Beitrage zur Orthopadie und Traumatologie最新文献

In the time between 1981 to 1987 about 9,190 operations had been performed at the Orthopaedic Department of the Humboldt University Charité Berlin. In 1592 cases (= 17.3%) we transplanted autogeneic or allogeneic bone tissues. We report about the kind and selection of transplanted bone tissue with respect to availability and target function.

The demand for consistent supply of nonvital allogenous implants in tissue banks has the supposition for graft preservation. Besides of many logistic advantages the preservation methods are accompanied by the influence of original attributes, especially of biomechanic parameters in soft tissue preparations. A procedure of dura mater preparation, of fascia lata, tendons and skin is demonstrated which is preserving the required qualities of plasticity, softness and resistance. Biomechanic comparative investigations of other preservation procedures are done and first clinical results are demonstrated.

Since the foundation of the tissue bank at the District Institute for Blood Donation--and Transfusion Service of Leipzig in 1966 the range of production and the assortment of nonvital tissue transplants has considerably increased. The amount of clinical establishments and their requirements is considerably increased, in which the realization of demands is not always possible without waiting periods. The main tissue conservation method is the cryo-drying. Besides the extreme cooling and cryo-preservation were used. Problems of transportation of cooled tissue conserves were discussed.

Analysed are altogether 119 acetabuloplasties correcting acetabular fossae using corticospongiose bankchips. The operations of the years from 1975-1983 have been used for this analysis. Examined are by clinical progress and serial roentgenography the compatibility, the resistance to mechanical stress as well as building in and transformation of the corticospongiose bankchips. Finally is determined the progress of the socket by using the socket-roof- and centre-corner-angle postoperative on an average of 10 years.

Demineralized bone matrix has been tested in a clinical study concerning the filling of bone defects in the surgical stomatology. It is reported on the clinical results and the X-ray evaluation of the replacement of bones by demineralized bone matrix. Fifty two implantations in the maxilla and mandible of 51 patients were carried out to be able to evaluate the efficacy of demineralized bone matrix.

The conservation of tissue in GDR is an example system of superregional supply with tissue transplants, which was established with the foundation of the Central Tissue Bank at the Charité in 1956 e. g. with the following arrangement of tissue banks in Leipzig and Rostock in 1966 and 1969. The concept of this tissue banks is characterized by means of decentralised production of tissue material under conditions of section and the central preparation, conservation and storage (chemical or radiation sterilization, conservation on base of freeze-drying (or freeze-storage), aseptic packing and storage by room temperature). This system allows the consistent disposal of 30 various nonvital tissue preparations. Until 1989 more than 170,000 allogeneic and xenogeneic tissue transplants have been produced in the tissue banks of country of which nearly 130,000 were used in 300 clinics.

The implantation of bone matrix in muscle bag or trepanation defects of rats with greatest reproducibility will induce osteogenesis and defect healing. The phenomenon of osteo-induction was possible to obtain only in first steps in higher developed mammals. Investigations in nude rats have shown a clear difference in biologic reaction on the matrix of various species. The osteo-regeneration in replacement weak defect of ulnar bone in dogs showed a massive greater reactivity of autogenous spongiosa, whereas bank spongiosa and bone matrix produced not more new bone as the control. An increase of osteoinductive matrix potency is a supposition for practical use in case of severe bone defects.

We present first results of our clinical trial with a demineralized-bone-matrix (DBM) not only as a transplant to fill up a defect of bone but above all to induce local osteogenesis. Indications and practical applications of the material of transplants are described. By help of the clinical progresses and the reports of laboratory examinations the biological compatibility is regarded in this paper. Roentgen morphologically fine structures of the transplants and their transplant beds are described in serial roentgenography and used as evaluation of processes of transformation and building in of bones. The in a relative good time appearing markings of trajectories of the fine structures in the sphere of the transplant as a sign of accelerated regeneration of "organic bony substance" allows the expectation on being released osteogenetic potencies by DBM for the induction of local bone regeneration.

In an animal experiment we could prove, that a spontaneous regeneration of periosteum on thermally injured bone is not to be seen within three month, when the bone is covered by soft tissue only. Using a periosteal flap to cover a burned bone, regeneration could be observed from the endosteum and the periosteum alike. After making the bone with a fluorescent labels, paths and velocity of bony regeneration could be defined.

Juvenile bone cysts are characterized by trials of hypothetic interpretations in case of aetiology and general disagreement in relation to indicated therapy. The therapeutic spectrum is ranging from primary conservative treatment till subtotal e.g. total cyst resections. Because in juveniles a quantitative limitation for gathering of autogenous material exists the use of allogenous cancellous bone chips has a definitive place in treatment strategy.