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Ergebnisse der Pseudarthrosenbehandlung mit „bone morphogenetic protein 7“ (BMP-7)

Results of nonunion treatment with bone morphogenetic protein 7 (BMP-7)

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Zusammenfassung

Hintergrund

Komplexe Verläufe der Knochenheilungsstörung führen zu einer schweren wirtschaftlichen und sozialen Belastung des Patienten. Ziel dieser prospektiven Studie ist die Überprüfung des Therapieerfolgs nach der lokalen Applikation von „bone morphogenetic protein 7“ (BMP-7).

Material und Methode

Von 06/2002 bis 06/2008 wurden bei 98 Patienten 101 Operationen mit BMP-7 vorgenommen. Das Durchschnittsalter lag bei 50 (18–88) Jahren. Die Patienten waren zum Zeitpunkt der BMP-7-Applikation durchschnittlich 3,3-mal (Median 3; 1- bis 13-mal) voroperiert. Wir verwendeten BMP-7 im „off label use“ an allen langen Röhrenknochen.

Ergebnisse

In 93 Fällen (92%) fand eine Konsolidierung statt. Die mittlere Heilungsdauer betrug 4,8 (4; 1,5–11) Monate. BMP-7 wurde im Durchschnitt 18,4 (14; 3–84) Monate nach der Verletzung angewendet. In 65 Fällen erfolgte die BMP-7-Applikation mit Reosteosynthese und Spongiosaplastik. Ernsthafte Nebenwirkungen wurden nicht beobachtet.

Schlussfolgerung

BMP-7 zeigt gerade bei therapierefraktären Pseudarthrosen eine hohe Effektivität. Die Anwendung von BMP-7 bleibt jedoch eine Einzelfallentscheidung, wobei BMP-7 im klinischen Alltag nach kritischer individueller Indikationsstellung auch im „off label use“ eingesetzt werden kann.

Abstract

Background

Complex patterns of impaired bone healing can result in a severe economic and social burden for the patient. Herein we describe the local application of recombinant human bone morphogenetic protein 7 (BMP-7). The goal of this prospective study is to review the indications, application and validation of this therapy.

Material and method

From June 2002 to June 2008, we applied 101 BMP-7 treatments in 101 nonunions of 98 patients. The average age of the patients was 50 years (18–88 years). The gender composition was 29 women (30%) and 69 men (70%). Before BMP-7 application, patients had already underwent surgical treatement an average of 3.3 times (median 3, 1- to 13-times). We used BMP-7 “off-label” in all long bones.

Results

In 93 cases (92%), we observed proper bone healing. The average healing time was 4.8 months (range 1.5–11 months). The average time from injury to BMP-7 application was 18.4 months (3-84 months). In 65 cases, BMP-7 application was combined with re-osteosynthesis and autologous bone grafting. Serious side effects were not observed.

Conclusions

BMP-7 should not be used as general treatment of nonunion in all patients, but appears to be effective for the treatment of complex cases. In clinical practice, the decision to proceed with off-label use of BMP-7 should be made on a case-by-case basis.

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Authors and Affiliations

  1. Department Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland

    A. Moghaddam-Alvandi, A. Büchler, C. Elleser, B. Biglari, P.A. Grützner & C.G. Wölfl

  2. Department of Trauma Surgery, Theresienkrankenhaus Mannheim, Mannheim, Deutschland

    G. Zimmermann

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  1. A. Moghaddam-Alvandi
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  2. G. Zimmermann
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  3. A. Büchler
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  4. C. Elleser
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  5. B. Biglari
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  6. P.A. Grützner
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  7. C.G. Wölfl
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Correspondence to A. Moghaddam-Alvandi.

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Moghaddam-Alvandi, A., Zimmermann, G., Büchler, A. et al. Ergebnisse der Pseudarthrosenbehandlung mit „bone morphogenetic protein 7“ (BMP-7). Unfallchirurg 115, 518–526 (2012). https://doi.org/10.1007/s00113-011-2100-0

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