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Knochen-Tissue-Engineering in der klinischen Anwendung

Eine Standortbestimmung

Bone tissue engineering in clinical application

Assessment of the current situation

  • Leitthema
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Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Die Behandlung großer Knochendefekte stellt nach wie vor in vielen Bereichen der Orthopädie und Unfallchirurgie eine Herausforderung dar. Bei der Verwendung von Knochentransplantaten und -ersatzstoffen sind für den klinischen Erfolg neben einer ausreichenden Primärstabilität die biologische Stimulation des Lagers und ein entsprechendes Remodelling wichtige Voraussetzungen. Während die osteokonduktive Wirkung von derzeit verfügbaren Knochenersatzstoffen den konventionellen Knochentransplantaten durchaus ähnlich sein kann, weisen sie als reiner Platzhalter keinerlei osteoinduktive oder gar osteogenetische Potenz auf. Dies ist nur unter Zusatz entsprechender Proteine (Wachstumsfaktoren) oder zellulärer Komponenten erreichbar. Eine Möglichkeit dazu ist die Verwendung von Stammzellen zur Vitalisierung von Trägerstoffen (Tissue Engineering). Im Rahmen dieser Arbeit sollen die derzeitigen Grundlagen der Technik in der Behandlung knöcherner Defekte zusammengefasst und anhand eines Fallberichts die klinische Applikation stammzellbeladener Trägerstoffe bei der Behandlung ausgedehnter periprothetischer azetabulärer Knochendefekte illustriert werden.

Abstract

Treatment of severe bone defects remains a challenge in orthopaedic surgery and traumatology. Surgical techniques should provide primary stability to reach osseous integration and secondary remodeling of bone grafts and substitute materials. None of the currently available substitute materials provides osteoconduction and osteogenesis comparable to those of human allografts and autografts. To enhance osteoinductive and osteogenetic properties of these implants mesenchymal stem cells are used successfully in bone tissue engineering approaches. The aim of this report is to summarize the currently available data on bone tissue engineering and preliminary experience with a tissue engineered graft in acetabular revision surgery after loosening of a hip replacement.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Die durchgeführten Arbeiten zur regenerativen Therapie an unserer Klinik werden aus Mitteln der Endostiftung Hamburg, des DFG-Center for Regenerative Therapies Dresden (CRTD) und des BMBF gefördert. Es besteht keine industrielle Förderung. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Orthopädische Klinik, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland

    P. Bernstein, K.-P. Günther & M. Stiehler

  2. Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland

    M. Bornhäuser

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  1. P. Bernstein
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  2. M. Bornhäuser
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  3. K.-P. Günther
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  4. M. Stiehler
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Correspondence to P. Bernstein.

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Bernstein, P., Bornhäuser, M., Günther, KP. et al. Knochen-Tissue-Engineering in der klinischen Anwendung. Orthopäde 38, 1029–1037 (2009). https://doi.org/10.1007/s00132-009-1493-8

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  • DOI: https://doi.org/10.1007/s00132-009-1493-8

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