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Orthopädie und Unfallchirurgie up2date 2022; 17(04): 337-358
DOI: 10.1055/a-1692-0760
Grundlagen

Knochenaufbau und Knochenersatzmaterialien

Siegmund Lang
,
Lisa Klute
,
Markus Rupp
,
Volker Alt
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Erratum: Knochenaufbau und KnochenersatzmaterialienOrthopädie und Unfallchirurgie up2date 2022; 17(04): e15-e15
DOI: 10.1055/a-1975-2666

Knochendefekte können primär aus traumatologischen Ursachen sowie sekundär aus Knocheninfektionen und Tumorerkrankungen resultieren. Die chirurgische Wiederherstellung der Bewegungsorgane bei Vorliegen eines behandlungsbedürftigen Knochendefekts stellt trotz der Entwicklung diverser Verfahren zum Knochenersatz und Knochenaufbau auch heute noch eine Herausforderung dar. Das autologe Knochentransplantat gilt als Goldstandard in der Behandlung. Wachsende Bedeutung wird den synthetischen Knochenersatzmaterialien beigemessen.
Kernaussagen

  • Die autologe Knochentransplantation gilt weiterhin als Goldstandard in der Behandlung von Knochendefekten.

  • Trotz der wachsenden Bedeutung existiert bislang kein synthetisches Knochenersatzmaterial (KEM), das alle notwendigen biologischen Eigenschaften ohne Risiken vereint.

  • Das ideale Knochenersatzmaterial sollte ein Gerüst für Osteokonduktivität und Wachstumsfaktoren für Osteoinduktivität bereitstellen sowie strukturell dem echten Knochen ähnlich sein.

  • Eine der Hauptindikationen zum Einsatz von synthetischem KEM stellt die Tibiakopffraktur dar, bei der für Kalziumphosphatzemente und Kalziumsulfat-Hydroxylapatit-Knochenzement überzeugende klinische Ergebnisse gezeigt werden konnten.

  • Aufgrund der fehlenden mechanischen Festigkeit müssen KEM in der Regel mit stabilen Osteosynthesen verbunden werden.

  • Eine Optimierung der Eigenschaften von KEM kann durch Kombination mit Wachstumsfaktoren erreicht werden.

  • BMPs (Bone morphogenetic Proteins) spielen als Wachstumsfaktoren eine wichtige Rolle in der Osteogenese. Der Einsatz von BMP-2 hat sich jedoch außerhalb der Wirbelsäulenchirurgie klinisch bislang nicht durchgesetzt.

  • Die Entwicklung moderner Technologien wie das Tissue-Engineering und der 3-D-Biodruck zielt bei der Herstellung von Knochenersatzmaterialien auf eine Kombination aus strukturellen mit zellbasierten biologischen Eigenschaften ab.

Schlüsselwörter

Knochenaufbau - Knochenersatz - autologe Knochentransplantation - allogenes Knochenimplantat - synthetische Knochenersatzmaterialien


Publication History

Article published online:
04 August 2022

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