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Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2002, Número 4

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Acta Ortop Mex 2002; 16 (4)


Alternativas para obtener un injerto óseo

Rojas DS, Domínguez HVM

Idioma: Español
Referencias bibliográficas: 75
Paginas: 225-231
Archivo PDF: 57.26 Kb.


RESUMEN

Uno de los mayores problemas en ortopedia es la reconstrucción de defectos óseos que resultan de infecciones, traumas o resección de tumores óseos, porque la disponibilidad de injerto óseo autólogo es limitada. Por ello se estudian alternativas para obtener injerto óseo viable: 1) los cultivos in vitro de células óseas (osteoblastos) con sus características de osteoinducción, y biocompatibilidad son una opción atractiva, 2) proteína morfogenética recombinante humana-2 (rhMBP-2), que es útil para reconstruir grandes segmentos, 3) factores de crecimiento (IGF I y II, TGF-b, FGFa,b, PDGF y las BMP) como formadores potenciales de hueso, sin embargo se desconoce cuál es su papel en la remodelación ósea y su capacidad para incrementar la densidad mineral ósea. Adicionalmente, pueden formar neoplasias, si no se manejan adecuadamente, 4) hueso desmineralizado y congelado, disminuye la respuesta inmune y favorece la osteoinducción, 5) hueso esponjoso autólogo, se considera el injerto ideal, ya que proporciona células osteoprogenitoras (osteoblastos) con propiedades biomecánicas adecuadas. No obstante, su disponibilidad es limitada y, 6) citocinas producidas por osteoblastos (IL-1, IL-6) que participan en la formación y resorción ósea; y citocinas producidas por osteoclastos (TNF-a, IL-1b, INF-g y anexina II), que mantienen la hematopoyesis y respuesta inmune normales. Se analizan las características biomecánicas, así como los modelos experimentales en animales que se emplean para valorar las distintas opciones de injerto.


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