Early diagnosis and treatment, prevention, reduction of inflammatory reaction, prevention of granulation formation and inhibition of mediator activity are the principles of early treatment of the disease. If the disease remains uncontrolled at an advanced stage and seriously affects joint function, local ossification can only be removed with the help of surgery.
1.Drugs
(1) Non-steroidal anti-inflammatory drugs.
Can be used for prevention as well as treatment. Possible mechanism: stop the formation of nociceptive nerve impulses in inflammatory tissues, inhibit the inflammatory response and pain relief, including the inhibition of lysosomal enzyme release and leukocyte chemotaxis; reduce the synthesis of prostaglandins through the inhibition of cyclooxygenase, thus inhibiting prostaglandins to promote the proliferation of mesenchymal cells and vasodilatation; inhibit the proliferation and migration of mesenchymal stem cells and block the differentiation to osteoblasts. The common ones are celecoxib, indomethacin, anti-inflammatory pain, ibuprofen, aspirin, etc.
(2) Diphosphonates.
It can be used for prevention and treatment. It is an endogenous pyrophosphate analogue that has a strong affinity for hydroxyapatite, preventing the dissolution and growth of phosphate crystals. In addition, diphosphate acts as an anti-inflammatory agent also modulates immunity, probably by interfering with pro-inflammatory factors such as II-6, IL-1, etc. The main side effect of diphosphonates is that long-term use can lead to bone softening, and it only inhibits bone matrix mineralization, not bone matrix formation, and once the drug is discontinued, the formed bone matrix can continue to mineralize, resulting in “rebound ossification”, so the use of diphosphonates is still very controversial. The representative drugs are etidronate disodium, alendronate sodium, pamo phosphate sodium, etc.
(3) Chinese medicine treatment.
Heterotopic ossification belongs to the category of fetish blood paralysis in traditional Chinese medicine. The mechanism is traumatic injury stopping fetish, blood coagulation, fetish blood accumulation in muscle tissue, forming lumps and hard knots over time, paralyzing the meridians. The treatment is based on the principles of softening and dispersing the knots, activating blood circulation and fetishes, relaxing the tendons and activating the collaterals, dispelling wind and dampness, opening up the joints and relieving swelling and pain. For example, fumigation and thromboxane combined with Chuanxiongzin, external application of tincture of Tongluo pain relief, etc.
(4) Calcium ion antagonists.
Osteomyositis such as other sclerosis in the body (such as atherosclerosis) has similarities, formed in cells, tissues, a pathological healing after injury caused by inflammation and trauma. Macrophages play an important role in the sclerosis of organs, playing a key regulatory role in antigen presentation, inflammation formation, wound healing, tissue destruction, and paralytic scar proliferation. Studies in the literature have reported that local use of calcium antagonists can inhibit the secretion and chemotactic activity of macrophages, which in turn inhibits the expression of BMP-2, thereby reducing local calcium deposition and acting as a treatment for ossifying myositis. There have been a number of reports on the ability of calcium antagonists to slow the development of atherosclerosis by inhibiting local calcium accumulation, etc. It is evident that calcium antagonists do have similar inhibitory effects on sclerosis. Diltiazem, for example, is expected to be used in the treatment of ossifying myositis. However, it has negative conduction, negative muscle strength and hypotensive effects, so this drug should not be applied if there are contraindications to related drugs.
(5) Hormone therapy.
Ossifying myositis can also have local or joint tissue redness, swelling, heat and pain, cool like acute rheumatism. Hormone therapy can be considered. It should be emphasized that during the application of hormones, potassium supplementation, calcium supplementation, liver protection, protection of gastric mucosa, prevention of fungal infections, and other treatments should be done. However, there are few reports related to the application of hormone therapy for ossifying myositis, and further research is needed.
2.Physical therapy
(1) Exercise therapy
There are continuous passive activity training, joint release, muscle strength training, stretching techniques and simple apparatus training, etc. It has been reported that passive exercises such as CPM can maintain the joint mobility of ossifying myositis without aggravating the disease. Patients can also be treated with active activities and training with the help of elastic bandages under the guidance of a medical professional. Once osteoarthritis is present, especially during the active phase, when there is localized redness, swelling, heat, pain and impaired movement, excessive functional activity should not be performed. If the above local symptoms are not obvious, the exercise should be within the range of pain tolerance to maintain certain joint activities and functions.
(2) Physical therapy
There are ultra-short wave, microwave, magnetic therapy, laser, ultrasound and electrotherapy, etc. However, it has been reported that the application of the above treatment can aggravate the hematoma and worsen the condition in the early stage, so the key to the application of physiotherapy is to master the timing of application, which can be determined with the help of ultrasound examination, and it is more critical to choose the appropriate physiotherapy method and site. Therefore, when to choose which physical therapy method to apply to what part of the site can be further studied in depth.
3.Surgical treatment
Surgery is mainly to remove the ossified tissue and the peripheral low-density area shown on CT to improve and restore the function of the joint, the ossified block and the thin layer of normal muscle should be removed during the removal, and thorough hemostasis should be performed. Postoperatively, it should be fixed in plaster for 1-3 weeks. However, there are still cases of recurrence after surgery.
Osteomyositis is a self-limiting disease, avoiding and reducing the formation of hematoma after the injury, removing the hematoma, avoiding multiple periosteal injuries, and avoiding forced passive activities are important principles of prevention.