen, wie die Computertomografie, helfen insbesondere bei einem geplanten operativen Eingriff. Es konnten sich für die unterschiedlichen anatomischen Regionen verschiedene Klassifikationssysteme durchsetzen, hierunter die Brooker-Klassifikation an der Hüfte und die Klassifikation nach Hastings und Graham am Ellenbogen. Als Prophylaxe existieren die medikamentöse Therapie mit NSAR und die Bestrahlung. Nach hüftendoprothetischer Versorgung konnte für beide Formen eine gute Wirksamkeit belegt werden, für andere anatomische Regionen sind die Ergebnisse häufig nicht so eindeutig. Die operative Therapie ist bei der klinisch einschränkenden MOC insbesondere bei Kontakt zu neurovaskulären Strukturen indiziert. Die Indikation muss streng gestellt werden und unterliegt auch anderen Überlegungen, wie dem Abstand zum Trauma und einem entsprechenden postoperativen Management.

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  1. Klinikum der Universität München, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, München, Deutschland

    Christian Zeckey

  2. Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland

    Christian Kammerlander

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Zeckey, C., Kammerlander, C. (2019). Myositis ossificans circumscripta. In: Orthopädie und Unfallchirurgie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54673-0_41-1

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