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Schmerztherapie bei nichtjuvenilen, aseptischen Osteonekrosen

Pain management in non-juvenile, aseptic osteonecrosis

  • Schwerpunkt: Orthopädische Schmerztherapie
  • Published:
Der Schmerz Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die aseptische Osteonekrose (ON) des Erwachsenen stellt ein Krankheitsbild ungeklärter Ätiologie dar. Da eine kurative Behandlung dieser Erkrankung häufig nur in Frühstadien gelingt, kommt der Schmerztherapie eine zentrale Behandlungsrolle zu.

Methode

Bewährte und neue Therapieoptionen für die ON sowie eigene Therapieresultate nach i.v.-Applikation des Prostazyklinanalogons Iloprost werden mit entsprechenden Studien in der Literatur verglichen.

Ergebnisse

Neben der Behandlung mit NSRA und Opioiden sind operative „core decompression“, vasoaktive Medikamente sowie hyperbare Oxygenierung wirksam. Eine 5-tägige Applikation von Iloprost ergab eine hochsignifikante Schmerzreduktion.

Schlussfolgerung

Die symptomatische Therapie ist in allen ON-Stadien indiziert, die kurative in den Stadien I und frühem Stadium II. Bei Progredienz ist im Falle der großen Gelenke der frühzeitige endoprothetische Gelenkersatz indiziert, um Sekundärschäden zu vermeiden. Neben dem Einsatz vasoaktiver Substanzen könnte ein weiterer kurativer Therapieansatz in mesenchymalen Stammzellen bestehen.

Abstract

Background

Adult aseptic osteonecrosis (ON) represents a clinical picture with unexplained etiology. Since curative treatment of this disease often succeeds only in the early stage, pain therapy plays an important role in the treatment process.

Method

We compared established and novel treatment options for ON as well as our own results after i.v. administration of the prostacyclin analogue iloprost with corresponding studies in the literature.

Results

In addition to treatment with nonsteroidal antirheumatic agents and opioids, surgical “core decompression,” vasoactive medications, and hyperbaric oxygenation are effective. Treatment with iloprost for 5 days resulted in highly significant pain reduction.

Conclusion

Symptomatic treatment is indicated in all stages of ON and curative treatment in stage I and early stage II. In cases of disease progression in the large joints, early endoprosthetic replacement is indicated to avoid secondary damage. In addition to employing vasoactive substances, a further curative treatment approach could be the use of mesenchymal stem cells.

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  1. Orthopädische Universitätsklinik, Heinrich-Heine-Universität Düsseldorf

    M. Jäger, A. Werner & R. Krauspe

  2. Institut für Diagnostische Radiologie, Heinrich-Heine-Universität Düsseldorf

    S. Lentrodt & U. Mödder

  3. Orthopädische Universitätsklinik, Heinrich-Heine-Universität, Moorenstr. 5, 40225 , Düsseldorf

    M. Jäger

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Jäger, M., Werner, A., Lentrodt, S. et al. Schmerztherapie bei nichtjuvenilen, aseptischen Osteonekrosen. Schmerz 18, 481–491 (2004). https://doi.org/10.1007/s00482-004-0356-9

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