Neuere Ergebnisse in der Osteologie pp 334-340 | Cite as
Möglichkeiten zur Verhinderung ektoper Ossifikationen bei totalendoprothetischem Hüftgelenkersatz
Zusammenfassung
Zur Verhinderung periartikulärer Ossifikationen bei 15 Risikopatienten erfolgte die postoperative Kombinationstherapie in Form der Bestrahlung, der Gabe von Magnesium, Tetracyclin, Biphosphonat und Indometacin. Nur die muskelstarken männlichen Patienten mit kräftigem Knochenbau (7 Fälle) zeigten eine leichte Verknöcherung Grad I nach Arcq., sämtliche anderen Fälle (TEP bei M. Forestier — 1 Fall -, M. Bechterew — 1 Fall -, Entfernung ektoper Ossifikationen nach TEP — 3 Fälle — sowie geplanter TEP bei bereits eingetretener massiver Ossifikation nach TEP der kontralateralen Seite — 3 Fälle -) zeigten keine Verknöcherungen.
Summary
A prospective study was done to evaluate the efficacy of a combined medical treatment with 20 Gy of radiation, Magnesium, Tetracycline, Indomethacin and Biphosphonate in the prevention of heterotopic ossification after total hip arthroplasty in 15 patients who were at high risk. In the present study it is demonstrated that radiation initiated within 2 days after total hip arthroplasty combined with medical treatment is highly effective in the prevention of heterotopic ossification and in the prevention of recurrence after resection of existing ossification.
Preview
Unable to display preview. Download preview PDF.
Literatur
- 1.Almasbakk K, Roysland P (1977) Does Indomethacin (IMC) prevent postoperative ectopic ossification in total hip replacement? Acta Orthop Scand 48:556Google Scholar
- 2.Ayers DC, McCollister E, Parkinson JR (1986) The prevention of heterotopic ossification in high-risk patients by low-dose radiation therapy after total hip arthroplasty. J Bone Joint Surg 68-A:1423–1429Google Scholar
- 3.Bachra BN, Fischer HRA (1969) The effect of some inhibitors on the nucleation and crystal growth of apatite. Calc Tiss Res 3:348CrossRefGoogle Scholar
- 4.Bevelander G, Nakahara H, Rolle GK (1959) Inhibition of skeletal formation in the chick embryo following administration of tetracycline. Nature 184:728PubMedCrossRefGoogle Scholar
- 5.Bevelander G (1963) Effect of tetracycline on crystal growth. Nature 198:1103CrossRefGoogle Scholar
- 6.Brown W, Courth M, Abbat JD The incidence of leukaemia in ankylosing spondylitis treated with X-rays. A preliminary report. Lancet 1955/I, 1283Google Scholar
- 7.Cooper AGS, Steinbeck AW (1959) Leukaemia following irradiation for ankylosing spondylitis. Brit J Radiol 32:266PubMedCrossRefGoogle Scholar
- 8.Coventry MB, Scanion PW (1981) The use of radiation to discourage ectopic bone. A nine-year study in surgery about the hip. J Bone Joint Surg 63-A:201–208Google Scholar
- 9.Dahl HK (1975) Kliniske observationsjoner. In: Symposium on Arthrosis: Proceedings of a Conference, October 1974, Blindem. Norway, MSD. pp 37–46Google Scholar
- 10.Dietrich JW, Raisz LG (1975) Prostaglandin in calcium and bone metabolism. Clin Orthop 111:228–237PubMedCrossRefGoogle Scholar
- 11.Eger W (1963) Kalziumnachweis und Mineralisation des Knochengewebes. Verhdlg dtsch Ges Path 47:54Google Scholar
- 12.Eger W, Kämmerer H, Bothmann G (1965) Experimentelle Beiträge zur Tetracyclinablagerung in den Zähnen. Dtsch Zahnärztl Zschr 7:829Google Scholar
- 13.Farr D, Pochai W, Brown M, Shapiro E, Weinfeld N, Dziak R (1984) Effects of prostaglandins on rat calvarial bone-cell calcium. Arch Oral Biol 29:885–891PubMedCrossRefGoogle Scholar
- 14.Finerman GAM, Milch RA (1963) In vitro binding of tetracyclines to calcium. Nature 198:486CrossRefGoogle Scholar
- 15.Finerman GAM, Krengel WF, Lowell JR, Murray WR, Volz RG, Bowerman JW, Gold RH (1977) Role of diphosphonate (EHDP) in the prevention of heterotopic ossification after total hip arthroplasty: A preliminary report. In: The Hip: Proceedings of the Fifth Open Scientific Meeting of The Hip Society. C.V. Mosby, St. Louis, pp 222–234Google Scholar
- 16.Frances MD, Rusell RGG, Fleisch H (1969) Diphosphonates inhibit formation of calcium phosphate crystals in vitro and pathological calcification in vivo. Science 165:1264–1266CrossRefGoogle Scholar
- 17.Hartmann F, Gattow G, Fricke R (1957) Untersuchungen über die Struktur und Funktion des Bindegewebes, 4. Mitteilung. Z Rheumaforsch 16:243PubMedGoogle Scholar
- 18.Kämmerer H, Gattow G, Eger W (1965) Tetracycline und Knochenstoffwechsel. Med Welt 986Google Scholar
- 19.Kim Jae Ho, Cho FC, Woodard HQ, Melamed MR, Huvus A, Cantin J (1978) Radiation induced soft tissue and bone sarkoma. Radiology 129:501–508Google Scholar
- 20.Kjaersgaard-Andersen P, Schmidt SA (1986) Indomethacin for prevention of ectopic ossification after hip arthroplasty. Acta Orthop Scand 57:12–14PubMedCrossRefGoogle Scholar
- 21.Klein DC, Raisz LG (1970) Prostaglandins: Stimulation of bone resorption in tissue culture. Endocrinology 86:1436–1440PubMedCrossRefGoogle Scholar
- 22.Kühr J (1986) Tierexperimentelle Untersuchungen zur Beeinflußbarkeit der Immobilisationsosteoporose durch Magnesium. Mag Bull 8, Sonderheft 1bGoogle Scholar
- 23.Lidgren L, Nordström B (1979) Treatment of periarticular calcification after total hip arthroplasty. Arch Orthop Traumat Surg 94:67–70CrossRefGoogle Scholar
- 24.Meßler H, Münzenberg KJ, Kühr J, Rüther W (1986) Histologische Veränderungen in der Wachstumsfuge durch Magnesium, Nifedipin und Verapamil. In: 9. Hohenheimer Magnesium Symposium. Universität HohenheimGoogle Scholar
- 25.Münzenberg KJ, Gattow G (1963) Röntgenographische Untersuchungen der Dupuytrenschen Kontraktur und des muskulären Schiefhalses. Arch f Orthop und Unfallchir 55:139CrossRefGoogle Scholar
- 26.Münzenberg KJ, Gebhard M, Przybilka A, Lawrenz U (1972) Kristallographische Untersuchungen der Knochenminerale. III. Mitteilung: Beeinflussung der Substanzabscheidung durch Magnesium und Glucosaminsulfat in vitro. Z Orthop 110:482PubMedGoogle Scholar
- 27.Münzenberg KJ, Taschner WP (1978) Die Wirkung von Magnesium während der Knochenbildung. Krankenhausarzt 51Google Scholar
- 28.Parkinson JR, Evarts CM, Hubbard LF (1982) Radiation therapy in the prevention of heterotopic ossification after total hip arthroplasty. In: The hip. Proceedings of the Tenth Open Scientific Meeting of the Hip Society, chapter 14. Mosby, St. LouisGoogle Scholar
- 29.Plasmans CMT, Kuypers W, Slooff TJJH (1978) The effect of Ethane-1-Hydroxy-1, 1-Diphosphonic Acid (EHDP) on matrix induced ectopic bone formation. Clin Orthop 132:233–243PubMedGoogle Scholar
- 30.Rane A, Oelz O, Frolich JC, Seiberth HW, Sweetman BJ, Watson JT, Wilkinson GR, Oates JA (1978) Relation between plasma concentration of indomethacin and its effect on prostaglandin synthesis and platelet aggregation in man. Clin Pharmacol Ther 23:658–668PubMedGoogle Scholar
- 31.Ritter MA, Gioe TJ (1982) The effect of indomethacin on para-articular ectopic ossification following total hip arthroplasty. Clin Orthop 167:113–117PubMedGoogle Scholar
- 32.Ro J, Sudmann E, Marton PF (1976) Effect of indomethacin on fracture healing in rats. Acta Orthop Scand 47:588–599CrossRefGoogle Scholar
- 33.Russell GG, Smith R (1973) Diphosphonates: Experimental and clinical aspects. J Bone Joint Surg (Br) 55:66Google Scholar
- 34.Russel GG, Fleisch H (1975) Pyrophosphate and diphosphonates in skeletal metabolism. Clin Orthop 108:241CrossRefGoogle Scholar
- 35.Rüther W (1987) Wirkungen von Diphosphonaten auf die Entwicklung der Matrix-induzierten ektopen Osteogenese. Habilitationsschrift (Rhein. Friedr.-Wilh.-Universität Bonn)Google Scholar
- 36.Schelling SH, Wolfe HJ, Tashjian AH (1980) Role of the osteoclast in prostaglandin E2-stimulated bone resorption. Lab Invest 42:290–295PubMedGoogle Scholar
- 37.Sobel AE, Hanok A (1952) Calcification VII. Reversible inactivation of calcification in vitro and related studies. J Biol Chem 197:669PubMedGoogle Scholar
- 38.Sudmann E (1975) Effect of Indomethacin on bone remodelling in rabbit ear chambers. Acta Orthop Scand Suppl 160:91–115PubMedGoogle Scholar
- 39.Sudmann E, Hagen T (1976) Indomethacin-induced delayed fracture healing. Arch Orthop Unfall-Chir 85:151–154CrossRefGoogle Scholar
- 40.Urist MR, Silverman BF, Birring K, Dubec FL, Rosenberg JM (1967) The bone induction principle. Clin Orthop 53:243–283PubMedGoogle Scholar
- 41.Vane JR (1971) Inhibition on prostaglandin synthesis as a mechanism of action for aspirin-like drugs. Nature New Biol 231:232–235PubMedGoogle Scholar