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2024, Número 4

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Ortho-tips 2024; 20 (4)


Propuesta de clasificación y algoritmo del manejo ortobiológico de las pérdidas óseas. Nuevo enfoque terapéutico

Sánchez AR, Gutiérrez MI, Barriga MMA, Reyes PR, Izquierdo MJF, Padilla RL, Silva MJA, Méndez CEA, Garín ZDE

Idioma: Ingles.
Referencias bibliográficas: 73
Paginas: 287-306
Archivo PDF: 593.93 Kb.


RESUMEN

Por medio de la señalización de factores de crecimiento, las células osteoprogenitoras y la matriz extracelular como andamio natural, se logra la consolidación ósea. La regeneración ósea puede ser afectada por factores mecánicos o biológicos. El concepto diamante es contar con mediadores osteoinductivos, células osteogénicas y matriz osteoconductiva (andamio), siendo este el marco de referencia para una respuesta exitosa en la reparación ósea, basado principalmente en la estabilidad mecánica y en el ambiente biológico, mediante una adecuada vascularidad y un óptimo estado fisiológico del huésped. Hay revisiones sistemáticas que apoyan el uso de politerapia con ortobiológicos bajo el concepto diamante en fracturas agudas, retardo en la consolidación y pseudoartrosis. Existen diversas opciones para el manejo de las pérdidas óseas: aplicación de autoinjerto con esponja de colágeno, colocación de bloque de cresta iliaca tricortical autólogo, la técnica de membrana inducida, aloinjerto en segmento intercalar, injerto de peroné vascularizado y transporte óseo. Proponemos una clasificación/algoritmo como guía de tratamiento de acuerdo con el tamaño de la pérdida ósea, aséptica o séptica, utilizando los mejores elementos ortobiológicos y técnicas que hay en la evidencia literaria, optimizando el ambiente mecánico y biológico para lograr la consolidación y el rescate óseo.


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