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Die autologe Fibulatransplantation zur Rekonstruktion knöcherner Defekte

Autologous fibula transplantation for reconstruction of bone defects

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Zusammenfassung

Die Rekonstruktion ausgedehnter ossärer Defekte nach Tumor, Trauma oder Infekt ist schwierig und unterliegt zumeist den individuellen Präferenzen des jeweiligen Operateurs. Freie autologe Fibulagrafts stellen eine verlässliche biologische Behandlungsoption dar, wobei die Transplantation grundsätzlich mit (vaskularisiert) oder ohne gleichzeitigen Gefäßanschluss (nichtvaskularisiert) erfolgen kann. Beide Varianten weisen jeweils individuelle Vor- und Nachteile auf. Vaskularisierte Fibulatransplantate sind insbesondere zur Überbrückung ausgedehnter segmentaler Knochendefekte und bei Patienten mit adjuvanter Chemo- oder Strahlentherapie geeignet. Nichtvaskularisierte Fibulae – welche den Vorteil eines Regenerationspotenzials an der Entnahmestelle sowie eine deutlich kürzere Operationszeit bieten – können hingegen günstig zur Rekonstruktion hemikortikaler Defekte oder segmentaler Defekte im ersatzstarken Lager eingesetzt werden.

Abstract

The reconstruction of large bone defects following tumor resection, trauma or infection is difficult and subject to individual preferences of each surgeon. Free autologous fibula grafts are a reliable biological treatment method, whereas both a vascularised and a non-vascularised transplantation is possible. The use of either treatment option – vascularised or non-vascularised – is accompanied by individual advantages and/or disadvantages that should be taken into consideration during the preoperative planning process. Vascularised fibula transplants should be used especially for the reconstruction of large segmental defects and in patients, in whom adjuvant chemo- and/or radiation therapy is to be administered. Non-vascularised fibula grafts – which offer the advantage of a certain regeneration potential at the donor site as well as a shorter operation time – might be beneficial for bridging hemicortical defects and segmental defects with good soft tissue coverage.

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Abbreviations

FS:

„Fat Saturation“

CT:

Computertomographie

MRT:

Magnetresonanztomographie

SPIR:

„Spectral Presaturation with Inverse Recovery“

STIR:

„Short Tau Inversion Recovery“

TSE:

„Turbo Spin Echo“

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Authors and Affiliations

  1. Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675, München, Deutschland

    U. Lenze, F. Pohlig, C. Knebel, F. Lenze, N. Harrasser, H. Mühlhofer, A. Toepfer, H. Rechl & R. von Eisenhart-Rothe

  2. Department of Orthopaedics, The Royal Children’s Hospital, Melbourne, Australien

    U. Lenze

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Correspondence to U. Lenze.

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U. Lenze, F. Pohlig, C. Knebel, F. Lenze, N. Harrasser, H. Mühlhofer, A. Toepfer, H. Rechl und R. von Eisenhart-Rothe geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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Lenze, U., Pohlig, F., Knebel, C. et al. Die autologe Fibulatransplantation zur Rekonstruktion knöcherner Defekte. Orthopäde 46, 648–655 (2017). https://doi.org/10.1007/s00132-017-3442-2

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