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Heterotope Ossifikationen bei Querschnittlähmung

Management zur Frühdiagnose und Therapie

Heterotopic ossification after acute spinal cord injury: early diagnosis and therapy

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Zusammenfassung

Heterotope Ossfikationen sind eine häufige und gefürchtete Komplikation bei Rückenmarkverletzten. Präzise Kenntnisse der Pathogenese und Ätiologie fehlen; die klinischen Symptome im Frühstadium sind wenig charakteristisch; pathognomonische Laborparameter gibt es nicht. In der Zeit zwischen 03/97 und 05/00 wurden 290 Frischverletzte ab der 2. Woche nach Rückenmarktrauma in 3-wöchentlichen Rhythmen sonographisch untersucht, wobei das periartikuläre Gewebe des Hüftgelenks als Prädilektionsstelle beurteilt wurde. Bei insgesamt 12% der Patienten fanden wir die spezifischen pathologischen Schallmuster, wobei zum Zeitpunkt der ersten sonographischen Diagnose das konventionelle Röntgenbild noch unauffällig und laborchemisch kein signifikantes Korrelat nachzuweisen war. Nur wenige Patienten zeigten zudem klinische Symptome. Sämtliche Patienten wurden unmittelbar nach Diagnosestellung einer Bestrahlungstherapie in Form von 5×3 Gy zugeführt. Im weiteren Verlauf konnte bei allen Patienten eine Progredienz verhindert werden, insofern die Diagnose im Frühstadium gestellt wurde und eine sofortige Behandlung erfolgte. Die Studie zeigt, dass die Ultraschalldiagnostik eine sichere, schnelle und jederzeit reproduzierbare Methode zur Frühdiagnostik heterotoper Ossfikationen darstellt.

Abstract

Heterotopic ossification is a frequent and potentially disastrous complication of acute spinal cord injury. Pathogenesis and etiology are not well described, initial clinical symptoms are uncharacteristic, specific laboratory findings do not exist. Between March 1997 and May 2000 all 290 patients admitted to our facility with acute spinal cord injury underwent standardized sonographic examinations of the soft tissue around the hip joint every three weeks, starting as early as two weeks after injury. In 12% of the patient population characteristic sonographic findings for heterotopic ossification were present while the regular x-ray examination was still unremarkable. Laboratory findings (alkaline phosphatase, C-reaktive protein, anorganic phosphate) were unspecific. Clinical findings were present only in a few patients. All patients underwent radiotherapy consisting of the administration of 5 times 3 Gy to the area as soon as possible. Follow up demonstrated no progression of the heterotopic bone formation in these cases. In conclusion, regular ultrasound examination proved to be a secure, fast and reproducible method for the very early diagnosis of heterotopic ossification after acute spinal cord injury.

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  1. Abteilung für Wirbelsäulen- und Rückenmarkverletzte, BG-Unfallklinik Murnau

    D. Maier

  2. Abteilung für Wirbelsäulen- und Rückenmarkverletzte, BG-Unfallklinik, Prof. Küntscherstraße 8, 82418, Murnau

    D. Maier

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Maier, D. Heterotope Ossifikationen bei Querschnittlähmung. Orthopäde 34, 120–127 (2005). https://doi.org/10.1007/s00132-004-0754-9

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