Skip to main content
Erschienen in: Der Orthopäde 11/2003

01.11.2003 | Leitthema

Allografts in der Rekonstruktion von knöchernen Defekten bei primär malignen Knochentumoren

verfasst von: Prof. Dr. P. Wuisman, F. Gohlke, A. Witlox

Erschienen in: Die Orthopädie | Ausgabe 11/2003

Einloggen, um Zugang zu erhalten

Zusammenfassung

Zur Rekonstruktion langstreckiger Defekte nach Resektion von Knochentumoren bieten sich unterschiedliche Modifikationen eines Aufbaus mit großen, strukturellen Transplantaten homologer Herkunft, sog. massiven Allografts an. Die Kombination dieser Transplantate mit Endoprothesen (composite allografts), verschiedenen Osteosyntheseverfahren oder vaskularisierten autologen Transplantaten (meist Fibula) kann den individuell unterschiedlichen Anforderungen an Stabilität und Funktion je nach Lokalisation angepasst werden. Während im höheren Lebensalter eher die Kombination mit Endoprothesen bevorzugt wird, sollte bei jüngeren Patienten der körpereigene Ersatz (Umdrehplastiken z. B.) angestrebt werden. Die Vorteile der Allografts einer besseren anatomischen Rekonstruktion und damit verbundenem Funktionserhalt stehen die Nachteile insbesondere der Spätkomplikationen (Ermüdungsbrüche, Resorption und Infektion) entgegen.
Literatur
1.
Zurück zum Zitat Leads from the MMWR (1988) Transmission of HIV through bone transplantation: case report and public health recommendations. JAMA 260: 2487–2488 Leads from the MMWR (1988) Transmission of HIV through bone transplantation: case report and public health recommendations. JAMA 260: 2487–2488
2.
Zurück zum Zitat Bolano L, Kopta JA (1991) The immunology of bone and cartilage transplantation. Orthopedics 14: 987–996 Bolano L, Kopta JA (1991) The immunology of bone and cartilage transplantation. Orthopedics 14: 987–996
3.
Zurück zum Zitat Buck BE, Malinin TI, Brown MD (1989) Bone transplantation and human immunodeficiency virus. An estimate of risk of acquired immunodeficiency syndrome (AIDS). Clin Orthop 240: 129–136 Buck BE, Malinin TI, Brown MD (1989) Bone transplantation and human immunodeficiency virus. An estimate of risk of acquired immunodeficiency syndrome (AIDS). Clin Orthop 240: 129–136
4.
Zurück zum Zitat Ceruso M, Falcone C, Innocenti M, Delcroix L, Capanna R, Manfrini M (2001) Skeletal reconstruction with a free vascularized fibula graft associated to bone allograft after resection of malignant bone tumor of limbs1. Handchir Mikrochir Plast Chir 33: 277–282 Ceruso M, Falcone C, Innocenti M, Delcroix L, Capanna R, Manfrini M (2001) Skeletal reconstruction with a free vascularized fibula graft associated to bone allograft after resection of malignant bone tumor of limbs1. Handchir Mikrochir Plast Chir 33: 277–282
5.
Zurück zum Zitat Clatworthy MG, Gross AE (2001) The allograft prosthetic composite: when and how. Orthopedics 24: 897–898 Clatworthy MG, Gross AE (2001) The allograft prosthetic composite: when and how. Orthopedics 24: 897–898
6.
Zurück zum Zitat Crosby LA, Norris BL, Dao KD, McGuire MH (2000) Humeral shaft nonunions treated with fibular allograft and compression plating. Am J Orthop 29: 45–47 Crosby LA, Norris BL, Dao KD, McGuire MH (2000) Humeral shaft nonunions treated with fibular allograft and compression plating. Am J Orthop 29: 45–47
7.
Zurück zum Zitat Donati D, Di Liddo M, Zavatta M et al. (2000) Massive bone allograft reconstruction in high-grade osteosarcoma. Clin Orthop 377: 186–194 Donati D, Di Liddo M, Zavatta M et al. (2000) Massive bone allograft reconstruction in high-grade osteosarcoma. Clin Orthop 377: 186–194
8.
Zurück zum Zitat Eisenschenk A, Lautenbach M, Schwetlick G, Weber U (2001) Treatment of femoral head necrosis with vascularized iliac crest transplants. Clin Orthop 386: 100–105 Eisenschenk A, Lautenbach M, Schwetlick G, Weber U (2001) Treatment of femoral head necrosis with vascularized iliac crest transplants. Clin Orthop 386: 100–105
9.
Zurück zum Zitat Engh GA, Herzwurm PJ, Parks NL (1997) Treatment of major defects of bone with bulk allografts and stemmed components during total knee arthroplasty. J Bone Joint Surg Am 79: 1030–1039 Engh GA, Herzwurm PJ, Parks NL (1997) Treatment of major defects of bone with bulk allografts and stemmed components during total knee arthroplasty. J Bone Joint Surg Am 79: 1030–1039
10.
Zurück zum Zitat Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop 286: 241–246 Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop 286: 241–246
11.
Zurück zum Zitat Enneking WF, Gearen PF (1986) Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting. J Bone Joint Surg Am 68: 1415–1422 Enneking WF, Gearen PF (1986) Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting. J Bone Joint Surg Am 68: 1415–1422
12.
Zurück zum Zitat Friedlaender GE (1991) Bone allografts: the biological consequences of immunological events. J Bone Joint Surg Am 73: 1119–1122 Friedlaender GE (1991) Bone allografts: the biological consequences of immunological events. J Bone Joint Surg Am 73: 1119–1122
13.
Zurück zum Zitat Friedlaender GE, Strong DM, Tomford WW, Mankin HJ (1999) Long-term follow-up of patients with osteochondral allografts. A correlation between immunologic responses and clinical outcome. Orthop Clin North Am 30: 583–588 Friedlaender GE, Strong DM, Tomford WW, Mankin HJ (1999) Long-term follow-up of patients with osteochondral allografts. A correlation between immunologic responses and clinical outcome. Orthop Clin North Am 30: 583–588
14.
Zurück zum Zitat Gebhardt MC, Roth YF, Mankin HJ (1990) Osteoarticular allografts for reconstruction in the proximal part of the humerus after excision of a musculoskeletal tumor. J Bone Joint Surg Am 72: 334–345 Gebhardt MC, Roth YF, Mankin HJ (1990) Osteoarticular allografts for reconstruction in the proximal part of the humerus after excision of a musculoskeletal tumor. J Bone Joint Surg Am 72: 334–345
15.
Zurück zum Zitat Getty PJ, Peabody TD (1999) Complications and functional outcomes of reconstruction with an osteoarticular allograft after intra-articular resection of the proximal aspect of the humerus. J Bone Joint Surg Am 81: 1138–1146 Getty PJ, Peabody TD (1999) Complications and functional outcomes of reconstruction with an osteoarticular allograft after intra-articular resection of the proximal aspect of the humerus. J Bone Joint Surg Am 81: 1138–1146
16.
Zurück zum Zitat Gitelis S, Heligman D, Quill G, Piasecki P (1988) The use of large allografts for tumor reconstruction and salvage of the failed total hip arthroplasty. Clin Orthop 231: 62–70 Gitelis S, Heligman D, Quill G, Piasecki P (1988) The use of large allografts for tumor reconstruction and salvage of the failed total hip arthroplasty. Clin Orthop 231: 62–70
17.
Zurück zum Zitat Haddad FS, Garbuz DS, Masri BA, Duncan CP (2000) Structural proximal femoral allografts for failed total hip replacements: a minimum review of five years. J Bone Joint Surg Br 82: 830–836 Haddad FS, Garbuz DS, Masri BA, Duncan CP (2000) Structural proximal femoral allografts for failed total hip replacements: a minimum review of five years. J Bone Joint Surg Br 82: 830–836
18.
Zurück zum Zitat Hallfeldt KK, Kessler S, Puhlmann M, Mandelkow H, Schweiberer L (1992) Der Einfluss verschiedener Sterilisationsverfahren auf die osteoinduktiven Eigenschaften demineralisierter Knochenmatrix. Unfallchirurg 95: 313–318 Hallfeldt KK, Kessler S, Puhlmann M, Mandelkow H, Schweiberer L (1992) Der Einfluss verschiedener Sterilisationsverfahren auf die osteoinduktiven Eigenschaften demineralisierter Knochenmatrix. Unfallchirurg 95: 313–318
19.
Zurück zum Zitat Hornicek FJJ, Mnaymneh W, Lackman RD, Exner GU, Malinin TI (1998) Limb salvage with osteoarticular allografts after resection of proximal tibia bone tumors. Clin Orthop 352: 179–186 Hornicek FJJ, Mnaymneh W, Lackman RD, Exner GU, Malinin TI (1998) Limb salvage with osteoarticular allografts after resection of proximal tibia bone tumors. Clin Orthop 352: 179–186
20.
Zurück zum Zitat Horowitz MC, Friedlaender GE (1991) Induction of specific T-cell responsiveness to allogeneic bone. J Bone Joint Surg Am 73: 1157–1168 Horowitz MC, Friedlaender GE (1991) Induction of specific T-cell responsiveness to allogeneic bone. J Bone Joint Surg Am 73: 1157–1168
21.
Zurück zum Zitat Langlais F, Lambotte JC, Thomazeau H (2001) Long-term results of hemipelvis reconstruction with allografts. Clin Orthop 388: 178–186 Langlais F, Lambotte JC, Thomazeau H (2001) Long-term results of hemipelvis reconstruction with allografts. Clin Orthop 388: 178–186
22.
Zurück zum Zitat Malawer MM, Price WM (1984) Gastrocnemius transposition flap in conjunction with limb-sparing surgery for primary bone sarcomas around the knee. Plast Reconstr Surg 73: 741–750 Malawer MM, Price WM (1984) Gastrocnemius transposition flap in conjunction with limb-sparing surgery for primary bone sarcomas around the knee. Plast Reconstr Surg 73: 741–750
23.
Zurück zum Zitat Mejdahl S, Hansen CA, Skjodt H, Reimann I (1998) Human bone bank allografts stimulate bone resorption and inhibit proliferation in cultures of human osteoblast-like cells. Acta Orthop Scand 69: 63–68 Mejdahl S, Hansen CA, Skjodt H, Reimann I (1998) Human bone bank allografts stimulate bone resorption and inhibit proliferation in cultures of human osteoblast-like cells. Acta Orthop Scand 69: 63–68
24.
Zurück zum Zitat Minami A, Kutsumi K, Takeda N, Kaneda K (1995) Vascularized fibular graft for bone reconstruction of the extremities after tumor resection in limb-saving procedures. Microsurgery 16: 56–64 Minami A, Kutsumi K, Takeda N, Kaneda K (1995) Vascularized fibular graft for bone reconstruction of the extremities after tumor resection in limb-saving procedures. Microsurgery 16: 56–64
25.
Zurück zum Zitat Molinari RW, Bridwell KH, Klepps SJ, Baldus C (1999) Minimum 5-year follow-up of anterior column structural allografts in the thoracic and lumbar spine. Spine 24: 967–972 Molinari RW, Bridwell KH, Klepps SJ, Baldus C (1999) Minimum 5-year follow-up of anterior column structural allografts in the thoracic and lumbar spine. Spine 24: 967–972
26.
Zurück zum Zitat Muscolo DL, Caletti E, Schajowicz F, Araujo ES, Makino A (1987) Tissue-typing in human massive allografts of frozen bone. J Bone Joint Surg Am 69: 583–595 Muscolo DL, Caletti E, Schajowicz F, Araujo ES, Makino A (1987) Tissue-typing in human massive allografts of frozen bone. J Bone Joint Surg Am 69: 583–595
27.
Zurück zum Zitat O’Connor MI, Sim FH, Chao EY (1996) Limb salvage for neoplasms of the shoulder girdle. Intermediate reconstructive and functional results. J Bone Joint Surg Am 78: 1872–1888 O’Connor MI, Sim FH, Chao EY (1996) Limb salvage for neoplasms of the shoulder girdle. Intermediate reconstructive and functional results. J Bone Joint Surg Am 78: 1872–1888
28.
Zurück zum Zitat Ortiz-Cruz E, Gebhardt MC, Jennings LC, Springfield DS, Mankin HJ (1997) The results of transplantation of intercalary allografts after resection of tumors. A long-term follow-up study. J Bone Joint Surg Am 79: 97–106 Ortiz-Cruz E, Gebhardt MC, Jennings LC, Springfield DS, Mankin HJ (1997) The results of transplantation of intercalary allografts after resection of tumors. A long-term follow-up study. J Bone Joint Surg Am 79: 97–106
29.
Zurück zum Zitat Ozaki T, Hillmann A, Bettin D, Wuisman P, Winkelmann W (1996) High complication rates with pelvic allografts. Experience of 22 sarcoma resections. Acta Orthop Scand 67: 333–338 Ozaki T, Hillmann A, Bettin D, Wuisman P, Winkelmann W (1996) High complication rates with pelvic allografts. Experience of 22 sarcoma resections. Acta Orthop Scand 67: 333–338
30.
Zurück zum Zitat Ozaki T, Hillmann A, Bettin D, Wuisman P, Winkelmann W (1997) Intramedullary, antibiotic-loaded cemented, massive allografts for skeletal reconstruction. 26 cases compared with 19 uncemented allografts. Acta Orthop Scand 68: 387–391 Ozaki T, Hillmann A, Bettin D, Wuisman P, Winkelmann W (1997) Intramedullary, antibiotic-loaded cemented, massive allografts for skeletal reconstruction. 26 cases compared with 19 uncemented allografts. Acta Orthop Scand 68: 387–391
31.
Zurück zum Zitat Rodl RW, Ozaki T, Hoffmann C, Bottner F, Lindner N, Winkelmann W (2000) Osteoarticular allograft in surgery for high-grade malignant tumours of bone. J Bone Joint Surg Br 82: 1006–1010 Rodl RW, Ozaki T, Hoffmann C, Bottner F, Lindner N, Winkelmann W (2000) Osteoarticular allograft in surgery for high-grade malignant tumours of bone. J Bone Joint Surg Br 82: 1006–1010
32.
Zurück zum Zitat Salai M, Ganel A, Horoszowski H (1997) Fresh osteochondral allografts at the knee joint: good functional results in a follow-up study of more than 15 years. Arch Orthop Trauma Surg 116: 423–425 Salai M, Ganel A, Horoszowski H (1997) Fresh osteochondral allografts at the knee joint: good functional results in a follow-up study of more than 15 years. Arch Orthop Trauma Surg 116: 423–425
33.
Zurück zum Zitat Shih HN, Chen YJ, Huang TJ, Hsu KY, Hsu RW (1998) Treatment of fibrous dysplasia involving the proximal femur. Orthopedics 21: 1263–1266 Shih HN, Chen YJ, Huang TJ, Hsu KY, Hsu RW (1998) Treatment of fibrous dysplasia involving the proximal femur. Orthopedics 21: 1263–1266
34.
Zurück zum Zitat Soucacos PN, Beris AE, Malizos K, Koropilias A, Zalavras H, Dailiana Z (2001) Treatment of avascular necrosis of the femoral head with vascularized fibular transplant. Clin Orthop 386: 120–130 Soucacos PN, Beris AE, Malizos K, Koropilias A, Zalavras H, Dailiana Z (2001) Treatment of avascular necrosis of the femoral head with vascularized fibular transplant. Clin Orthop 386: 120–130
35.
Zurück zum Zitat Stevenson S, Horowitz M (1992) The response to bone allografts. J Bone Joint Surg Am 74: 939–950 Stevenson S, Horowitz M (1992) The response to bone allografts. J Bone Joint Surg Am 74: 939–950
36.
Zurück zum Zitat Stockley I, McAuley JP, Gross AE (1992) Allograft reconstruction in total knee arthroplasty. J Bone Joint Surg Br 74: 393–397 Stockley I, McAuley JP, Gross AE (1992) Allograft reconstruction in total knee arthroplasty. J Bone Joint Surg Br 74: 393–397
37.
Zurück zum Zitat Thoren K, Aspenberg P, Thorngren KG (1995) Lipid extracted bank bone. Bone conductive and mechanical properties. Clin Orthop 311: 232–246 Thoren K, Aspenberg P, Thorngren KG (1995) Lipid extracted bank bone. Bone conductive and mechanical properties. Clin Orthop 311: 232–246
38.
Zurück zum Zitat Tomford WW (1995) Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg Am 77: 1742–1754 Tomford WW (1995) Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg Am 77: 1742–1754
39.
Zurück zum Zitat Winkelmann WW (1986) Hip rotationplasty for malignant tumors of the proximal part of the femur. J Bone Joint Surg Am 68: 362–369 Winkelmann WW (1986) Hip rotationplasty for malignant tumors of the proximal part of the femur. J Bone Joint Surg Am 68: 362–369
40.
Zurück zum Zitat Wong P, Gross AE (1999) The use of structural allografts for treating periprosthetic fractures about the hip and knee. Orthop Clin North Am 30: 259–264 Wong P, Gross AE (1999) The use of structural allografts for treating periprosthetic fractures about the hip and knee. Orthop Clin North Am 30: 259–264
41.
Zurück zum Zitat Wood MB (1987) Upper extremity reconstruction by vascularized bone transfers: results and complications. J Hand Surg Am 12: 422–427 Wood MB (1987) Upper extremity reconstruction by vascularized bone transfers: results and complications. J Hand Surg Am 12: 422–427
42.
Zurück zum Zitat Wood MB, Cooney WP, Irons GB (1985) Lower extremity salvage and reconstruction by free-tissue transfer. Analysis of results. Clin Orthop 201: 151–161 Wood MB, Cooney WP, Irons GB (1985) Lower extremity salvage and reconstruction by free-tissue transfer. Analysis of results. Clin Orthop 201: 151–161
43.
Zurück zum Zitat Wuisman P, Dethloff M, Grunert J, Rummeny E, Blasius S, Winkelmann W (1995) Die Anwendung von massiven Allografts als Rekonstruktionsverfahren nach Resektion von Knochentumoren im Bereich der Extremitaten. Z Orthop Ihre Grenzgeb 133: 166–175 Wuisman P, Dethloff M, Grunert J, Rummeny E, Blasius S, Winkelmann W (1995) Die Anwendung von massiven Allografts als Rekonstruktionsverfahren nach Resektion von Knochentumoren im Bereich der Extremitaten. Z Orthop Ihre Grenzgeb 133: 166–175
44.
Zurück zum Zitat Wuisman PI, Jiya TU, Van Dijk M, Sugihara S, Van Royen BJ, Winters HA (1999) Free vascularized bone graft in spinal surgery: indications and outcome in eight cases. Eur Spine J 8: 296–303 Wuisman PI, Jiya TU, Van Dijk M, Sugihara S, Van Royen BJ, Winters HA (1999) Free vascularized bone graft in spinal surgery: indications and outcome in eight cases. Eur Spine J 8: 296–303
45.
Zurück zum Zitat Zehr RJ, Enneking WF, Scarborough MT (1996) Allograft-prosthesis composite versus megaprosthesis in proximal femoral reconstruction. Clin Orthop 322: 207–223 Zehr RJ, Enneking WF, Scarborough MT (1996) Allograft-prosthesis composite versus megaprosthesis in proximal femoral reconstruction. Clin Orthop 322: 207–223
Metadaten
Titel
Allografts in der Rekonstruktion von knöchernen Defekten bei primär malignen Knochentumoren
verfasst von
Prof. Dr. P. Wuisman
F. Gohlke
A. Witlox
Publikationsdatum
01.11.2003
Verlag
Springer-Verlag
Erschienen in
Die Orthopädie / Ausgabe 11/2003
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-003-0580-5

Weitere Artikel der Ausgabe 11/2003

Der Orthopäde 11/2003 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.