Schierholz J M, Morsczeck C, Brenner N, König D P, Yücel N, Korenkov M, Neugebauer E, Rump A F E, Waalenkamp G, Beuth J, Pulverer G, Arens S
Center of Advanced European Studies and Research, Bonn.
Orthopade. 2004 Apr;33(4):397-404. doi: 10.1007/s00132-004-0643-2.
One of the most important risk factors in orthopedic surgery is implant-associated infection. Adhesion and colonization mediated implant infections are extremely resistant to antibiotics and host defences and frequently persist until the biomaterial or foreign body is removed, which is standard therapy. Tissue damage caused by surgery and foreign body implantation increases the susceptibility to infections, activates host defences and stimulates the generation of inflammatory mediators including radicals that are further aggravated by bacterial activity and toxins. Nearly one third of implant-related infections can be prevented by strictly following established infection control guidelines. However, a significant number of implant-associated infections remains. The escape of bacteria from host defence and antibiotic therapy makes the development of infection-resistant materials as anti-microbial drug delivery systems feasible. This concept consists of the sustained delivery of antimicrobial drugs into the local microenvironment of implants avoiding systemic side effects exceeding usual systemic concentrations by magnitudes of order.
骨科手术中最重要的风险因素之一是植入物相关感染。由黏附和定植介导的植入物感染对抗生素和宿主防御具有极强的抵抗力，并且通常会持续存在，直到生物材料或异物被移除，这是标准治疗方法。手术和异物植入引起的组织损伤会增加感染易感性，激活宿主防御并刺激包括自由基在内的炎症介质的产生，而细菌活性和毒素会进一步加剧这种情况。严格遵循既定的感染控制指南可预防近三分之一的植入物相关感染。然而，仍有相当数量的植入物相关感染存在。细菌逃避宿主防御和抗生素治疗使得开发作为抗菌药物递送系统的抗感染材料成为可能。这一概念包括将抗菌药物持续递送至植入物的局部微环境中，避免全身副作用超过通常全身浓度几个数量级。
