Ferguson Jamie, Diefenbeck Michael, McNally Martin
The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom.
J Bone Jt Infect. 2017 Jan 1;2(1):38-51. doi: 10.7150/jbji.17234. eCollection 2017.
Local release of antibiotic has advantages in the treatment of chronic osteomyelitis and infected fractures. The adequacy of surgical debridement is still key to successful clearance of infection but local antibiotic carriers seem to afford greater success rates by targeting the residual organisms present after debridement and delivering much higher local antibiotic concentrations compared with systemic antibiotics alone. Biodegradable ceramic carriers can be used to fill osseous defects, which reduces the dead space and provides the potential for subsequent repair of the osseous defect as they dissolve away. A dissolving ceramic antibiotic carrier also raises the possibility of single stage surgery with definitive closure and avoids the need for subsequent surgery for spacer removal. In this article we provide an overview of the properties of various biodegradable ceramics, including calcium sulphate, the calcium orthophosphate ceramics, calcium phosphate cement and polyphasic carriers. We summarise the antibiotic elution properties as investigated in previous animal studies as well as the clinical outcomes from clinical research investigating their use in the surgical management of chronic osteomyelitis. Calcium sulphate pellets have been shown to be effective in treating local infection, although newer polyphasic carriers may support greater osseous repair and reduce the risk of further fracture or the need for secondary reconstructive surgery. The use of ceramic biocomposites to deliver antibiotics together with BMPs, bisphosphonates, growth factors or living cells is under investigation and merits further study. We propose a treatment protocol, based on the Cierny-Mader classification, to help guide the appropriate selection of a suitable ceramic antibiotic carrier in the surgical treatment of chronic osteomyelitis.
局部释放抗生素在慢性骨髓炎和感染性骨折的治疗中具有优势。手术清创的彻底性仍是成功清除感染的关键，但局部抗生素载体似乎能通过针对清创后残留的微生物并提供比单纯全身使用抗生素更高的局部抗生素浓度，从而获得更高的成功率。可生物降解的陶瓷载体可用于填充骨缺损，减少死腔，并在其溶解时为骨缺损的后续修复提供可能。一种可溶解的陶瓷抗生素载体还增加了一期手术直接闭合伤口的可能性，避免了后续取出间隔物的手术需求。在本文中，我们概述了各种可生物降解陶瓷的特性，包括硫酸钙、正磷酸钙陶瓷、磷酸钙骨水泥和多相载体。我们总结了先前动物研究中所研究的抗生素洗脱特性以及临床研究中调查其在慢性骨髓炎手术治疗中应用的临床结果。硫酸钙颗粒已被证明在治疗局部感染方面有效，尽管更新的多相载体可能更有利于骨修复，并降低再次骨折的风险或二次重建手术的必要性。将陶瓷生物复合材料与骨形态发生蛋白、双膦酸盐、生长因子或活细胞一起用于递送抗生素的研究正在进行中，值得进一步探讨。我们基于Cierny-Mader分类法提出了一种治疗方案，以帮助指导在慢性骨髓炎手术治疗中合适的陶瓷抗生素载体的选择。
