改良混合技术与低频超声相结合以控制载万古霉素丙烯酸骨水泥的洗脱曲线
Combination of modified mixing technique and low frequency ultrasound to control the elution profile of vancomycin-loaded acrylic bone cement.
作者信息
Wendling A, Mar D, Wischmeier N, Anderson D, McIff T
机构信息
Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
出版信息
Bone Joint Res. 2016 Feb;5(2):26-32. doi: 10.1302/2046-3758.52.2000412.
OBJECTIVES
The objective of this study was to determine if combining variations in mixing technique of antibiotic-impregnated polymethylmethacrylate (PMMA) cement with low frequency ultrasound (LFUS) improves antibiotic elution during the initial high phase (Phase I) and subsequent low phase (Phase II) while not diminishing mechanical strength.
METHODS
Three batches of vancomycin-loaded PMMA were prepared with different mixing techniques: a standard technique; a delayed technique; and a control without antibiotic. Daily elution samples were analysed using flow injection analysis (FIA). Beginning in Phase II, samples from each mix group were selected randomly to undergo either five, 15, 45, or 0 minutes of LFUS treatment. Elution amounts between LFUS treatments were analysed. Following Phase II, compression testing was done to quantify strength. A-priori t-tests and univariate ANOVAs were used to compare elution and mechanical test results between the two mix groups and the control group.
RESULTS
The delayed technique showed a significant increase in elution on day one compared with the standard mix technique (p < 0.001). The transition point from Phase I to Phase II occurred on day ten. LFUS treatments significantly increased elution amounts for all groups above control. Delayed technique resulted in significantly higher elution amounts for the five-minute- (p = 0.004) and 45-minute- (p < 0.001) duration groups compared with standard technique. Additionally, the correlations between LFUS duration and total elution amount for both mix techniques were significant (p = 0.03). Both antibiotic-impregnated groups exhibited a significant decrease in offset yield stress compared with the control group (p < 0.001), however, their lower 95% confidence intervals were all above the 70 MPa limit defined by International Standards Organization (ISO) 5833-2 reference standard for acrylic bone cement.
CONCLUSION
The combination of a delayed mix technique with LFUS treatments provides a reasonable means for increasing both short- and long-term antibiotic elution without affecting mechanical strength.Cite this article: Dr. T. McIff. Combination of modified mixing technique and low frequency ultrasound to control the elution profile of vancomycin-loaded acrylic bone cement. Bone Joint Res 2016;5:26-32. doi: 10.1302/2046-3758.52.2000412.
目的
本研究的目的是确定将抗生素浸渍聚甲基丙烯酸甲酯（PMMA）骨水泥混合技术的变化与低频超声（LFUS）相结合，是否能在初始高释放阶段（I期）和随后的低释放阶段（II期）改善抗生素洗脱，同时不降低机械强度。
方法
采用不同的混合技术制备了三批负载万古霉素的PMMA：一种标准技术；一种延迟技术；以及不含抗生素的对照。使用流动注射分析（FIA）分析每日洗脱样本。从II期开始，随机选择每个混合组的样本进行5、15、45或0分钟的LFUS治疗。分析LFUS治疗之间的洗脱量。II期之后，进行压缩测试以量化强度。使用先验t检验和单因素方差分析来比较两个混合组和对照组之间的洗脱和力学测试结果。
结果
与标准混合技术相比，延迟技术在第1天的洗脱量显著增加（p < 0.001）。从I期到II期的转变点出现在第10天。LFUS治疗显著增加了所有组高于对照组的洗脱量。与标准技术相比，延迟技术在5分钟（p = 0.004）和45分钟（p < 0.001）持续时间组中导致显著更高的洗脱量。此外，两种混合技术的LFUS持续时间与总洗脱量之间的相关性均显著（p = 0.03）。与对照组相比，两个抗生素浸渍组的偏移屈服应力均显著降低（p < 0.001），然而，它们较低的95%置信区间均高于国际标准化组织（ISO）5833-2丙烯酸骨水泥参考标准定义的70 MPa限值。
结论
延迟混合技术与LFUS治疗相结合为增加短期和长期抗生素洗脱提供了一种合理的方法，且不影响机械强度。引用本文：T. McIff博士。改良混合技术与低频超声相结合以控制负载万古霉素的丙烯酸骨水泥的洗脱曲线。骨关节研究2016；5：26 - 32。doi：10.1302/2046 - 3758.52.2000412。
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