Füllmaterialien und adjuvante Agenzien in der lokalen Behandlung benigner Knochentumoren und tumorähnlicher Läsionen

Zusammenfassung

Benigne Knochentumoren sind als autonom und langsam wachsende Neoplasien definiert. Die nicht neoplastischen selbst limitierenden tumorähnlichen Läsionen der Knochen bestehen aus unterschiedlichen Gewebearten, die zur Aushöhlung oder Auftreibung des Knochens führen. Beide Entitäten bleiben lange klinisch stumm und werden meist als Zufallsbefunde diagnostiziert. Entsprechend ihres biologischen Verhaltens, das anhand bildgebender Verfahren häufig gut einschätzbar ist, erfolgt eine Einteilung in drei Stadien. Diese Unterteilung hat entscheidenden Einfluss auf die Behandlung, die von der einfachen Beobachtung bis zur Resektion in weiten Grenzen reicht. Problematisch bei der operativen Behandlung ist zum einen die Auffüllung der teils erheblichen Knochendefekte und zum anderen das Auftreten von Lokalrezidiven nach intraläsionaler Ausräumung. Die intraoperative Anwendung von Adjuvantien wie Phenol, flüssigem Stickstoff oder neuerdings Bisphosphonaten kann die Rezidivrate signifikant senken. Zur Auffüllung der Defekte stehen neben autologem Knochen zahlreiche Knochenersatzmaterialien und PMMAZement zur Verfügung.

Summary

Benign tumours of the bone are defined as autonomous and slowly-growing neoplastic lesions. The self-limiting non-neoplastic tumour-like lesions consist of different types of tissue, leading to the cortical erosion or blow up of the bone. Both entities remain clinically inactive for a long time and are usually diagnosed by chance. They are staged into three groups, according to their biological behavior, assessing common by imaging techniques. This staging has an important influence on the treatment, ranging from simple observation to resection in a wide range. Problems in surgical treatment are the reconstruction of some large bone defects on the one hand. On the other there is the local recurrence of the tumours after intralesional removal.The intraoperative use of adjuncts such as phenol, liquid nitrogen or more recently bisphosphonates can reduce the local recurrence significantly. To fill the lesions bone substitutes and PMMA cement among autologous bone are available.

Schlüsselwörter

Benigne Knochentumoren - tumorähnliche Läsionen - Lokalrezidiv - Knochenersatzmaterialien

Keywords

Benign bone tumours - tumour-like lesions - local recurrence - bone substitutes

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