Hake Mark E, Young Heather, Hak David J, Stahel Philip F, Hammerberg E Mark, Mauffrey Cyril
Department of Orthopaedics, University of Colorado, School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA.
Department of Orthopaedics, University of Colorado, School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA.
Injury. 2015 Aug;46(8):1447-56. doi: 10.1016/j.injury.2015.05.008. Epub 2015 May 14.
The use of local antibiotics for the prevention of infection in the setting of open fractures and as part of the treatment of osteomyelitis is well established. Antibiotics are most commonly incorporated into polymethylmethacrylate (PMMA) cement, which can then be formed into beads, moulded to fit a bone defect or used to coat a guide wire or IM nail. Newer delivery vehicles and techniques are being evaluated to improve upon these methods. Many factors influence how local antibiotics are applied. Treatment strategies are challenging to standardise due to the variability of clinical presentations. The presence of hardware, upper versus lower extremity, healed versus non-healed fracture and quality of soft tissues overlying the affected bone, as well as patients' comorbidities all need to be considered. Despite the accepted use of local antibiotic therapy in orthopaedic trauma, high-quality evidence regarding the use of local antibiotics is lacking. Indications, techniques, dosages, types of antibiotics, elution properties and pharmacokinetics are poorly defined in the clinical setting. The purpose of our manuscript is to review current strategies and provide practical tips for local application of antibiotics in orthopaedic trauma. We focus on delivery vehicles, types of antibiotics, dosage recommendations when mixed with PMMA and indications.
局部使用抗生素预防开放性骨折感染以及作为骨髓炎治疗的一部分，这一做法已得到充分确立。抗生素最常被混入聚甲基丙烯酸甲酯（PMMA）骨水泥中，然后可制成珠子、塑形以适应骨缺损或用于包裹导丝或髓内钉。目前正在评估更新的给药载体和技术，以改进这些方法。许多因素会影响局部抗生素的应用方式。由于临床表现的多样性，治疗策略难以标准化。内固定物的存在、上肢与下肢、骨折已愈合与未愈合、患骨上方软组织的质量，以及患者的合并症等所有因素都需要考虑。尽管局部抗生素治疗在骨科创伤中已被广泛接受，但关于局部使用抗生素的高质量证据仍然缺乏。在临床环境中，适应症、技术、剂量、抗生素类型、洗脱特性和药代动力学都定义不清。我们撰写本文的目的是回顾当前的策略，并为骨科创伤中局部应用抗生素提供实用建议。我们重点关注给药载体、抗生素类型、与PMMA混合时的剂量建议以及适应症。
