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Osteologie 2023; 32(01): 42-51
DOI: 10.1055/a-2010-7193
Review

Die chirurgische Therapie der Fibrösen Dysplasie

Surgical Intervention in Fibrous Dysplasia
Andreas Kurth
1   Zentrum für Orthopädie und Unfallchirurgie Marienhaus Klinikum Mainz, Mainz, Germany
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Zusammenfassung

Die fibröse Dysplasie ist eine seltene Knochenerkrankung mit einem breiten klinischen Spektrum von Erscheinungsformen bei Erwachsenen und Kindern. Die komplexe Veränderung des Knochens führt bei Kindern sehr häufig zu Frakturen und Deformitäten und im Erwachsenenalter zu chronischen, belastungsabhängigen Schmerzen. Trotz der Fortschritte im Verständnis der Pathogenese der Fibrösen Dysplasie ist ihre Behandlung nicht klar und immer noch umstritten. In den letzten drei Jahrzehnten hat es sowohl bei den chirurgischen als auch bei den medikamentösen Behandlungsmöglichkeiten Fortschritte gegeben. Das Ziel der Therapie muss es sein, Deformitäten, Frakturen und chronische Schmerzen zu vermeiden. In der Vergangenheit wurde die Fibröse Dysplasie ausschließlich chirurgisch behandelt, hauptsächlich durch eine Kürettage der Läsionen. Eine autologe Knochentransplantation hat sich als wenig erfolgreich herausgestellt, hingegen die Verwendung von allogenen kortikalen Spänen scheint vorteilhaft zu sein. Die Verwendung von intramedullären Osteosynthesen ist gegenüber Platten- und Schraubenosteosynthesen zu bevorzugen. Die Behandlung jedes Patienten muss individuell nach Rücksprache mit dem Patienten gestaltet werden. Antiresorptive Therapien haben in kleineren Untersuchungen Vorteile in Bezug auf Knochenschmerz und Frakturen erbracht.

Abstract

Surgical Intervention in Fibrous Dysplasia Fibrous dysplasia is a rare bone disease with a wide clinical spectrum of manifestations in adults and children. The complex alteration of bone very commonly results in fractures and deformities in children and chronic, weight-bearing pain in adults. Despite advances in understanding the pathogenesis of fibrous dysplasia, its treatment is not clear and is still controversial. Over the past three decades, there have been advances in both surgical and drug treatment options. The goal of therapy must be to prevent deformity, fracture, and chronic pain. In the past, fibrous dysplasia was treated exclusively surgically, mainly by curettage of the lesions. Autologous bone grafting has been shown to have little success, whereas the use of allogeneic cortical strout grafts appears to be beneficial. The use of intramedullary osteosyntheses is preferable to plate and screw osteosyntheses. The treatment of each patient must be individualized after consultation with the patient. Antiresorptive therapies have provided benefits in terms of bone pain and fractures in small studies.

Schlüsselwörter

Fibröse Dysplasie - Therapie - Chirurgie

Key words

Fibrous Dysplasia - Treatment - Surgical Intervention


Publikationsverlauf

Eingereicht: 02. November 2022

Angenommen: 09. Januar 2023

Artikel online veröffentlicht:
28. Februar 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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