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Distraction OsteogenesisOleh
HERu ALFARES
030 . 08 . 121
Fakultas Kedokteran Universitas Trisakti
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PENDAHULUAN
Tidak seperti jaringan lainnya, tulang
yang mengalami fraktur dapat
sembuh tanpa jaringan parut.
Proses penyembuhan pada fraktur
mulai terjadi segera setelah tulang
mengalami kerusakan apabila
lingkungan untuk penyembuhanmemadai sampai tejadi konsolidasi.
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PENDAHULUAN
Factor mekanis yang penting seperti
imobilisasi fragmen tulang secara fisik
sangat penting dalam penyembuhan,
selain factor biologis yang jugamerupakan suatu factor yang sangat
essential dalam penyembuhan fraktur.
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HISTOLOGI TULANG
Tulang adalah jaringan yang tersusun oleh
sel dan didominasi oleh matrix kolagen
ekstraselular (type I collagen) yang
disebut sebagai osteoid. Osteoid ini
termineralisasi oleh deposit kalsium
hydroxyapatite, sehingga tulang menjadi
kaku dan kuat
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Osteoblast
yang mensintesis dan menjadi perantaramineralisasi osteoid.
Osteoblast ditemukan dalam satu lapisan
pada permukaan jaringan tulang sebagai sel
berbentuk kuboid atau silindris pendek yang
saling berhubungan melalui tonjolan-tonjolan
pendek.
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Osteosit
merupakan komponen sel utama dalam
jaringan tulang. Mempunyai perananpenting dalam pembentukan matriks tulang
dengan cara membantu pemberian nutrisi
pada tulang.
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Osteoklas
sel fagosit yang mempunyai kemampuan
mengikis tulang dan merupakan bagianyang penting. Mampu memperbaiki tulang
bersama osteoblast. Osteoklas ini berasal
dari deretan sel monosit makrofag.
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Sel osteoprogenitor
merupakan sel mesenchimal primitive yang
menghasilkan osteoblast selamapertumbuhan tulang dan osteosit pada
permukaan dalam jaringan tulang.
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Penyembuhan Fraktur
1. Stadium Pembentukan Hematom
terbentuk dari darah yang mengalir yang
berasal dari pembuluh darah yang robek
2. Stadium Proliferasi sel/inflamasi
sel-sei berproliferasi dari lapisan dalamperiosteum, sekitar lokasi fraktur
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3. Stadium Pembentukan Kallus
Osteoblast membentuk tulang lunak
(kallus)
4. Stadium Konsolidasi
5. Stadium Remodeling
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Definisi
Osteogenesis distraksi juga disebut gangguankalus callotasisdanosteodistraction
proses bedah merekonstruksi cacat tulang
danmemperpanjang panjang tulang tubuh
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Sejarah penemuan- 1905, Alessandro Codivilla : praktek bedah untuk
pemanjangan tungkai bawah.
- ahli bedah ortopedi Gavril Ilizarov biologi tulang dan
kemampuan sekitar jaringan lunak untuk regenerasi di
bawah ketegangan fixator eksternal, yang terstruktur
sebagai cincin modular.
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Teknik
Ilizarov eksternal fixator.
Fixators eksternal lainnya adalah Wagner,
Orthofix dan Judet.
Dr Helong Bai Micro-luka" dengan alat
yang berbeda.
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enggunaan osteogenesis distraksi Cacat kongenital (cacat lahir):
Femur pendek
Fibula hemimelia
Hemiatrophy
Ollier's disease
Developmental deformities
Neurofibromatosis
Bow legs, akibat rakhitisatau sekunder arthritis.
Pasca-trauma cedera
Growth platesfractures
Malunion or non union
Shortening dan deformitas, dan
Cacat tulang.
Infeksi dan penyakit
Osteomyelitis
Septic arthritis
Poliomyelitis
Setelah tumor
Perawakan pendek
Achondroplasia
Constitutional short stature
http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/w/index.php%3Ftitle%3DFibular_hemimelia%26action%3Dedit%26redlink%3D1&usg=ALkJrhjtrwp0j7aRpcHECeibCalIoeX9iAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/w/index.php%3Ftitle%3DHemiatrophy%26action%3Dedit%26redlink%3D1&usg=ALkJrhimMq2yaiy8HtVFUc0aoyFpmu-FYQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Ollier%27s_disease&usg=ALkJrhg44v3FJmbHYGNc3YtU78R7RT5_pAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Neurofibromatosis&usg=ALkJrhglGwzSQ-2FoYxzYFnCu9h9x1MHNQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Rickets&usg=ALkJrhjYoO26Vc4fEF9MdWunKooo8V5C8Ahttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Arthritis&usg=ALkJrhgfTdvjMa7KfKHdi3v_6o2wHoW1AQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Growth_plate&usg=ALkJrhhTVrKjtSEmVh7oGZnPuB-eVwHzwQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Disease&usg=ALkJrhhQ7HLjhEI-ElNv4uTmT63ZFQxn7ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Osteomyelitis&usg=ALkJrhg7zAK8oGtlQNye-lNk2OHwNXBlxghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Septic_arthritis&usg=ALkJrhhV9gt1o52BrF9CXB2iYTMQW9GQ0Ahttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Poliomyelitis&usg=ALkJrhgIXePk34YiIcBzmmUrwT1LdL4MkQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Tumor&usg=ALkJrhgavkszFp6jp21Q52EIoQOI2dmrZAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Short_stature&usg=ALkJrhhynjQatWzewJGeemX4sbUmn8cDbQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Achondroplasia&usg=ALkJrhjdvo8wxTMCrFqZIItiA1ZyEZBVfghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Constitutional_short_stature&usg=ALkJrhgcPpxXACsAfyLa5D7i6kti37DUfwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Constitutional_short_stature&usg=ALkJrhgcPpxXACsAfyLa5D7i6kti37DUfwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Achondroplasia&usg=ALkJrhjdvo8wxTMCrFqZIItiA1ZyEZBVfghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Short_stature&usg=ALkJrhhynjQatWzewJGeemX4sbUmn8cDbQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Tumor&usg=ALkJrhgavkszFp6jp21Q52EIoQOI2dmrZAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Ddistraction%2Bosteogenesis%26hl%3Did%26prmd%3Divnsb&rurl=translate.google.co.id&sl=en&u=http://en.wikipedia.org/wiki/Poliomyelitis&usg=ALkJrhgIXePk34YiIcBzmmUrwT1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ara kerja merangsang pembentukan tulang baru denganmenerapkan traksi (menarik tekanan) ke
tulang secara terkendali. Teknik ini didasarkanpada prosedur ortopedi awalnya digunakan
untuk memperpanjang tulang di kaki. Tulang abnormal osteotomi 2 buah segmentulang) menempelkan perangkat pd kedua ujung
tulang diregangkan setiap hari / minggu 1 mmperhari) jaringan baru mengisi celah
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Osifikasi endokondral fase awal DO
Osifikasi intramembranosa
mekanisme utamapd fase akhir
Osifikasi transkondraltulang chondroid
terbentuk scr langsung o/ chondrosyte like cellsdgn transisi dari jaringan fibrosa menjadi tulang
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3 tahapan distraction osteogenesis
1. latency: awal trauma respon (osteotomy smpsaat aktivasi dari distraksi)
2. distraksi : kaluscentral fibrous zone =fibrousinterzone
3.consolidation
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Peran sitokin pro inflamasi pd DO
IL 1IL 6 stlh osteotomy & stlh fase
laten
IL 6osifikasi intramembranosa dgn
diferensiasi sel u menghasilkan keturunan
osteoblas.
TNF tidak diekspresikan .
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Peran transforming growth factor beta superfamily pd DO
Bone morphogenic proteinBMP 2 & 4 pd fase laten = diferensiasi dari
sel2 prekursor mjd sel kondrogenik/osteogenik
BMP 2 & 4 kuat pd fase distraksi ,diproduksidari sel kondrogenik pd pembentukan kartilago
dan osteogenik sel pd PMF , & sel oval pd FIZ
BMP 6 pd akhir fase laten dan awal dari fasedistraksi.
Perbedaan penyembuhan fraktur &
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Perbedaan penyembuhan fraktur &distraksi osteogenesis
1. Osifikasi endokondral >> dominan pd penyembuhan fraktur pd mgg pertamaosifikasi intramembranosa >> dominan pd DO
2. Angiogenesispd penyembuhan fraktur pd hr ke 7- 14 , sewaktu jaringan
kondrogenik mengalami apoptosis dan diserap
pd DOstlh aktivasi dari distraksi
3. IL 1, IL 6 & TNF pd penyembuhan fraktur
IL 1 & IL 6 sdgkn TNF tdk meningkat pd DO
4. Vaskularisasi yg lbh besar pd DO dibandingkan penyembuhan fraktur
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Pasca Bedah
fisioterapi latihan peregangan
Tujuannya adalah untuk menghindari
kekakuan dan untuk merangsang otot,sarafdan pembuluh darahuntuk
tumbuh di samping tulang.
obat penghilang rasa sakitdan tidakbekerja saat menjalani rehabilitasi
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