Knochen Tissue Engineering zur Therapie von Knochendefekten

Zusammenfassung

Knochendefekte können zum Beispiel nach Tumorexzision oder Osteomyelitiden genauso auftreten wie nach Trauma bei Fraktur mit langer Defektstrecke, wenn die physiologische Reaktion auf einen Knochenbruch ausbleibt oder eine Pseudarthrose entsteht. In diesen Fällen wird eine chirurgische Intervention notwendig. Die Verwendung von autologen Knochentransplantaten aus z. B. Spongiosa, Kortikalis oder beidem sowie alternativ bei speziellen Indikationen die Kallusdistraktion stellen in solchen Fällen zumeist den heutigen Goldstandard dar. Bei größeren Defekten, ersatzschwachem Lager oder z. B. avaskulärer Knochennekrose kann ein gestieltes oder freies vaskularisiertes Knochentransplantat notwendig werden. Die Verfügbarkeit von autologen vaskularisierten Knochentransplantaten ist jedoch limitiert aufgrund einer unter Umständen signifikanten Hebemorbidität. Synthetische Knochenersatzstoffe, die entwickelt wurden, um die Grenzen des humanen Auto- und Allografts zu überwinden, stellen eine gute Alternative dar. Sie sind dazu in der Lage, Knochenneubildung in Knochendefekten kritischer Größe zu induzieren, aber sie bieten bis heute keine eigene Vaskularisation. Diese synthetischen Materialien bestehen aus einem großen Spektrum von unterschiedlichen Materialien, einschließlich natürlicher und synthetischer Polymere, Keramiken und zusammengesetzten Werkstoffen mit dem Ziel, den dreidimensionalen Charakter des Autografts zu imitieren und fungieren zum Teil als Vehikel für Wachstumsfaktoren, Antibiotika oder Zellen. Dieser Artikel gibt einen Überblick über den Einsatz von Matrix, Zellen und therapeutischen Substanzen im stetig wachsenden Feld des Knochen Tissue Engineerings.

Abstract

In critical size bone defects resulting from failed fracture healing or pseudarthrosis surgery is usually required. In this context, autologous bone grafts and callus distraction represent the gold standard, while sometimes even vascularised bone transfer is mandatory including microsurgical techniques. The availability of donor sites for such procedures is limited and the resulting morbidity significant. Therefore, synthetic bone grafts have been developed as an alternative. They consist of a broad range of different materials such as natural and synthetic polymers, ceramic and compound materials, aiming to mimic the three-dimensional character of autografts. In addition, they may act as a delivery vehicle for growth factors, antibiotics or cells. Their main limitation has been the lack of an intrinsic blood supply, limiting the potential for transplantation. This review provides an overview of matrices, cells and other therapeutic substances in the field of bone tissue engineering.

Schlüsselwörter

Knochen Tissue Engineering - bioartifizielles Knochengewebe - Vaskularisation - AV loop

Key words

bone tissue engineering - bone replacement - vascularisation - AV loop

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