KOŠTANA TRANSPLANTACIJA U ORTOPEDSKOJ HIRURGIJI

  • Dejan Aleksandrić Institut za ortopediju Banjica
  • Lazar Mičeta Institut za ortopediju Banjica, Beograd, Srbija
  • Želimir Jovanović Institut za ortopediju Banjica, Beograd, Srbija
  • Jovana Grupković Dr
  • Uroš Dabetić Univerzitetski klinički centar Srbije, Klinika za ortopedsku hirurgiju i traumatologiju, Beograd, Srbija
  • Boris Vukomanović Institut za ortopediju Banjica, Beograd, Srbija
DOI: https://doi.org/10.5937/smclk4-41419
Ključne reči: koštani graft, koštani defekti, osteokondukcija, osteoindukcija

Sažetak


Osteoni su osnovne jedinice koštanog tkiva. Četiri tipa koštanih ćelija su odgovorna za izgradnju koštanog matriksa, njegovo održavanje i remodelaciju kosti. To su osteoprogenitorske ćelije, osteoblasti, osteociti i osteoklasti. Glavna uloga kosti je u izgradnji skeleta koji pruža potporu, omogućava održavanje stalnog telesnog oblika i kretanje, što se ustvari postiže složenim sistemom poluga na koje deluju mišićne sile u tačkama pripojišta. Nastanak preloma dovodi do procesa zapaljenja, zarastanja, te remodelovanja koji može vratiti povređenu kost u njeno prvobitno stanje. U današnje vreme sve češće se suočavamo sa defektima različite veličine i etiologije, koji povećavaju potrebu za usavšavanjem koštane transplantacije. Ova procedura podrazumeva hiruršku tehniku kojom se postavlja nova kost ili odgovarajuća zamena na mesto između ili oko prelomljenih fragmenata ili u predelu defekta kako bi se potpomoglo zarastanje kosti. Koštana transplantacija je moguća jer koštano tkivo, za razliku od većine drugih, ima sposobnost da se u potpunosti regeneriše ukoliko mu se obezbede adekvatni uslovi i prostor u koji će prorasti. Osnovni biološki mehanizmi koji opravdavaju i objašnjavaju princip funkcionisanja i upotrebe koštane transplantacije su osteokondukcija, osteoindukcija i osteogeneza, ali se takođe govori i o pojmu osteopromocije. Autogeni transplantati predstavljaju „zlatni standard“, ali usled povećane potrebe danas se prevashodno koriste alotransplantati iz koštane banke, dok se sve više teži razvoju sintetskih zamena, čija bi aplikacija bila moguća i minimalno invazivnim tehnikama.

Biografije autora

Dejan Aleksandrić, Institut za ortopediju Banjica

Specijalista ortopedske hirurgije i traumatologije

Lazar Mičeta , Institut za ortopediju Banjica, Beograd, Srbija

Specijalizant ortopedske hirurgije i traumatologije

Želimir Jovanović, Institut za ortopediju Banjica, Beograd, Srbija

Specijalista ortopedske hirurgije i traumatologije

Uroš Dabetić , Univerzitetski klinički centar Srbije, Klinika za ortopedsku hirurgiju i traumatologiju, Beograd, Srbija

Specijalista ortopedske hirurgije i traumatologije

Boris Vukomanović, Institut za ortopediju Banjica, Beograd, Srbija

Specijalista ortopedske hirurgije i traumatologije 

Docent na predmetu Hirurgija sa anesteziologijom na Medicinskom Fakultetu Univerziteta u Beogradu 

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Bezstarosti H, Metsemakers WJ, van Lieshout EMM, Voskamp LW, Kortram K, McNally MA, et al. Management of critical-sized bone defects in the treatment of fracture-related infection: a systematic review and pooled analysis. Arch Orthop Trauma Surg. 2021;141(7):1215-30. doi: 10.1007/s00402-020-03525-0. 

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doi: 10.1016/j.injury.2021.01.043.

Jahn K, Braunstein V, Furlong PI, Simpson AE, Richards RG, Stoddart MJ. A rapid method for the generation of uniform acellular bone explants: a technical note. J Orthop Surg Res. 2010 May 10;5(1):32.

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Cha HS, Kim JW, Hwang JH, Ahn KM. Frequency of bone graft in implant surgery. Maxillofac Plast Reconstr Surg. 2016;38(1):19. Published 2016 Mar 31. 

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Chen X, Wang Z, Duan N, Zhu G, Schwarz EM, Xie C. Osteoblast-osteoclast interactions. Connect Tissue Res. 2018;59(2):99-107.

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Bumbasirevic M, Stevanovic M, Bumbasirevic V, Lesic A, Atkinson HD. Free vascularised fibular grafts in orthopaedics. Int Orthop. 2014;38(6):1277-1282.

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doi: 10.5999/aps.2020.00969.

Вукашиновић З. и сарадници. Специјална ортопедија. ИОХБ „Бањица“ Београд 2004.

Cho Y, Byun YS, Suh JD, Yoo J. Osteoperiosteal Decortication and Autogenous Cancellous Bone Graft Combined with Bridge Plating for Non-hypertrophic Diaphyseal Nonunion. Clin Orthop Surg. 2021;13(3):301-306.

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Roberti Di Sarsisa T, Fiore M, Coco V, et al. Fresh Osteochondral Allograft Transplantation in Osteochondritis Dissecans in the Knee Joint. Life (Basel). 2021;11(11):1205. Published 2021 Nov 8.

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doi: 10.1177/2041731418776819.

Fillingham Y, Jacobs J. Bone grafts and their substitutes. Bone Joint J. 2016;98-B(1 Suppl A):6-9.

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doi: 10.1302/0301-620X.98B.36350.

Objavljeno
2023/06/30
Broj časopisa
Vol. 4 Br. 2 (2023): Srpski medicinski časopis Lekarske komore
Rubrika
Pregledni članci