Department of Orthopaedic Surgery, Jefferson Medical College, Philadelphia, PA 19107, USA.
Adv Drug Deliv Rev. 2012 Sep;64(12):1165-76. doi: 10.1016/j.addr.2012.03.015. Epub 2012 Apr 4.
Many surgical procedures require the placement of an inert or tissue-derived implant deep within the body cavity. While the majority of these implants do not become colonized by bacteria, a small percentage develops a biofilm layer that harbors invasive microorganisms. In orthopaedic surgery, unresolved periprosthetic infections can lead to implant loosening, arthrodeses, amputations and sometimes death. The focus of this review is to describe development of an implant in which an antibiotic tethered to the metal surface is used to prevent bacterial colonization and biofilm formation. Building on well-established chemical syntheses, studies show that antibiotics can be linked to titanium through a self-assembled monolayer of siloxy amines. The stable metal-antibiotic construct resists bacterial colonization and biofilm formation while remaining amenable to osteoblastic cell adhesion and maturation. In an animal model, the antibiotic modified implant resists challenges by bacteria that are commonly present in periprosthetic infections. While the long-term efficacy and stability is still to be established, ongoing studies support the view that this novel type of bioactive surface has a real potential to mitigate or prevent the devastating consequences of orthopaedic infection.
许多外科手术需要将惰性或组织衍生的植入物放置在体腔深处。虽然大多数这些植入物不会被细菌定植，但一小部分会形成生物膜层，其中存在侵袭性微生物。在矫形外科手术中，未解决的假体周围感染可导致植入物松动、融合、截肢，有时甚至导致死亡。本综述的重点是描述一种植入物的开发，其中将抗生素固定在金属表面上，以防止细菌定植和生物膜形成。在经过充分验证的化学合成基础上，研究表明可以通过硅氧基胺的自组装单层将抗生素与钛结合。稳定的金属-抗生素结构可抵抗细菌定植和生物膜形成，同时仍易于成骨细胞的黏附和成熟。在动物模型中，经抗生素修饰的植入物能够抵抗假体周围感染中常见细菌的挑战。虽然其长期疗效和稳定性仍有待确定，但正在进行的研究支持这样一种观点，即这种新型生物活性表面具有减轻或预防骨科感染破坏性后果的真正潜力。
