Einsatz der Bone morphogenetic Proteins (BMPs) zur Behandlung von Pseudarthrosen – Effizienz und Therapieversagen

Abstract

Zusammenfassung In der Therapie von Pseudarthrosen der proximalen Tibia kommen seit einigen Jahren die humanen rekombinanten ?bone morphogenetic proteins? (BMP-2 und BMP-7) zum Einsatz. Trotz limitiertem und spezifischem Einsatz als lokale Mediatoren der Knochenheilung k?nnen bisher keine Aussagen ?ber den jeweiligen Erfolg der Therapie im Voraus getroffen werden. Die Regelmechanismen zeigen sich als wesentlich komplexer und patientenspezifischer als bisher angenommen. Zum Verst?ndnis der zellbiologischen Abl?ufe (Signalling) und der bisher m?glichen Pr?diktion eines erfolgreichen Einsatzes von BMP sind in diesem Artikel die relevanten Erkenntnisse zusammengefasst.

Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion

“…In contrast to earlier studies, the latest research recommended the early use of rhBMPs in treatment of nonunion even in terms of economic aspects specifically in cases with increased severity of osseous and soft tissue damage [14, 15, 47]. Due to the results of the current study, we cannot recommend the use of additional rhBMP in revision surgery as an effective additive treatment tool for aseptic nonunion in humerus, femur, and tibia shaft.…”

“…RhBMPs promote osteogenesis by enhancing cell signaling, chemotaxis, mitosis, and cellular differentiation and thereby, are beneficial in promoting osteoinduction [14, 15]. …”

“…In addition, it is well established that autologous bone graft is beneficial for promoting bone healing specifically in nonunion [14]. Various graft forms can be harvested and utilized including non-vascularized or vascularized grafts with or without mechanical, structural support [15]. Although the stimulating effect on bone healing is undisputed, adverse side effects such as donor site morbidity specifically at the iliac crest, risk of infection, and impaired graft incorporation remain problematic [16].…”

Comparative study suggests that human bone morphogenetic proteins have no influence on the outcome of operative treatment of aseptic clavicle non-unions

“…2: elective metal removal following non-union healing 12 months after revision surgery have been utilised including local injection, direct and open application into the non-union site, or insertion of rhBMPcoated implants [22]. RhBMPs promote signalling, chemotaxis, mitosis and differentiation of progenitor cells in the biological process of osteogenesis, and have been shown to accelerate bone healing in both settings of fracture and non-union healing [23]. To our knowledge, this study represents the only trial of aseptic clavicle non-union treated with additional application of both, rhBMP-2 and rhBMP-7, and with at least one year of functional and radiological follow-up.…”