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Therapieerfolg bei atrophen Tibiaschaftpseudarthrosen

Bone Morphogenetic Protein 7 (BMP 7) versus autologe Spongiosaplastik

Therapeutic outcome in tibial pseudarthrosis

Bone morphogenetic protein 7 (BMP-7) versus autologous bone grafting for tibial fractures

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Zusammenfassung

Je nach Frakturtyp und Lokalisation beträgt die Pseudarthrosenrate bei Tibiaschaftfrakturen 10% bis 40%. Alternativ zur Spongiosaplastik kann seit 2001 der Knochenwachstumsfaktor Bone Morphogenetic Protein 7 (BMP 7, Osigraft®) bei Revisionen eingesetzt werden. Ziel dieser Studie war es, die Effizienz der ersten Spongiosaplastik gegenüber BMP 7 bei verzögerter Frakturheilung zu bestimmen. Von 01/1995 bis 12/2002 erhielten 82 Patienten (Gruppe 1) bei verzögerter Frakturheilung als erste Therapiemaßnahme eine Eigenknochentransplantation. Zum Vergleich (Gruppe 2) dienten 26 Patienten, bei denen durchschnittlich nach 4 erfolglosen Revisionen im Zeitraum von 05/2002 bis 06/2005 BMP 7 lokal implantiert wurde. Als erfolgreiche Heilung wurde eine radiologisch erkennbare Durchbauung der Fraktur gewertet. In Gruppe 1 mit alleiniger Eigenknochentransplantation, wiesen 24 Patienten (28%) nach 4 Monaten und in Gruppe 2 mit BMP-7-Implantation 2 Patienten (8%) keine knöcherne Durchbauung auf (p=0,025). Die BMP-7-Gruppe zeigte trotz eines ungünstiger selektierten Patientenkollektivs eine signifikant höhere Heilungsrate gegenüber der Gruppe mit Eigenspongiosatransplantation.

Abstract

Depending on the type and localisation, nonunions of tibial fractures will occur in 10–40% of cases. Bone morphogenetic protein 7 (BMP-7; Osigraft), a recombinant bone growth factor, can be implanted locally as an alternative to autologous bone grafting. The objective of our study was to compare the efficiency of the two procedures. From January 1995 to December 2002, 82 patients (group 1) with delayed union of a tibial fracture received autologous bone grafting as their first procedure. To compare their results with the efficiency of BMP-7, between May 2002 and June 2005 we followed up on 26 patients (group 2) who had local implantation of BMP-7 after having had, on average, four surgical procedures. Healing was considered successful if x-rays showed bony consolidation and if no further procedure was necessary. Group 1 had no signs of consolidation in 24 cases (28%), whereas group 2 had only two (8%) such patients (p=0.025). The BMP-7 group showed a significantly higher success rate compared with patients with autologous bone grafting, despite the fact that the BMP-7 group contained more complicated cases.

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Authors and Affiliations

  1. Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Klinik für Unfallchirurgie und Orthopädie, Unfallchirurgische Klinik an der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland

    G. Zimmermann, U. Müller, A. Wentzensen & A. Moghaddam

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  1. G. Zimmermann
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  2. U. Müller
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  3. C. Löffler
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  4. A. Wentzensen
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  5. A. Moghaddam
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Correspondence to G. Zimmermann.

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Zimmermann, G., Müller, U., Löffler, C. et al. Therapieerfolg bei atrophen Tibiaschaftpseudarthrosen. Unfallchirurg 110, 931–938 (2007). https://doi.org/10.1007/s00113-007-1347-y

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  • DOI: https://doi.org/10.1007/s00113-007-1347-y

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