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Transkutane osseointegrierte Prothesensysteme (TOPS) nach Extremitätenamputation

Status quo und Ausblick

Transcutaneous osseointegrated prosthesis (TOP) after limb amputation

Status quo and perspectives

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Zusammenfassung

Die Mehrheit transfemoral und -tibial Amputierter kann mit der herkömmlichen Prothesentechnik funktionell zufriedenstellend versorgt werden. Dennoch haben ca. 60 % der Patienten erhebliche Probleme mit der konventionellen Stumpfversorgung, sodass selbst jüngere Patienten in ca. 1/6 der Fälle ihre Prothese nicht täglich tragen können. Nach Einführung der transkutanen osseointegrierten Prothesensysteme (TOPS) besteht für diese Patienten die Möglichkeit, stumpfassoziierte Probleme zu vermeiden. Die vorliegende Übersicht zeigt den aktuellen Stand der Entwicklung transkutaner osseointegrierter Prothesensysteme in Schweden, Deutschland, den Niederlanden, Australien und den USA – heute mittlerweile in 9 Zentren. Bei den Arbeitsgruppen dieser Zentren besteht Übereinstimmung, dass TOPS eine Situation der Endbelastung, eine verbesserte Beweglichkeit der proximalen Gelenke, ein osseoperzeptives sensorisches Feedback und damit eine bessere Kontrolle der betroffenen Extremität ermöglicht. Ebenso besteht Übereinstimmung, dass in der Regel eine klinisch weniger relevante oberflächliche Kontamination des Stomas besteht. TOPS wird heute auch zur Versorgung transhumeral Amputierter und nach Daumenverlust eingesetzt, inzwischen mit einer Ausweitung der Indikation für diese Technik. Für zukünftige Anwendungen besteht die Möglichkeit, in das intramedulläre Implantat Elektroden zu verlegen und somit eine fortlaufende bidirektionale Kommunikation mit dem Körper zu erlauben („osseointegrated human-machine gateway“). So können eventuell eine innovative Form der Prothesenkontrolle, aber auch die Möglichkeit der Kombination mit der Targeted-muscle-reinnervation(TMR)-Chirurgie realisiert werden, um schließlich weiter fortgeschrittene Prothesenmodelle für die obere und untere Extremitätenamputationschirurgie zu entwickeln.

Abstract

The majority of transfemoral and transtibial amputees can be functionally fitted with conventional suspension sockets; however, due to socket problems using conventional stump care, 60% of the patients have limited function and even in younger patients approximately one sixth are unable to wear the prosthesis daily. After the introduction of transcutaneous osseointegrated prostheses (TOP) the inherent problems of socket-stump care can be avoided for these patients. Against this background this article reviews the recent clinical development of TOP in Sweden, Germany, the Netherlands, Australia and USA currently in nine centers. Unanimously, all groups show that TOP enables physiological weight bearing, improved range of motion in the proximal joint, as well as osseoperceptive sensory feedback and better control of the artificial limb. Likewise, there is agreement that as a rule that there is a clinically less relevant superficial contamination of the stoma. Furthermore, TOP is nowadays also used for transhumeral amputees and after thumb amputation and the development of the indications for this technique are increasing. Future aspects include novel treatment options using implanted intramedullary electrodes allowing permanent and unlimited bidirectional communication with the human body (osseointegrated human-machine gateway). This could possibly realize an innovative form of prosthesis control as well as the combination of TOP and targeted muscle reinnervation (TMR) surgery to create more advanced prosthesis systems for upper and lower extremity amputees.

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Authors and Affiliations

  1. Abteilung Unfallchirurgie und Orthopädie, Septisch-rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland

    Christian Willy

  2. Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, Hannover, Deutschland

    Christian Krettek

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Correspondence to Christian Willy.

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C. Willy und C. Krettek geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Willy, C., Krettek, C. Transkutane osseointegrierte Prothesensysteme (TOPS) nach Extremitätenamputation. Unfallchirurg 120, 395–402 (2017). https://doi.org/10.1007/s00113-017-0347-9

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