Knochenersatz und Knochenaufbau

Zusammenfassung

Die Behandlung von Knochendefekten kann den Operateur – abhängig von Ursache, Lokalisation und Größe – vor große Herausforderungen stellen. Zur möglichen Therapie stehen diverse Verfahren zum Knochenersatz und Knochenaufbau zur Verfügung, die dieser Artikel vorstellt.

Abstract

Autologous cancellous bone grafting remains the gold standard in the treatment of bone defects as it meets all requirements (osteoinduction, osteoconduction, osteointegration). Over time, bone replacement materials will become increasingly important in orthopedics and trauma surgery. The main representatives of bone replacement materials are calcium phosphates (ceramics and cements). To plan the surgical procedure, the surgeon must choose a preoperative strategy: is an autologous bone substitute sufficient for defect replenishment? If not: which characteristics of the bone substitute are required? Is a combination of materials to be considered? In the future the development of bone replacement materials will lead to composites of proven substances supplemented with growth factors and bioactive ions to improve the performance of osteoinduction, osteoconduction, osteointegration and osteogenesis. Currently, no standards exist for both indication and use of bone replacement materials.

Schlüsselwörter

Knochenersatzverfahren - Spongiosa - autologe Knochenspende - Wachstumsfaktor - Knochendefekt - autologe Knochentransplantation

Key words

bone defect - bone repair - artificial bone - autologous bone grafting

• Literatur

• 1 Heinemann S, Gelinsky M, Worch H. et al. Resorbierbare Knochenersatzmaterialien. Orthopäde 2011; 40: 761
• 2 Bohner M, Galea L, Doebelin N. et al. Calcium phosphate bone graft substitutes: failures and hopes. J Eur Ceramic Soc 2012; 32: 2663-2671
• 3 Bellucci D, Sola A, Cannillo V. et al. Hydroxyapatite and tricalcium phosphate composites with bioactive glass as second phase: state of the art and current applications. J Biomed Mater Res A 2016; 104: 1030-1056
• 4 Roberts TT, Rosenbaum AJ. et al. Bone grafts, bone substitutes and orthobiologics: the bridge between basic science and clinical advancements in fracture healing. Organogenesis 2012; 8: 114-124
• 5 Dimitriou R, Mataliotakis G, Angoules A. et al. Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 2011; 42 (Suppl. 02) S3-S15
• 6 Tong K, Zhong Z, Peng Y. et al. Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis. Injury 2017; 48: 1616-1622
• 7 Khan S, Cammisa F, Sandhu H. et al. The biology of bone grafting. J Am Acad Orthop Surg 2005; 13: 77-86
• 8 Butini M, Cabric S, Trampuz A. et al. In vitro anti-biofilm activity of a biphasic gentamicin-loaded calcium sulfate/hydroxyapatite bone graft substitute. Colloids Surf B Biointerfaces 2018; 161: 252-260
• 9 Wang W, Yeung K. Bone grafts and biomaterials substitutes for bone defect repair: a review. Bioact Mater 2017; 2: 224-247
• 10 Liu B, Lun DX. Current application of β-tricalcium phosphate composites in orthopaedics. Orthop Surg 2012; 4: 139-144
• 11 Schieker M, Heiss C, Mutschler W. Knochenersatzstoffe. Unfallchirurg 2008; 111: 613-620
• 12 Sariibrahimoglu K, Wolke JGC, Leeuwenburgh SCG. et al. Injectable biphasic calcium phosphate cements as a potential bone substitute. J Biomed Mater Res B Appl Biomater 2014; 102: 415-422
• 13 OʼNeill R, McCarthy H, Montufar E. et al. Critical review: injectability of calcium phosphate pastes and cements. Acta Biomater 2017; 50: 1-19
• 14 Heinemann S, Rössler S, Lemm M. et al. Properties of injectable ready-to-use calcium phosphate cement based on water-immiscible liquid. Acta Biomater 2013; 9: 6199-6207
• 15 Schneiders W, Reinstorf A, Ruhnow M. et al. Effect of chondroitin sulphate on material properties and bone remodelling around hydroxyapatite/collagen composites. J Biomed Mater Res A 2008; 85: 638-645
• 16 Moimas L, Biasotto M, Lenarda RD. et al. Rabbit pilot study on the resorbability of three-dimensional bioactive glass fibre scaffolds. Acta Biomater 2006; 8: 191-199
• 17 Zhang D, Leppäranta O, Munukka E. et al. Antibacterial effects and dissolution behavior of six bioactive glasses. J Biomed Mater Res A 2010; 93: 475-483
• 18 Govender S, Csimma C, Genant HK. et al. Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients. J Bone Joint Surg Am 2002; 84-A: 2123-2134
• 19 Lo K, Ulery B, Ashe K. et al. Studies of bone morphogenetic protein based surgical repair. Adv Drug Deliv Rev 2012; 64: 1277-1291
• 20 Lode A, Heiss C, Knapp G. et al. Strontium-modified premixed calcium phosphate cements for the therapy of osteoporotic bone defects. Acta Biomat 2018; 65: 475-485