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Rekonstruktion knöcherner Defekte in der Knochensarkomchirurgie

Tumorendoprothese vs. biologische Rekonstruktion

Bone defect reconstruction in bone sarcoma surgery

Tumour endoprosthesis versus biological reconstruction

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Zusammenfassung

Hintergrund

Knochensarkome kommen sowohl gehäuft im Kindes und Jugendalter aber auch in jedem Erwachsenenalter vor. Hauptlokalisation sind die langen Röhrenknochen der Extremitäten sowie das Beckenskelett. Meta-/diaphysär lokalisierte Tumoren, deren Entfernung einen Gelenkersatz notwendig macht, überwiegen gegenüber rein diaphsyär lokalisierten Tumoren.

Fragestellung

Lokalisationsabhängig kommen sowohl endoprothetische oder auch biologische Rekonstruktionsverfahren zu Anwendung. Alle Verfahren bieten verfahrensspezifische Vor- und Nachteile.

Ergebnisse

Bei der Wahl des geeigneten Verfahrens müssen eine Vielzahl von Einflussfaktoren berücksichtigt werden. So sind grundlegende Erwägungen wie das Alter des Patienten (Weichteilsituation/Restwachstum/biologisches Potential), die Therapieintention im onkologischen Kontext (Palliation/Kuration), die Lokalisation (obere/untere Extremität) als auch die Tumorausdehnung im Knochen (Diaphyse/Metaphyse) oder auch die onkologische Gesamttherapie (Chemotherapie/lokale Strahlentherapie) zu berücksichtigen. Alle diese Faktoren beeinflussen die Wahl des Rekonstruktionsverfahrens ebenso wie das zu erwartende Gesamtergebnis.

Schlussfolgerung

Die Knochensarkomchirurgie bedarf einer breiten operativen Erfahrung des onkologischen Chirurgen. Nur durch Kenntnis der einzelnen Operationsverfahren kann das gesamte Spektrum der aktuellen Rekonstruktionsformen angeboten werden um das bestmögliche onkologische und funktionale Ergebnis für den individuellen Patienten zu erzielen.

Abstract

Background

Primary bone sarcomas typically arise in the long bones and the pelvis of children and adolescence but may also occur in adults. Meta/diaphysial tumour involvement resulting in the necessity of a joint replacement is more common than diaphysial tumour sites.

Aim

In the treatment of these tumours, both endoprosthetic replacement and biological reconstruction techniques are used. Each technique has method-specific advantages and disadvantages.

Results

To choose the appropriate surgical method, a multitude of influencing parameters need to be considered. The age at treatment (soft tissue situation/estimated growth/biological potential of the bone), therapeutic concept (palliative vs. curative), the tumour site (upper/lower extremity), tumour expansion (diaphysis/metaphysis) and oncological treatment concept (chemotherapy/radiotherapy) are key factors significantly influencing the surgical technique in terms of functional outcome and longevity of the reconstruction.

Conclusion

Surgical treatment of bone sarcoma requires broad-based experience of the oncological surgeon. Knowledge of the different surgical technics and reconstruction methods is decisive to offer the individual patient the best oncological and functional outcome.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Streitbürger, G. Gosheger, R. Dieckmann, M. Nottrott, H. Ahrens und J. Hardes geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland

    A. Streitbürger, G. Gosheger, R. Dieckmann, M. Nottrott, H. Ahrens & J. Hardes

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  1. A. Streitbürger
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  2. G. Gosheger
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  3. R. Dieckmann
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  4. M. Nottrott
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  5. H. Ahrens
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  6. J. Hardes
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Correspondence to A. Streitbürger.

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Streitbürger, A., Gosheger, G., Dieckmann, R. et al. Rekonstruktion knöcherner Defekte in der Knochensarkomchirurgie. Unfallchirurg 117, 600–606 (2014). https://doi.org/10.1007/s00113-013-2476-0

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