Knochenzemente für die Behandlung osteoporotischer Frakturen

Zusammenfassung

Die Versorgung osteoporotischer Frakturen mittels metallischer Implantate erreicht zunehmend ihre Grenzen. Eine mögliche Lösung, um eine ausreichende Verankerung des Implantats sicherzustellen, ist die Verstärkung der geschwächten Knochenstruktur mit Knochenzement, die sog. Implantataugmentation. Hierfür kommen meist Acrylate (PMMA) oder resorbierbare Kalziumphosphatzemente (CaP) zum Einsatz. PMMA-Zemente besitzen ausgewogene mechanische Eigenschaften, sind einfach zu handhaben und lassen sich gut und sicher injizieren. Allerdings geht die Aushärtung von PMMA mit Entstehung von Wärme einher. Es konnte aber gezeigt werden, dass die für die Implantataugmentation benötigten kleinen Mengen an PMMA nicht zu kritischen Temperaturen im umliegenden Gewebe führen. CaP-Zemente besitzen eine sehr gute Biokompatibilität, erwärmen sich bei der Aushärtung nicht und sind resorbierbar. Wegen der verminderten mechanischen Eigenschaften wird jedoch oft geraten, die derzeit verfügbaren CaP-Zemente eher an nicht oder wenig belasteten Stellen anzuwenden. Neuere Entwicklungen deuten jedoch darauf hin, dass in Zukunft deutlich bessere Eigenschaften von CaP-Zementen zu erwarten sind. Mit der kurz- bis mittelfristig klaren Zunahme von Altersfrakturen bildet die Implantataugmentation mit CaP oder Acrylat eine interessante Möglichkeit, um den kommenden Problemen zu begegnen.

Abstract

Fixation of osteoporotic fractures using metallic implants is reaching its limits. A possible solution to assure proper implant anchorage is to strengthen the compromised bone stock with bone cement, also called implant augmentation. For this purpose, acrylic cements (PMMA) or resorbable calcium phosphate (CaP) cements can be used. PMMA cements show good mechanical properties, are easy to handle and demonstrate good and safe injectability. The hardening of PMMA, however, is accompanied by the production of heat. It has been shown though, that the small amounts of PMMA needed for implant augmentation do not lead to critical temperatures in the surrounding tissues. CaP cements demonstrate very good biocompatibility, do not heat up during hardening and are resorbable. Due to their inferior mechanical properties, it is, however, often recommended to use the currently available CaP cements rather in non- or low weight-bearing situations. New developments show evidence, however, that future CaP cements will have considerably better properties. Implant augmentation with CaP or acrylic bone cement offers an interesting option to face the future problems that will arise with the expected short- to mid-term increase in fragility fractures.

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