Anagnostakos Konstantinos, Meyer Christof
Zentrum für Orthopädie und Unfallchirurgie, Klinikum Saarbrücken, Saarbrücken, Germany.
Biomed Res Int. 2017;2017:4657874. doi: 10.1155/2017/4657874. Epub 2017 Jun 5.
Knowledge about the elution from antibiotic-loaded cement spacers is an indispensable premise for guarantee of clinical success. A systematic literature search was performed through PubMed. Search terms were "antibiotic elution" and "antibiotic release" in combination with "spacer," "hip spacer," and "knee spacer," respectively. A total of 11 studies could be identified. Seven studies reported on the release of antibiotics after spacer implantation, three studies at spacer removal, and one study on both time points. Seven studies reported on hip spacers, one study on knee spacers, and three studies on both. In eight studies, custom-made spacers have been implanted and in three prefabricated ones. In the majority of the studies, the cement has been loaded with an antibiotic combination, mostly consisting of aminoglycoside (either gentamicin or tobramycin) and vancomycin. Measured concentrations exceeded the minimal inhibitory concentration of the particular pathogen organisms in each case. However, large discrepancies were observed with regard to the height of the antibiotic concentration depending on the antibiotic combination and the antibiotic ratio used. Current literature data indicate a sufficient elution of antibiotics after spacer implantation and at spacer removal, respectively. Future studies are required to optimize the local antibiotic therapy at the site of spacer implantation.
了解抗生素负载骨水泥间隔物的洗脱情况是确保临床成功的不可或缺的前提。通过PubMed进行了系统的文献检索。检索词分别为“抗生素洗脱”和“抗生素释放”，并与“间隔物”、“髋关节间隔物”和“膝关节间隔物”组合。共识别出11项研究。7项研究报告了间隔物植入后抗生素的释放情况，3项研究报告了间隔物取出时的情况，1项研究报告了两个时间点的情况。7项研究涉及髋关节间隔物，1项研究涉及膝关节间隔物，3项研究涉及两者。在8项研究中，植入的是定制间隔物，3项研究中植入的是预制间隔物。在大多数研究中，骨水泥负载了抗生素组合，主要由氨基糖苷类（庆大霉素或妥布霉素）和万古霉素组成。所测浓度在每种情况下均超过了特定病原体的最低抑菌浓度。然而，根据所用抗生素组合和抗生素比例，抗生素浓度的高度存在很大差异。当前文献数据表明，间隔物植入后和取出时抗生素分别有足够的洗脱。需要进一步研究以优化间隔物植入部位的局部抗生素治疗。
