{"id":1221,"date":"2020-11-03T12:48:03","date_gmt":"2020-11-03T12:48:03","guid":{"rendered":"https:\/\/ingenieriadebarcelona.es\/?p=1221"},"modified":"2020-11-09T13:01:51","modified_gmt":"2020-11-09T13:01:51","slug":"implantes-protesicos-femur-remanente","status":"publish","type":"post","link":"https:\/\/ingenieriadebarcelona.es\/?p=1221","title":{"rendered":"Los implantes prot\u00e9sicos osteointegrados para amputados en el f\u00e9mur"},"content":{"rendered":"

En el a\u00f1o 1990, en Suecia, se produjo un avance para los amputados que sufren multitud de problemas relacionados con el encaje de la pr\u00f3tesis externa con el mu\u00f1\u00f3n de amputaci\u00f3n. Estos problemas b\u00e1sicamente son lesiones cut\u00e1neas, infecciones y dolor por mal encaje del mu\u00f1\u00f3n. Ellas condicionan un menor uso de la pr\u00f3tesis externa y un mayor esfuerzo para movilizarle. \u00c9ste, a veces, acaba por provocar el abandono de la misma. Cuando la pr\u00f3tesis externa no encaja perfectamente condiciona una sobrecarga de la extremidad contralateral y la columna, a causa de una din\u00e1mica de la marcha anormal.<\/p>\n

Aprovechando la experiencia de los dentistas que efect\u00faan implantes dentales osteointegrados en la mand\u00edbula, se desarroll\u00f3 la pr\u00f3tesis OPRA. \u00c9sta se inserta en el f\u00e9mur remanente y deja un encaje externo. \u00c9ste, a trav\u00e9s de la piel, conecta la pr\u00f3tesis externa que puede ser de brazo o de pierna y a distintos niveles (por encima o debajo de la rodilla<\/a>).<\/p>\n

\"\"<\/p>\n

Dicho avance empez\u00f3 a estandarizarse a partir del a\u00f1o 1999. Posteriormente, otros sistemas se desarrollaron en Alemania (ILP, Integrated Leg Prosthesis<\/a>), en Australia (OGAP-OPL), en Inglaterra (ITAP) y en Estados Unidos (POP y Compress).<\/p>\n

El sistema proporciona al paciente una funcionalidad mayor, incrementa el per\u00edmetro y tiempo de marcha, y mejora la estabilidad. Lo hace al transmitir las fuerzas del pie al hueso directamente. En contrapartida, los potenciales problemas son la infecci\u00f3n, la fractura del f\u00e9mur remanente y el aflojamiento del implante femoral, que requiere una cirug\u00eda de revisi\u00f3n. Para evitar la fractura del f\u00e9mur remanente, los implantes incorporan sistemas de desconexi\u00f3n del implante. Esto se produce en caso que las fuerzas de carga sean excesivas.<\/p>\n

El proceso de implantaci\u00f3n consta de dos pasos: el primer tiempo consiste en poner el implante dentro del f\u00e9mur para que se integre con el hueso. Esto se produce gracias a la capacidad de \u00e9ste de crecer dentro de las rugosidades del titanio que cubre el implante. El segundo tiempo consiste en poner el puente. \u00c9ste conecta el implante interno con la pr\u00f3tesis externa a trav\u00e9s de la piel que debe quedar apropiadamente sellada para evitar la entrada de bacterias. Dos meses separar\u00e1n el primer tiempo del segundo. A partir del segundo tiempo, cuando la herida est\u00e1 cicatrizada, empieza un periodo de carga progresiva para alcanzar la carga completa a las 8 semanas, aproximadamente.<\/p>\n

Se calcula que la supervivencia de los implantes a los dos a\u00f1os es del 92%.<\/p>\n

Existen algunas contraindicaciones absolutas como la osteoporosis, obesidad, embarazo, vasculopat\u00eda, diabetes complicada, trastornos ps\u00edquicos, infecci\u00f3n o neuropat\u00edas. No se recomienda implantar estas pr\u00f3tesis cuando existen problemas de piel en pacientes por encima de 65 a\u00f1os o por debajo de los 20.<\/p>\n

IM\u00c1GENES<\/strong><\/em><\/p>\n

\"\"
Aspecto radiol\u00f3gico de la pr\u00f3tesis femoral insertada en el f\u00e9mur, con un extremo externo donde se coloca la pr\u00f3tesis<\/figcaption><\/figure>\n
\"\"
Aspecto radiol\u00f3gico de un paciente con pr\u00f3tesis externa y encaje de mu\u00f1\u00f3n y el mismo con pr\u00f3tesis osteointegrada. Se observa una mejor alineaci\u00f3n de la extremidad, que permite una mejor funcionalidad de la pierna, pelvis y columna.<\/figcaption><\/figure>\n
\"\"
Esquema de un implante osteointegrado en la tibia.<\/figcaption><\/figure>\n
\"\"
Caso real donde podemos ver el aspecto del mu\u00f1\u00f3n con la pr\u00f3tesis implantada.<\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"

En el a\u00f1o 1990, en Suecia, se produjo un avance para los amputados que sufren multitud de problemas relacionados con el encaje de la pr\u00f3tesis externa con el mu\u00f1\u00f3n de amputaci\u00f3n. Estos problemas b\u00e1sicamente son lesiones cut\u00e1neas, infecciones y dolor por mal encaje del mu\u00f1\u00f3n. Ellas condicionan un menor uso de la pr\u00f3tesis externa y … Read more<\/a><\/p>\n","protected":false},"author":4,"featured_media":1223,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-1221","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-dr-antoni-fraguas-castany"],"yoast_head":"\nImplantes prot\u00e9sicos en el f\u00e9mur remanente para amputados<\/title>\n<meta name=\"description\" content=\"Los implantes prot\u00e9sicos en el f\u00e9mur remanente y su impacto en los pacientes amputados. 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