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Ossoskopie gutartiger osteolytischer Läsionen des Kalkaneus

Ossoscopy of benign osteolytic lesions of the calcaneus

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Tumorerkrankungen des Kalkaneus sind selten, müssen in der Differenzialdiagnostik unklarer Fersenschmerzen aber berücksichtigt und abgeklärt werden. Die juvenile Knochenzyste und das intraossäre Lipom sind bekannte Vertreter gutartiger Knochentumoren, die typischerweise das Fersenbein betreffen. Das Ward-Dreieck, welches am Os calcis auch als „Diard’s area 6“ bezeichnet wird und zwischen den Haupttrabekelgruppen zu finden ist, stellt hierbei den mit Abstand am häufigsten betroffenen Abschnitt des Kalkaneus dar. Im Fall von Schmerzen, aber auch um drohende pathologische Frakturen zu vermeiden, ist die operative Therapie mit Zystenausräumung und Auffüllung indiziert. Traditionell wurden symptomatische Fälle von intraossärem Lipom und juveniler Knochenzyste meist mittels offen-chirurgischer Kürettage und autologer Knochentransplantation behandelt. Die minimal-invasive Ossoskopie mit endoskopischer Resektion des Tumors und perkutaner Auffüllung des Defekts vermag Risiken und Komplikationen offen-chirurgischer Verfahren zu minimieren und stellt für den erfahrenen Arthoskopeur und Tumororthopäden eine interessante Behandlungsmöglichkeit gutartiger Osteolysen des Fußskeletts dar. Dieser Beitrag soll eine detaillierte Beschreibung der Operationstechnik bieten und vorläufige Ergebnisse der ersten Fallserie diskutieren.

Abstract

Tumorous lesions of the calcaneus are rare but must be considered and clarified in the differential diagnosis of unclear heel pain. Juvenile (unicameral) bone cysts and intraosseous lipoma are well-known representatives of benign bone tumors that are typically located in the heel bone. The Ward triangle, which is also referred to as Diard’s area 6 at the calcaneus, and which is located between the main trabecular groups, is the most commonly affected area of the calcaneus. In the case of pain and also to avoid imminent pathological fractures, surgical therapy is indicated with cyst resection and grafting. Traditionally, symptomatic cases of intraosseous lipoma and juvenile bone cysts were usually treated by means of open surgical curettage and autologous bone grafting. The use of minimally invasive ossoscopy with endoscopic resection of the tumor and percutaneous grafting of the defect may minimize the risks and complications of open surgical procedures and can offer an interesting option for the experienced arthroscopist and tumor specialist in the treatment of benign osteolytic lesions of the foot. This review is intended to provide a detailed description of the surgical technique and to discuss preliminary results of the first patient series.

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Abbreviations

AKZ:

Aneurysmatische Knochenzyste

AOFAS:

American Orthopaedic Foot and Ankle Society

CT:

Computertomographie

MRT:

Magnetresonanztomographie

PMMA:

Polymethylmetacrylat

PRP:

Platelet-rich plasma

UBC:

„Unicameral bone cyst“, solitäre/juvenile Knochenzyste

WHO:

World Health Organisation

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Danksagung

Der Autor dankt Herrn Prof. von Eisenhart-Rothe herzlich für die Unterstützung seiner wissenschaftlichen Arbeit, welche am Klinikum rechts der Isar der Technischen Universität München durchgeführt wurde.

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  1. Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Straße 51, 81547, München, Deutschland

    A. Toepfer

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A. Toepfer gibt an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt.

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Toepfer, A. Ossoskopie gutartiger osteolytischer Läsionen des Kalkaneus. Arthroskopie 31, 123–133 (2018). https://doi.org/10.1007/s00142-017-0172-8

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