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Platelet-rich-Plasma in Kombination mit autologer Spongiosa

Eine Alternative bei therapierefraktären Pseudarthrosen?

Platelet-rich plasma combined with autologous cancellous bone

An alternative therapy for persistent non-union?

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Zusammenfassung

Hintergrund

Neben einer stabilen Osteosynthese ist bei bestehender Pseudarthrose die autologe Spongiosaplastik die Therapie der Wahl. Trotz Ausschöpfung dieser Behandlungsoptionen kommt es bei einer nicht zu vernachlässigenden Anzahl von Patienten zu therapierefraktären Pseudarthrosen. Ziel dieser Studie war zu evaluieren, in wieweit der kombinierte Einsatz von Platelet-rich-Plasma (PRP) und autologer Spongiosa zur Therapie refraktärer Pseudarthrosen geeignet ist.

Material und Methode

Im Rahmen dieser prospektiven Studie wurden von 08/2005 bis 02/2008 insgesamt 17 Patienten mit einer therapierefraktären Pseudarthrose an den langen Röhrenknochen mittels kombiniertem Einsatz von PRP und autologer Spongiosa behandelt. Alle Patienten wiesen eine atrophe Knochenbruchheilung auf und hatten durchschnittlich 9 (6–14 Monate) zuvor bereits mindestens eine erfolglose autologe Spongiosaplastik erhalten. Klinische und radiologische Untersuchungen wurden in regelmäßigen Abständen nach 3, 6 und 9 Monaten postoperativ durchgeführt.

Ergebnisse

Die operative Therapie mit PRP und autologer Spongiosa erfolgte im Durchschnitt 17 (15–23 Monate) nach der Erstversorgung. In allen Fällen konnte durch dieses Verfahren eine radiologische Ausheilung der Pseudarthrosen nach durchschnittlich 5 (4–7 Monaten) erzielt werden. Komplikationen wurden nicht beobachtet.

Schlussfolgerung

Für die Behandlung therapierefraktärer Pseudarthrosen erscheint der kombinierte Einsatz von PRP und autologer Spongiosa ein sicheres und effektives Verfahren. Es verursacht zudem keine wesentlichen zusätzlichen Kosten, und mit Unverträglichkeits- oder Abstoßungsreaktionen ist aufgrund der autologen Gewinnung nicht zu rechnen.

Abstract

Background

In addition to a stabile osteosynthesis autologous cancellous bone graft remains an essential therapy option in persistent non-union. Despite this therapy regimen persistent non-union can occasionally occur. The aim of this study was to evaluate the treatment of persistent non-union with a combination of platelet-rich plasma (PRP) and autologous cancellous bone.

Material and methods

In this prospective study 17 patients with persistent non-union of long bones were treated by a combination of PRP and autologous iliac crest bone. Inclusion criteria were a minimum of one previously failed cancellous bone transplantation and an atrophic non-union persisting for 6–14 months (mean 9 months). The patients were examined clinically and radiologically at intervals of 3, 6 and 9 months postoperatively.

Results

After an average time of 17 months (range 15–23 months) the patients were treated by a combination of PRP and autologous cancellous bone. In all cases the non-union was successfully treated and osseous bridging was found radiologically after an average of 5 months (range 4–7 months) without any complications.

Conclusion

The combination of PRP and autologous cancellous bone appears to be a safe and effective method for treatment of persistent non-union. The use of PRP does not result in substantial additional costs. Allergies and graft versus host reactions are not expected because of the autologous origin.

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Authors and Affiliations

  1. Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    M. Hakimi,  P. Jungbluth, S. Thelen, M. Betsch, S. Flohé, J. Windolf & M. Wild

  2. Klinik für Unfallchirurgie und Orthopädie, SLK-Kliniken Heilbronn, Heilbronn, Deutschland

    W. Linhart

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  1. M. Hakimi
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  2. P. Jungbluth
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Correspondence to P. Jungbluth.

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Hakimi, M., Jungbluth, P., Thelen, S. et al. Platelet-rich-Plasma in Kombination mit autologer Spongiosa. Unfallchirurg 114, 998–1006 (2011). https://doi.org/10.1007/s00113-010-1836-2

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