Lalidou Fani, Kolios George, Drosos Georgios I
Medical School, Democritus University of Thrace Alexandroupolis, Greece.
Laboratory of Pharmacology Medical School Democritus University of Thrace Alexandroupolis, Greece.
Surg Technol Int. 2014 Mar;24:353-62.
Osteomyelitis is a bone infection by micro-organisms. Despite advances in antibiotics and operative techniques, osteomyelitis remains an orthopaedic challenge and expensive to treat. Antimicrobial therapy is adequate for the treatment of most cases of acute osteomyelitis of any type, provided that diagnosis is made early. The treatment of chronic osteomyelitis is operative followed by adjunctive antibiotic therapy. Apart from surgical debridement and systemic antibiotic treatment, local antibiotic treatment by using various antibiotic delivery vehicles is a preferred method by most surgeons. Antibiotic-loaded bone cement (polymethylmethacrylate, PMMA) is the most widely used material and represents the current standard as an antibiotic delivery vehicle in orthopaedic surgery. Despite that, there are some disadvantages or concerns about the use of antibiotic-loaded PMMA that have led to the use of bioabsorbable or biodegradable material. Although the number of clinical studies is small, it seems that antibiotic-loaded hydroxyapatite and calcium sulfate are safe methods for local antibiotic delivery. They deliver great amounts of antibiotics locally with serum concentrations in safe margins, they obliterate the dead space, and aid in bone repair, while there is no need for a second operation for their removal. The purpose of this article is to review the recent literature concerning osteomyelitis and local antibiotic treatment with special reference to bone graft substitutes as vehicles for local antibiotic delivery.
骨髓炎是由微生物引起的骨感染。尽管抗生素和手术技术有所进步，但骨髓炎仍然是骨科面临的一项挑战，且治疗费用高昂。对于大多数类型的急性骨髓炎病例，只要早期做出诊断，抗菌治疗就足以治愈。慢性骨髓炎的治疗是先进行手术，然后辅助使用抗生素治疗。除了手术清创和全身抗生素治疗外，使用各种抗生素递送载体进行局部抗生素治疗是大多数外科医生首选的方法。载抗生素骨水泥（聚甲基丙烯酸甲酯，PMMA）是使用最广泛的材料，是目前骨科手术中作为抗生素递送载体的标准材料。尽管如此，使用载抗生素PMMA仍存在一些缺点或问题，这导致了生物可吸收或可生物降解材料的使用。虽然临床研究数量较少，但载抗生素羟基磷灰石和硫酸钙似乎是局部抗生素递送的安全方法。它们能在局部递送大量抗生素，血清浓度处于安全范围内，可消除死腔，并有助于骨修复，同时无需二次手术取出。本文的目的是回顾近期有关骨髓炎和局部抗生素治疗的文献，特别提及作为局部抗生素递送载体的骨移植替代物。
