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Biologisierung von Implantaten in der Chirurgie des Stütz- und Bewegungsapparates

Biological coating of implants in trauma and orthopedic surgery

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Zusammenfassung

Insbesondere bei komplexen Verletzungsmustern, zunehmender Verlagerung der Bevölkerungspyramide mit komplizierten Frakturmustern bei Osteoporose und aufwändigeren Operationsverfahren treten in der Chirurgie des Stütz- und Bewegungsapparates immer wieder Komplikationen wie verzögerte Frakturheilung, Pseudarthrosen und Knocheninfektionen auf. Derzeit verfügbare lokal applizierbare Wachstumsfaktoren (BMP-2, BMP-7) konnten sich nicht durchsetzen, da erhebliche Mengen dieser begrenzt erhältlichen und teuren Substanzen implantiert werden müssen, die Freisetzung aus kollagenhaltigen Trägermaterialien unkontrolliert erfolgt und zu Nebenwirkungen führen kann. Ideal wäre die „Biologisierung“ osteosynthetischer Implantate mit Einarbeitung von Wirksubstanzen, die lokal und kontrolliert freigesetzt werden. Somit lässt sich eine hohe Konzentration am Wirkort erzielen und das Risiko systemischer Nebenwirkungen minimieren. Als Wirksubstanzen können Wachstumsfaktoren zur Verbesserung der Frakturheilung und Antibiotika zur Infektprophylaxe und Therapie eingesetzt werden. Dazu wurde eine biodegradierbare Poly(D,L-lactid)-Beschichtung von Implantaten entwickelt, die neben der kontrollierten lokalen Freisetzung der Wirksubstanz weiterhin der Frakturstabilisierung dienen. Experimentelle Untersuchungen an Hand verschiedener Modelle (Knochenheilung—intervertebrale Fusion—Infektmodell) konnten die Effizienz dieser Beschichtungstechnologie nachweisen. Diese Ergebnisse scheinen die Voraussetzungen für einen klinischen Einsatz zu rechtfertigen.

Abstract

In spite of improved operation techniques and optimized implants in trauma and orthopedic surgery complications like delayed fracture healing, non-unions or broad osseous infections may occur. This may be explained by more complex patterns of injuries, more extensive operative procedures and more complex fractures in cause of osteoporosis with increasing age. In the last years some growth factors for local application were approved (BMP-2, BMP-7), however not widely accepted. Reasons may be the high quantities of these limited and expensive proteins, which have to be implanted. Furthermore the local release from a bovine collagen carrier in tissue is not evident.

The use of coated implants with incorporated active ingredients could release drugs locally and thereby obtain a high concentration in the area of interest without systemic side effects. Possible compounds for the improvement of fracture healing could be growth factors as well as antibiotics for prophylaxis of implant related infections. A biodegradable poly (D,L-lactid)-coating of implants could release incorporated growth factors in a controlled manner directly into the fracture. Furthermore the coated implant remains as a fracture treatment device. Different models are demonstrated (fracture healing—intervertebral fusion—infection model) to prove the efficiency of the coating technology. These findings seem to justify the transfer of this technology into clinic.

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster

    M. J. Raschke

  2. Centrum für Muskuloskeletale Chirurgie, Charité, Universitätsmedizin Berlin

    G. Schmidmaier

  3. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstraße 1, 48149, Münster

    M. J. Raschke

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  2. G. Schmidmaier
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Correspondence to M. J. Raschke.

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Raschke, M.J., Schmidmaier, G. Biologisierung von Implantaten in der Chirurgie des Stütz- und Bewegungsapparates. Unfallchirurg 107, 653–663 (2004). https://doi.org/10.1007/s00113-004-0828-5

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