Jennison T, McNally M, Pandit H
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, UK.
Acta Biomater. 2014 Feb;10(2):595-603. doi: 10.1016/j.actbio.2013.09.019. Epub 2013 Sep 26.
Infection in external fixator pins is known to be a significant problem, with incidences between 3% and 80% reported in the literature. An infection occurs when planktonic bacteria adhere to external fixator pins and subsequently produce a biofilm which protects the bacteria from host defences. The most commonly implicated organisms are Staphylococcus aureus and Staphylococcus epidermidis. Once an infection occurs, treatment is difficult. Systemic antibiotics have limited benefits and considerable side-effects. The only definitive management is removal of the pin. This review will consider the current and potential future strategies for reducing pin site infection. Techniques to prevent infection must prevent bacterial adhesion, allow good osteointegration and have a low toxicity. Current areas of interest reviewed are titanium-copper alloys, nanosilver coatings, nitric oxide coatings, chitosan coatings, chlorhexidine and iodine, hydroxyapatite and antibiotic coatings. At present there is no consensus on the prevention of pin site infection, and there is a paucity of randomized controlled trials on which to draw a conclusion. Whilst a number of these strategies have potential future use, many of the above strategies need further studies in animal models to ensure no cytotoxicity and prevention of osteointegration. Following this, well-designed randomized controlled clinical trials are required to give future ways to prevent external fixator pin site infections.
外固定针感染是一个重大问题，文献报道的感染发生率在3%至80%之间。当浮游细菌附着在外固定针上并随后形成生物膜，从而保护细菌免受宿主防御时，就会发生感染。最常涉及的微生物是金黄色葡萄球菌和表皮葡萄球菌。一旦发生感染，治疗就很困难。全身使用抗生素益处有限且副作用很大。唯一的确定性治疗方法是拔除固定针。本综述将探讨目前及未来潜在的减少针道感染的策略。预防感染的技术必须防止细菌黏附，促进良好的骨整合且毒性低。目前所综述的热门领域包括钛铜合金、纳米银涂层、一氧化氮涂层、壳聚糖涂层、洗必泰和碘、羟基磷灰石以及抗生素涂层。目前在预防针道感染方面尚无共识，且缺乏可供得出结论的随机对照试验。虽然其中一些策略未来可能会被采用，但上述许多策略需要在动物模型中进一步研究，以确保无细胞毒性并防止骨整合。在此之后，需要精心设计的随机对照临床试验，为未来预防外固定针道感染提供方法。
