Mechanobiologie der Frakturheilung Teil 1

ZusammenfassungDass die Stabilität der Osteosynthese den Verlauf der Frakturheilung beeinflusst, ist unumstritten. Nicht bekannt war bisher jedoch, nach welchen Regeln die mechanischen Bedingungen die Knochenheilung steuern. Dadurch war es bisher nicht möglich, Osteosynthesen gezielt biomechanisch zu optimieren. In diesem Artikel wird beschrieben, wie Stabilität, interfragmentäre Bewegung und interfragmentäre Gewebedehnungen zusammenhängen und die zellulären Prozesse bei der Gewebedifferenzierung in der Knochenheilungszone beeinflussen. Es wird eine Gewebedifferenzierungshypothese dargestellt, die unter Berücksichtigung tierexperimenteller Studien, zellbiomechanischer Untersuchungen und numerischer Verfahren entwickelt wurde. Diese Gewebedifferenzierungshypothese erlaubt es, desmale und enchondrale Knochenneubildung in Abhängigkeit von den mechanischen Bedingungen im Frakturheilungsgebiet vorauszusagen. Dadurch wird die Möglichkeit eröffnet, die Stabilität der Osteosynthesen gezielt auszuwählen, um eine gute Knochenheilung zu erreichen.AbstractIt is undisputed that the stability of fracture fixation influences the fracture healing process; however, up until now the mechanical conditions which guide bone healing were unknown and it was therefore not possible to optimize the design of fracture fixation devices. This article presents how the stability of fracture fixation, interfragmentary movement and interfragmentary tissue strain depend on each other and how the mechanical environment influences the cellular processes in the healing tissue. A tissue transformation hypothesis is presented which was developed taking into consideration the results of animal experimental studies, cellular biomechanical investigations and numerical methods. This tissue differentiation hypothesis allows the prediction of bone healing by intramembranous and endochondral bone formation as a function of the local mechanical environment in the fracture healing zone. This allows the possibility for selection of a fracture fixation stability to achieve high-quality bone healing.

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