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Osteonekrosen nach Chemotherapie im Kindesalter

Osteonecrosis after chemotherapy in children

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Zusammenfassung

Aufgrund der verbesserten Heilungs- und Überlebensrate bei Kindern mit systemischen malignen Erkrankungen nach modernen Chemotherapieprotokollen gewinnen die Spätfolgen der Therapie zunehmend an Bedeutung. Osteonekrosen treten mit einer Häufigkeit von bis zu 40% durchschnittlich 12–18 Monate nach Therapiebeginn auf und verlaufen gelegentlich auch asymptomatisch. Im Vergleich zu anderen Knochen sind meist die lasttragenden Knochen insbesondere an Hüft- und Kniegelenk befallen. Risikofaktoren für das Auftreten der Osteonekrosen sind ein Alter von über 10 Jahren sowie die Gabe von Kortikosteroiden. Die genaue Ätiologie ist jedoch noch unklar. Nach primärer Knochendestruktion kommt es sekundär zur Knorpeldestruktion. Die Diagnose kann bereits im Frühstadium mittels Kernspintomographie gestellt werden. Standardisierte Therapiekonzepte sind bislang nicht verfügbar. Optional stehen konservative und operative Verfahren zur Verfügung.

Abstract

The application of modern chemotherapy protocols has improved healing and survival rates significantly in pediatric malignancies. As a result, the long-term drug-related side effects are becoming increasingly apparent. Avascular osteonecrosis (AVN) occurs in up to 40% of all patients who have undergone chemotherapy, the average time of onset being 12–18 months after chemotherapy. Compared to other bones, the weight-bearing regions of hip and knee joints are most commonly affected. Incidentally and in early stages, AVN may show only mild symptoms or may not be clinical apparent. Typical risk factors for AVN after chemotherapy are the application of glucocorticoids and an age of 10 ys. and older. The etiology remains unclear. In early stages, AVN can be detected by magnetic resonance imaging (MRI). Evidence-based, standardized therapeutic concepts or orthopedic guidelines are not available for these patients to date. The range of treatment options includes several operative and non-operative treatment alternatives.

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  1. Orthopädische Klinik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    B. Westhoff, M. Jäger &  R. Krauspe

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  1. B. Westhoff
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  2. M. Jäger
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  3. R. Krauspe
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Correspondence to R. Krauspe.

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B. Westhoff und M. Jäger haben zu gleichen Teilen zu dieser Arbeit beigetragen.

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Westhoff, B., Jäger, M. & Krauspe, R. Osteonekrosen nach Chemotherapie im Kindesalter. Orthopäde 37, 56–62 (2008). https://doi.org/10.1007/s00132-007-1184-2

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