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Knochenersatzstoffe in der Skoliosechirurgie

Bone substitutes in scoliosis surgery

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Zusammenfassung

Bei spinalen Fusionsoperationen wird v. a. der resezierte lokale Knochen verwendet, um eine biologische Fusion zu erzielen. Häufig reicht dieser aber nicht aus und erfordert eine Augmentation. Die autologe Knochentransplantation gilt noch immer als der Goldstandard, birgt jedoch zusätzliches Komplikationspotenzial. Zudem ist die Verfügbarkeit autologen Knochens begrenzt. Alternativ stehen allogener Spenderknochen und inzwischen eine Vielzahl unterschiedlicher Knochenersatzstoffe bereit.

Die aktuell in der Skoliosechirurgie verwendeten Knochenersatzstoffe werden dargestellt, ihre klinische Relevanz wird anhand einer Literaturrecherche erläutert. Eigene Erfahrungen und klinische Praxis werden mit der Literatur verglichen und kritisch diskutiert. Die gerade in jüngerer Zeit steigende Zahl wissenschaftlicher Publikationen über Knochenersatzstoffe spiegelt das enorme Interesse und die Relevanz dieses Themas wider. In der Skoliosechirurgie werden in zunehmendem Maße Calciumphospatkeramiken kombiniert mit Knochenmarkaspirat eingesetzt.

Obwohl die autologe Knochentransplantation weiterhin der akzeptierte Standard zur Augmentation des lokalen Autografts in der Skoliosechirurgie ist, zeichnet sich ein eindeutiger Trend zur Verwendung von Knochenersatzstoffen ab.

Abstract

In spinal fusion procedures, the local bone that is resected serves as the base bone graft for attaining biological fusion. The local bone is frequently not sufficient and requires supplementary grafting. Autologous bone transplantation is still regarded as the gold standard but might cause additional complications; also, autograft resources are limited. Alternatively, allografts and a wide variety of different bone substitutes are available.

The bone substitutes currently used in scoliosis surgery are presented, and their clinical significance is elucidated by a review of the literature. Furthermore, our own experiences and clinical practice are compared with those in the literature and are critically discussed. The recently growing number of scientific publications reporting on bone substitutes reflects the immense interest and relevance of this issue. In scoliosis surgery, calcium phosphate ceramics together with bone marrow aspirate are increasingly applied.

Although harvesting of autologous bone continues to be the accepted standard to extend the local autograft in scoliosis surgery, there is a clear trend toward the use of bone substitutes.

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  1. Orthopädische Klinik II – Wirbelsäulenchirurgie, St. Franziskus-Hospital, Hohenzollernring 72, 48145, Münster, Deutschland

    T. Lerner &  U. Liljenqvist

  2. Institut für Pathologie, St. Franziskus-Hospital, Münster, Deutschland

    H. Griefingholt

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Lerner, T., Griefingholt, H. & Liljenqvist, U. Knochenersatzstoffe in der Skoliosechirurgie. Orthopäde 38, 181–188 (2009). https://doi.org/10.1007/s00132-008-1369-3

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