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Resorbierbare Kalziumphosphatzemente

Resorbable calcium phosphate cements

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Knochenersatzmaterialien haben in den letzten Jahren einen festen Platz im klinischen Alltag des Orthopäden und Unfallchirurgen eingenommen. Für die knöcherne Defektbehandlung vor allem bei älteren osteoporotischen Patienten sind die verfügbaren Substanzen sehr hilfreich. Das langfristig größte Entwicklungspotential wird augenblicklich den resorbierbaren Materialien zugeschrieben. Hier sind es vor allem die resorbierbaren Kalziumphosphatzemente, die im derzeitigen Mittelpunkt des klinisch/experimentellen Interesses stehen. Durch ihre Viskosität können mit den Zementen Defekte unterschiedlicher Form und Größe vollständig aufgefüllt werden. Die minimal invasive Applikation über Stichinzisionen unter radiologischer Kontrolle ist möglich, wodurch die Zugangsmorbidität in vielen Fällen in denen die Behandlung eines knöchernen Defektes notwendig ist reduziert werden kann. Die Kombination mit einer stabilen Osteosynthese ist jedoch häufig erforderlich. Die Substanzen werden vollständig in das biologische Konstrukt Knochen integriert und sind dem physiologischen Remodelingprozeß unterworfen, d. h. die Materialien werden durch Osteoklasten resorbiert und durch neuen Knochen ersetzt. Diese Eigenschaft der Kalziumphosphatzemente ermöglicht es, das eigentliche Knochenersatzmaterial mit Medikamenten und/oder Wachstumsfaktoren zu vermischen und eine kontrollierte Freisetzung der Substanzen aus dem System zu erreichen. Zu berücksichtigen ist hierbei, dass die Resorption der kalziumhaltigen Zemente abhängig ist von ihrem Implantationsort (anatomische Lokalisation) und praktisch nie vollständig geschieht. In wie weit auch diaphysäre Defekt mit Hilfe von Kalziumphosphatzementen sicher überbrückt werden können müssen weitere experimentelle Untersuchungen belegen. Die biologische Wertigkeit im Vergleich zu autogenem Knochen kann nur durch—noch immer fehlende—kontrollierte klinische Studien bestimmt werden.

Abstract

In the last years bone substitute materials have taken up their definite place in clinical practice for orthopaedic and trauma surgeons. For the treatment of bony defects especially in older patients with severe osteoporosis the available substances are quite helpful. The biggest long-term development potential is currently imputed to the resorbable materials. In particular the resorbable calcium phosphate cements are in the middle of clinical and experimental interests. Due to their viscosity these cements are able to fill defects with variable forms and sizes. The minimal invasive application through slightest incisions is possible under radiological control whereby the morbidity of the approach can be reduced in most cases where treatment of bony defects is indicated. The combination with a stable osteosynthesis is frequently required. These substances are fully integrated in the biological construct which contains the physiologic remodelling process. That means these materials can be resorbed by osteoclasts and get replaced by new bone. This quality of calcium phosphate cements makes it possible that rather bone substitute materials can be mixed up with drugs or growth factors to achieve a controlled release of the substances. It has to be considered that the resorption of the cements containing calcium is dispensable from the place of implantation (anatomic location) and practically never appears to be complete. How diaphyseal defects can also be treated with calcium phosphate cements needs to be shown by further experimental trials. The biological valence compared to autogenous bone can only be determined with further controlled clinical studies.

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  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Zentrum für operative Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg

    W. Linhart, D. Briem, A. Peters, W. Lehmann, J. Windolf & J. M. Rueger

  2. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Zentrum für operative Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246 , Hamburg

    W. Linhart

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  1. W. Linhart
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Linhart, W., Briem, D., Peters, A. et al. Resorbierbare Kalziumphosphatzemente. Trauma Berufskrankh 6, 277–284 (2004). https://doi.org/10.1007/s10039-004-0967-5

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