Department of Orthopedics and Traumatology, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
Int J Immunopathol Pharmacol. 2011 Jan-Mar;24(1 Suppl 2):125-8. doi: 10.1177/03946320110241S223.
Optimal management of deep infections in orthopedic and trauma surgery is often challenging. Traditional prophylactic and treatment approaches are based on the systemic administration of relatively high doses of antibiotics, which may result in a number of side effects. Furthermore, systemically administered antimicrobials may not reach adequate concentration at the desired site. Finally, traditional approaches are based on two-step protocols, thus delaying definite fixation. In recent years, antibiotic-coated intramedullary nails (ACINs) have been introduced, which offer the advantage of delivering antibiotics locally, thus increasing their local concentrations and length of action. In addition, ACINs offer the great advantage of combining antimicrobial prophylaxis/treatment and stabilization in a single step. Preliminary evidence by small clinical studies appears to support the effectiveness of ACINs in the management of chronic osteomyelitis and infected non-unions, with high rates of infection eradication and bone union. However, randomized clinical trials are needed to definitely establish ACINs ' effectiveness and safety.
骨科和创伤外科深部感染的最佳治疗方法常常具有挑战性。传统的预防和治疗方法是基于全身给予相对较高剂量的抗生素，这可能会导致许多副作用。此外，全身给予的抗菌药物可能无法在所需部位达到足够的浓度。最后，传统方法基于两步方案，从而延迟了确定性固定。近年来，已引入抗生素涂层髓内钉（ACINs），其具有局部递送抗生素的优势，从而增加了其局部浓度和作用时间。此外，ACINs 具有将抗菌预防/治疗和稳定结合在单个步骤中的巨大优势。小型临床研究的初步证据似乎支持 ACINs 在慢性骨髓炎和感染性骨不连的治疗中的有效性，具有高感染清除率和骨愈合率。然而，需要进行随机临床试验以明确确定 ACINs 的有效性和安全性。
