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Biomechanik der Implantataugmentation

Biomechanics of implant augmentation

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Zusammenfassung

Hintergrund

Mit steigender Inzidenz osteoporotischer Frakturen sind zukünftig neue Behandlungsstrategien zu deren adäquater Versorgung unerlässlich.

Fragestellung

Die Implantataugmentation mit Knochenzementen bildet einen vielversprechenden Ansatz. Nutzen und Risiken sind detailliert zu bewerten.

Material und Methode

Experimentelle Untersuchung des biomechanischen Potenzials und der verbundenen Risiken mit speziellem Fokus auf Frakturen des osteoporotischen proximalen Femurs und des proximalen Humerus.

Ergebnisse

Schon mit kleinen Mengen Knochenzement (3 ml) lassen sich beispielsweise am proximalen Femur in Verbindung mit intramedullärer Nagelung die Lastzyklen bis zum Versagen um mehr als 50 % steigern. Im Knochen entstehende Wärme und Drücke unterschreiten kritische Grenzwerte. Gelenknahe Platzierung des Zements scheint kurz- bis mittelfristig keine negativen Auswirkungen auf den angrenzenden Knorpel zu haben. Die Gefahr von Leckagen ist zu beachten.

Schlussfolgerungen

Die Implantataugmentation bietet großes biomechanisches Potenzial, um mechanische Komplikationen nach Frakturversorgung im osteoporotischen Knochen zu vermeiden. Eine frühe und aktive Mobilisierung des älteren Patienten scheint daher möglich. Auftretende Risiken können bei fachgerechter Anwendung als beherrschbar eingestuft werden. Die überzeugenden experimentellen Ergebnisse dürfen aber nicht dazu verleiten, die Augmentation als Generallösung für die Versorgung osteoporotischer Frakturen zu betrachten. Die Anwendung des Konzepts bedarf einer sorgfältigen, individuellen Abklärung und ist immer im Gesamtkontext zu sehen.

Abstract

Background

The rising incidence of osteoporotic fractures requires novel treatment strategies.

Objective

Implant augmentation with bone cement is considered to be a promising approach but the benefits and risks need to be carefully evaluated.

Methods

Experimental investigation of the biomechanical potential and the associated risks with special reference to the osteoporotic proximal femur and proximal humerus.

Results

Even small amounts of bone cement (3 ml) applied to the proximal femur in combination with intramedullary nailing led to more than a 50 % increase in the number of test cycles before failure. The heat and pressure generated in the bone did not exceed critical thresholds. Short to midterm effects of subchondral cement placement on the adjacent cartilage can be excluded. The risk for cement leakage needs to be considered.

Conclusion

Implant augmentation offers high biomechanical potential to prevent mechanical complications after fracture fixation in osteoporotic bone. Early and confident mobilization of elderly patients therefore appears to be possible. With appropriate handling, associated risks seem controllable; however, implant augmentation cannot be applied as a routine concept for osteoporotic fracture management. The application requires careful evaluation on a case by case basis under comprehensive consideration of mechanical and biological factors.

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Danksagung

Die dargestellten biomechanischen Grundlagen wurden in verschiedenen Einzelstudien erarbeitet, welche freundlicherweise durch die AO Stiftung über das AOTrauma Netzwerk finanziert wurden (Grant-Nummer AR2008_01).

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Authors and Affiliations

  1. AO Forschungsinstitut Davos, Clavadelerstrasse 8, 7270, Davos, Schweiz

    M. Windolf

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  1. M. Windolf
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Correspondence to M. Windolf.

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M. Windolf gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Redaktion

F. Gebhard, Ulm

D. Höntzsch, Tübingen

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Windolf, M. Biomechanik der Implantataugmentation. Unfallchirurg 118, 765–771 (2015). https://doi.org/10.1007/s00113-015-0050-7

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  • DOI: https://doi.org/10.1007/s00113-015-0050-7

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