Drouet A, Marcel S, Guilloton L, Ribot C
Service de neurologie, hôpital d'instruction des armées Desgenettes, Lyon, France.
Rev Med Interne. 1998 Oct;19(10):734-9. doi: 10.1016/s0248-8663(98)80710-8.
Non-traumatic myositis ossificans circumscripta is a relatively rare, well defined entity. The pathogenic role of ischemia in its development is discussed.
We report two cases of myositis ossificans circumscripta that occurred in the hamstring muscle respectively 22 and 35 years after ischemic muscular injury in the same site. Clinical and radiologic informations and follow-up were reexamined, showing that patients are usually young and that the disease is equally distributed between both genders. Though the lesion may develop in various muscle, it is preferentially observed in proximal sites. Most patients have a history of localized pain or tenderness accompanied by swelling of the affected site. Following a 5- to 12-week increase, the soft-tissue mass is less sensitive and better defined. It may also resolve in less than 3 years.
Results of X rays, computerized tomography, MR imaging and biopsy are reviewed. Histologically, this lesion main feature is peripheral bone maturation within three areas. Mechanisms (traumatic or not) underlying these lesions are unknown. To our knowledge, only one published case would be comparable to ours. Proliferation followed by change in mesenchymal cells leading to heterotopic ossification must be regarded as a consequence of either ischemia or repeated micro-trauma occurring during muscle shortening.
局限性非创伤性骨化性肌炎是一种相对罕见、定义明确的病症。本文探讨了缺血在其发病过程中的致病作用。
我们报告了两例局限性骨化性肌炎病例,分别发生在同一部位缺血性肌肉损伤后的22年和35年的腘绳肌中。重新审视了临床和放射学信息及随访情况,结果显示患者通常较为年轻,且该疾病在男女之间分布均匀。尽管病变可能发生在各种肌肉中,但在近端部位更为常见。大多数患者有局部疼痛或压痛史,并伴有受累部位肿胀。经过5至12周的进展,软组织肿块的敏感性降低且边界更清晰。它也可能在不到3年的时间内消退。
回顾了X线、计算机断层扫描、磁共振成像和活检的结果。从组织学上看,该病变的主要特征是在三个区域内周边骨成熟。这些病变的潜在机制(是否为创伤性)尚不清楚。据我们所知,只有一例已发表的病例与我们的病例类似。间充质细胞增殖后发生变化导致异位骨化,这必须被视为缺血或肌肉缩短过程中反复发生的微创伤的结果。