Heterotope ossificaties - Regionale Intensive Care Opleiding

Heterotope ossificaties
8maart2017,MDOpraatje
KristineBeumer,ANIOSIC
Heterotopeossificatie
Depositievanbotinwekedelen
rondomde(grote)gewrichten
Heup44%,schouder27%,elleboog
26%,knie3%1
Pathogenese- Hypothese
Sluimerendeosteoprogenitor cellen
inwekedelenà stimulusà
differentiatieinosteoblastenà
botvorming
Risicofactoren
Intensivecareopname
§ Morbiditeitoplangetermijnin5%nalangdurige
opname2
Traumatischhersenletsel(8-22%)
§
Langdurigcomaenbeademing,chirurgische
behandelingfracturen,autonomedysregulatie3
Dwarslaesie(16–40%)1
Trauma
Risicofactoren
Brandwonden(1-23%)4
Langdurigeimmobilisatie
Spier/Skeletchirurgie(40%heupchirurgie)1
Genetischeafwijkingen
Symptomen– Naweken
“Rangeofmotion”↓
“Blokkeren”gewrichten
Neuropathie,Pijn,Zwelling,
Stijfheid,Erytheem
Diagnostiek
Röntgenfoto
CT-scan
5
MRIeerderediagnose
Echo?
SerumAF
Behandeling/Preventie
Fysiotherapie
NSAID
6
Bifosfonaten?RTx?IFN-α2b?
Laterstadiumchirurgie
(Vroege)mobilisatieterpreventie
Conclusie
§ Denkbijklachtenrondomdegrote
gewrichtenaanheterotopeossificatie
§ 1e stapdiagnostiekröntgenfoto
§ Preventie:vroegmobilisatie
§ BehandelingaanvankelijkNSAID’s +
fysiotherapie,laterevt.chirurgie
Referenties
1. Mitsionis etal. Functionaloutcomeafterexcisionofheterotopic
ossificationaboutthekneeinICUpatients.InternationalOrthopaedics
(SICOT)(2009)33:1619–1625
2. HudsonandBrett.Heterotopicossification– along-termconsequenceof
prolongedImmobility.CriticalCareVol10No6
3. P.J.vanKampen etal.PotentialRiskFactorsforDevelopingHeterotopic
OssificationinPatientsWithSevereTraumaticBrainInjury.HeadTrauma
Rehabil;Vol.26,No.5,pp.384–391
4. Huntetal.HeterotopicOssificationRevisited:A21-YearSurgical
Experience.JournalofBurnCare&Research536July/August2006
5. Argyropoulou etal.Heterotopic ossificationofthekneejointinintensive
careunitpatients:earlydiagnosiswithmagneticresonanceimaging.
CriticalCareVol10No5
6. Medinaetal.FibrocytesParticipateintheDevelopmentofHeterotopic
Ossification.JournalofBurnCare&ResearchVolume36,Number3
Referenties
§UpToDate - Complicationsandlong-termoutcomesofasevereburn+
Complicationsoftotalhiparthroplasty+Chroniccomplicationsofspinalcord
injuryanddisease
§Guo.HeterotopicOssificationinCriticalIllnessandCancer:AReportof2
Cases.ArchPhysMedRehabil Vol83,June2002
§Lane.Idiopathicheterotopicossificationintheintensivecaresetting.
PostgradMedJ2002;78:494–495
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