Ossifying miositis

Description:

Trophoneurotic ossifying miositis (myositis ossificans trophoneurotica; synonym: paraossalny ossification, para-articular ossification) — one of types of a heterotopic extra skeletal osteogenesis. On morphology it is close to a traumatic ossifying miositis. Results from disturbance of a motive and sensitive innervation at damages and diseases of the central and peripheral nervous system; develops at damages of a spinal cord after wounds, gaps, bruises, prelums, concussions, and also some diseases — tumors, myelites, etc. It is observed in 20% of cases of damage of a spinal cord, it is frequent at the combined injuries of a spinal cord and backbone. At diseases and injuries of other parts of the nervous system it is observed rather less often.

Reasons of an ossifying miositis:

Deep shifts and perversions in physiological processes of denervated muscles are an origin. The pathogeny is definitely not known. Time of emergence of ossificates is various: from 3 — the 8th week up to several years. Their emergence is preceded sometimes the osteomyelitis which arose because of decubituses, an erysipelatous inflammation of skin, the rough outbreak of cystitis with formation of stones of a bladder. Multiple muscular ossification forms during formation of dense hypostases; the artropatichesky form develops later and is more often connected with an additional local injury.

Symptoms of an ossifying miositis:

At a trophoneurotic ossifying miositis ossificates are formed about bones and joints of all skeleton, except a skull. Symmetry and plurality of okosteneniye with preferential localization in proximal departments of extremities are characteristic. Ossificates have the various form (lamellar, needle, tubular, branchy, conglomerates, cases, arches, etc.) and size (from several millimeters to tens of centimeters). The largest of them are located along several bones and joints.
The disease can be shown by one of four clinicoradiological forms: periartritichesky, osteoartropatichesky, multiple muscular ossification and mixed. The Periartritichesky form of a miositis is similar to Pellegrini's disease — Shtida (traumatic genesis calcification of soft tissues of a hip in the field of an internal epicondyle), but at the first ossificates are more rough also massivna, ripen longer, are quite often symmetrized, arise without pain and vasomotor reactions and at less heavy injuries of a spinal cord. The Osteoartropatichesky form of a trophoneurotic ossifying miositis is similar to kostnodistrofichesky processes at a myelosyringosis and back to tabes. At this form there occur changes in bones and joints: bones are exposed to a resorption and sometimes break, near changes ossificates which remind either ugly hypertrophied bone callosity, or a bone tumor are formed. The form of multiple muscular ossification is characterized by plurality and relevancy of the sizes of ossificates with a tendency to process generalization ossificates can increase gradually a little. The mixed form contains signs of two or three above-mentioned forms.
It is difficult to establish the beginning of formation of ossificates due to the lack of a sensitive and motive innervation and existence of hypostases. Symptoms of the beginning trophoneurotic ossifying miositis are consolidation and edematous swelling of fabrics, increase in local temperature and reddening of covers over ossificate. Skin in this place gains brightness, becomes slow-moving or, on the contrary, is sclerosed and thickened. In the field of ossificate crepitation is defined, passive mobility in adjacent joints is limited, joints can be deformed. These phenomena are usually expressed poorly and against the background of a heavy picture of a spinal syndrome are looked through.
The differential diagnosis is carried out with an ossifying hematoma which an odinochna, has rounded shape and the small sizes, and with some bone tumors. The last are closely connected with bones from which proceed, are located asymmetrically and have characteristic structure. The Periartritichesky form is differentiated with Pellegrini's disease — Shtida.
The forecast for life favorable. The created ossificates either remain not changed, or rezorbirutsya. They are not exposed to malignant regeneration.

Treatment of an ossifying miositis:

Treatment of this form of a miositis is closely connected with treatment of damages and diseases of a nervous system. If ossificates break function, delete them. Time of operation and a technique of prevention of a recurrence the same, as at treatment of an ossifying traumatic miositis.