Pseudarthrosen langer Röhrenknochen

 

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Zusammenfassung

Der Anteil von verzögerter oder ausbleibender Knochenbruchheilung bei Frakturen der langen Röhrenknochen liegt, je nach Risikoprofil des Patienten, bei ca. 10 %. Dies führt bei den Patienten häufig zu einer erheblichen Einschränkung der Lebensqualität und ist mit einer verlängerten Krankheitsdauer vergesellschaftet. Nach der aktuellen Definition ist eine Pseudarthrose eine Fraktur, die ohne weitere Intervention nicht mehr zur Ausheilung kommt – unabhängig von der bisherigen Behandlungsdauer. In der Frühphase ist bei ausreichender Stabilität eine konservative Therapie möglich. In der operativen Behandlung zielt die Therapie, angelehnt an das „Diamond Concept“, zunächst auf eine Analyse der Pseudarthrose nach festen Kriterien ab. Anschließend erfolgt die Optimierung der einzelnen Faktoren, wie der mechanischen Stabilität, z. B. durch Reosteosynthese, der Verbesserung der Vaskularisation, der Bereitstellung von osteokonduktivem Material wie z. B. Trikalziumphosphat sowie vitalen Zellen durch Spongiosaplastiken und der Applikation von Wachstumsfaktoren wie Bone morphogenetic Proteins (BMP-2 oder BMP-7). Diese Maßnahmen sind, je nach Analyse der Pseudarthrose, einzeln oder kombiniert möglich. Weiterhin besteht die Möglichkeit eines zweizeitigen Verfahrens in der Masquelet-Technik, vor allem bei atrophen und Defekt- bzw. Infektpseudarthrosen. Dabei wird nach Infektsanierung und Induktion einer „Neo-Knochenhaut“ der Knochenaufbau nach den gleichen Prinzipien in einer 2. Operation vorgenommen.

Abstract

The percentage of delayed or non-unions after fractures of long bones depends on the individual risk profile at approximately 10 %. The current definition states that a non-union is a fracture that will not consolidate without any further intervention – independent from the treatment time. At the early stage of a non-union a conservative treatment is possible in case of an adequately stable situation. The operative treatment depends on the type of the non-union. There are one-step or two-step procedures, all according to the principles of the “diamond concept”. This means improvement of the mechanical situation – in most cases by means of a reosteosynthesis – and vascularization, local application of osteoconductive carriers e.g. tricalciumphosphate, vital cells from autologous bone and osteoinductive substances like bone morphogenetic proteins (BMP-2 or BMP-7). Hypertrophic and atrophic non-unions without large defect gaps or signs of infection can be treated with a one-step procedure. For treating infected non-unions or non-unions with large defect gaps the Masquelet technique is recommended.

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