Información del artículo
Resumen
La aplicación de criterios tumorales en el tratamiento quirúrgico secuencial de las osteítis crónicas y seudoartrosis sépticas en forma de resecciones segmentarias origina amplios defectos óseos. Una vez controlado el proceso séptico, en un entorno estable y vascularizado, se procede a la reconstrucción en dichas lesiones mediante transporte óseo basado en la osteogénesis a distracción. A pesar de los buenos resultados obtenidos, los periodos de fijación externa y de curación son muy largos, 2,4 meses por centímetro reconstruido. Estos prolongados tratamientos motivan que haya un elevado número de complicaciones.
Los avances en ingeniería tisular y regeneración ósea contribuyen con nuevas técnicas y opciones terapéuticas. La estimulación de la formación de hueso nuevo en la zona de distracción o en el punto de atraque del fragmento transportado puede minimizar las complicaciones asociadas a la larga duración del procedimiento.
La utilización de un osteoinductor como BMP-7 origina en la práctica un aumento de la formación ósea y el nuevo hueso puede tener incrementadas sus propiedades biomecánicas.
Palabras clave:
Defecto óseo
Osteogénesis a distracción
Seudoartrosis séptica
Osteítis crónica
BMP
Ingeniería tisular
Reconstrucción esquelética
Transporte óseo
Abstract
The application of oncologic criteria in the sequential surgical treatment of chronic osteomyelitis foci and septic pseudarthrosis, through segmental resections, produces extensive bone defects. Once the septic process is under control, in a stable and well vascularized atmosphere, we perform reconstruction of intercalary defects through bone transportation based on distraction osteogenesis. Despite the good results, the healing index and the time on ex-fix are very long, about 10 weeks per centimeter rebuilt. These prolonged treatments lead to a large number of complications.
Advances in tissue engineering and bone regeneration have led to new techniques and therapeutic options. Stimulation of new bone formation in the distraction area or in the “docking-site” can minimize the complications associated with the length of time required by the procedure. The use of an osteoinducer, such as BMP-7, increases new bone formation and may enhance its biomechanical properties.
Keywords:
Bone defect
Distraction osteogenesis
Septic pseudoarthrosis
Chronic osteomyelitis
Bone morphogenetic protein
Tissue engineering
Skeletal reconstruction
Bone transport
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