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一种用于非骨水泥型髋关节假体感染预防的可生物降解庆大霉素-羟基磷灰石涂层

A biodegradable gentamicin-hydroxyapatite-coating for infection prophylaxis in cementless hip prostheses.

作者信息

Neut D, Dijkstra R J, Thompson J I, Kavanagh C, van der Mei H C, Busscher H J

机构信息

Department of Biomedical Engineering (FB40), W.J. Kolff Institute, University of Groningen and University Medical Center Groningen, PO Box 196, 9700 AD Groningen, The

出版信息

Eur Cell Mater. 2015 Jan 2;29:42-55; discussion 55-6. doi: 10.22203/ecm.v029a04.

Abstract

A degradable, poly (lactic-co-glycolic acid) (PLGA), gentamicin-loaded prophylactic coating for hydroxyapatite (HA)-coated cementless hip prostheses is developed with similar antibacterial efficacy as offered by gentamicin-loaded cements for fixing traditional, cemented prostheses in bone. We describe the development pathway, from in vitro investigation of antibiotic release and antibacterial properties of this PLGA-gentamicin-HA-coating in different in vitro models to an evaluation of its efficacy in preventing implant-related infection in rabbits. Bone in-growth in the absence and presence of the coating was investigated in a canine model. The PLGA-gentamicin-HA-coating showed high-burst release, with antibacterial efficacy in agar-assays completely disappearing after 4 days, minimising risk of inducing antibiotic resistance. Gentamicin-sensitive and gentamicin-resistant staphylococci were killed by the antibiotic-loaded coating, in a simulated prosthesis-related interfacial gap. PLGA-gentamicin-HA-coatings prevented growth of bioluminescent staphylococci around a miniature-stem mounted in bacterially contaminated agar, as observed using bio-optical imaging. PLGA-gentamicin-HA-coated pins inserted in bacterially contaminated medullary canals in rabbits caused a statistically significant reduction in infection rates compared to HA-coated pins without gentamicin. Bone ingrowth to PLGA-gentamicin-HA-coated pins, in condylar defects of Beagle dogs was not impaired by the presence of the degradable, gentamicin-loaded coating. In conclusion, the PLGA-gentamicin-HA-coating constitutes an effective strategy for infection prophylaxis in cementless prostheses.

摘要

一种可降解的聚(乳酸-乙醇酸共聚物)(PLGA)载庆大霉素的预防性涂层被开发用于羟基磷灰石(HA)涂层的非骨水泥型髋关节假体,其抗菌效果与用于在骨中固定传统骨水泥型假体的载庆大霉素骨水泥相似。我们描述了其研发过程,从在不同体外模型中对这种PLGA-庆大霉素-HA涂层的抗生素释放和抗菌性能进行体外研究,到评估其在预防兔植入物相关感染中的效果。在犬模型中研究了有无涂层时的骨长入情况。PLGA-庆大霉素-HA涂层显示出高突释,在琼脂试验中的抗菌效果在4天后完全消失,将诱导抗生素耐药性的风险降至最低。在模拟的假体相关界面间隙中,载抗生素涂层杀死了对庆大霉素敏感和耐药的葡萄球菌。如使用生物光学成像观察到的,PLGA-庆大霉素-HA涂层可防止生物发光葡萄球菌在安装于受细菌污染琼脂中的微型柄周围生长。与未载庆大霉素的HA涂层销钉相比,插入兔受细菌污染髓腔中的PLGA-庆大霉素-HA涂层销钉使感染率有统计学意义的降低。在比格犬髁突缺损处,可降解的载庆大霉素涂层的存在并未损害骨向PLGA-庆大霉素-HA涂层销钉的长入。总之,PLGA-庆大霉素-HA涂层是一种有效的非骨水泥型假体感染预防策略。

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