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Nanostrukturiertes synthetisches Knochenersatzmaterial zur Behandlung von Knochendefekten

Ergebnisse einer anwendungsbeobachtenden Studie

Nanostructured synthetic bone substitute material for treatment of bone defects

Results of an observational study

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Trauma und Berufskrankheit

Zusammenfassung

Bei der Versorgung von Knochendefektbrüchen ist bis heute die autologe Spongiosaplastik der Goldstandard zum Defektaufbau. In der Literatur werden Komplikationsraten bis zu 30 % angegeben. Deshalb ist man auf der Suche nach einem Knochenersatzmaterial, das den hohen Anforderungen an Osteoinduktivität, Osteokonduktivität und Osteogenese gerecht wird. Diese Studie untersucht Komplikationen und Frakturheilungsraten bei Patienten mit Knochendefekten, welche mit synthetischem silikatsubstituiertem Calciumphosphat behandelt wurden. Die festgestellten Komplikationsraten und Heilungsquoten zeigen im Literaturvergleich vergleichbare Ergebnisse wie sie mit einer Spongiosaplastik erreicht wurden. Die Komplikationsrate bei der Verwendung von silikatsubstituiertem Nanohydroxylapatit erscheint bei eingeschränkter Vergleichbarkeit niedriger als die Kombination der Komplikationsraten von Spongiosaplastik und Spongiosaentnahmestelle. Synthetische Knochenersatzstoffe zeigen hinsichtlich Komplikationen und Frakturheilungsraten gegenüber dem Goldstandard kein schlechteres Outcome und sollten bei der Behandlung von Knochendefektbrüchen an den Extremitäten und am Becken als Alternative zur autologen Spongiosaplastik berücksichtigt werden. Die Stärken dieser Studie liegen in einem prospektiven und konsekutiven Studiendesign. Eine Computertomographie aller eingeschlossenen Patienten wäre wünschenswert gewesen, war aber aus finanziellen und strahlenhygienischen Gründen nicht durchführbar.

Abstract

Autologous bone grafting is still the gold standard for the reconstruction of bone defects from fractures. Complication rates up to 30 % have been described in the literature for bone grafting procedures. Thus, research is concerned with the development of alternative bone substitutes, which satisfy the high requirements of bone inductivity, bone conductivity and osteogenesis. This study compared the complications and fracture healing rates of patients with bone defects treated with synthetic silicate-substituted calcium phosphate. Concerning complications and fracture healing rates, the results of our study are comparable to the results of autologous bone grafting in the available literature. Despite limited comparability, the complication rate of the treatment of bone defects with silicate-substituted nanohydroxyapatite seems lower than the combined complication rates for bone harvesting and grafting together. In our study synthetic bone substitutes did not show poorer results concerning complication rates and fracture healing compared to the gold standard. These materials should be considered as an alternative for the treatment of bone defects in fractures of the extremities and pelvis. The strength of the study lies in the prospective and consecutive design. A computed tomography of all included patients would have been desirable but could not be performed due to financial and radiation hygiene reasons.

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Authors and Affiliations

  1. Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Deutschland

    B. Kienast & H. Neumann

  2. Campus Lübeck, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    B. Kienast, F. Brüning-Wolter & A. P. Schulz

  3. Campus Lübeck, Labor für Biomechanik und orthopädisch-traumatologische Forschung, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    R. Wendlandt

  4. Klinik und Poliklinik für Orthopädie und Chirurgische Orthopädie, Universitätsmedizin Greifswald der Ernst-Moritz-Arndt-Universität Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland

    R. Kasch

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Correspondence to B. Kienast.

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B. Kienast, H. Neumann, F. Brüning-Wolter, R. Wendlandt, R. Kasch und A.P. Schulz geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Kienast, B., Neumann, H., Brüning-Wolter, F. et al. Nanostrukturiertes synthetisches Knochenersatzmaterial zur Behandlung von Knochendefekten. Trauma Berufskrankh 18, 308–318 (2016). https://doi.org/10.1007/s10039-016-0209-7

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