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Biologische Rekonstruktion von großen Knochendefekten

Masquelet-Technik und neue Verfahren

Biological reconstruction of large bone defects

Masquelet technique and new procedures

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Zusammenfassung

Ausgedehnte dia- und metaphysäre Knochendefekte stellen nach wie vor eine große Herausforderung für Unfallchirurg*innen dar. Zur biologischen Rekonstruktion derartiger Defekte wurden verschiedene Behandlungsoptionen beschrieben. Die am häufigsten verwendeten Methoden sind der Segmenttransport, die Masquelet-Technik und 3D-gedruckte Scaffolds (Gerüste). Bei der Masquelet-Technik dienen im Ersteingriff in den Knochendefekt eingebrachte Spacer aus Polymethylmethacrylat (PMMA), Kalziumsulfat oder Polypropylen der Induktion einer Fremdkörpermembran; im Zweiteingriff erfolgt die Auffüllung des membranös umgebenen Knochendefekts mit autologer Spongiosa. Der zeitliche Abstand zwischen beiden operativen Eingriffen beträgt 4 bis 8 Wochen, wobei die induzierten Membranen auch bei einer zeitlichen Latenz länger als 8 Wochen nicht ihre Bioaktivität einbüßen. Dreidimensional gedruckte Scaffolds finden zunehmend Anwendung, wobei jedoch große klinische Studie fehlen, um die genaue Rolle dieses Verfahrens bei der Rekonstruktion von Knochendefekten zu zeigen.

Abstract

Extensive diaphyseal and metaphyseal bone defects continue to pose a major challenge for orthopedic trauma surgeons. Various treatment options have been described for the biological reconstruction of these defects. The most frequently used methods are bone segment transport, the Masquelet technique and 3D printed scaffolds. As far as the Masquelet technique is concerned, in the first stage spacers, such as polymethyl methacrylate (PMMA), calcium sulfate or polypropylene are inserted into the bone defects to induce a foreign body membrane. In the second stage the bone defect surrounded by the induced membrane is filled with autologous cancellous bone. The time interval between the first and second interventions is usually 4–8 weeks whereby the induced membranes do not lose their bioactivity even with a latency period longer than 8 weeks. Three-dimensional printed scaffolds are increasingly used but large clinical studies are lacking in order to show the exact role of this procedure in the reconstruction of bone defects.

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Authors and Affiliations

  1. Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    Emmanouil Liodakis MBA FEBOT, Tarek Omar Pacha, Gökmen Aktas, Stephan Sehmisch & Philipp Mommsen

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Correspondence to Emmanouil Liodakis MBA FEBOT.

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E. Liodakis, T.O. Pacha, G. Aktas, S. Sehmisch und P. Mommsen geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Liodakis, E., Pacha, T.O., Aktas, G. et al. Biologische Rekonstruktion von großen Knochendefekten. Unfallchirurgie 126, 184–189 (2023). https://doi.org/10.1007/s00113-022-01267-9

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