1 Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
2 The Atlanta Veterans Affairs Medical Center, Decatur, GA, USA.
Foot Ankle Int. 2018 Aug;39(8):954-959. doi: 10.1177/1071100718766655. Epub 2018 Apr 5.
Vancomycin is frequently applied locally to the operative site during foot and ankle procedures to help prevent infection. Although the efficacy of locally applied vancomycin has been demonstrated in spine surgery, there is no consensus on dosing and indication within foot and ankle surgery. Osteogenic differentiation of human mesenchymal stromal cells (hMSCs) is key to healing of both fractures and arthrodesis. The purpose of this research was to determine the impact of vancomycin on human hMSCs during the process of osteogenic differentiation.
hMSCs were cultured in osteogenic differentiation media to promote osteogenic differentiation. Cells were treated with vancomycin at differing concentrations of 0, 50, 500, and 5000 µg/mL. Viability and cell growth were assessed via LIVE/DEAD viability/cytotoxicity kit (Invitrogen, Waltham, MA) after 1, 3, and 7 days of vancomycin treatment. Differentiation and mineralization was assessed via alizarin red staining after 21 days of treatment. Mean cell viability, cell number, and mineralization were compared between treatment groups using 1-way analysis of variance and the Tukey-Kramer method for post hoc pairwise comparisons.
At the highest concentrations of vancomycin, there was a significant reduction in cell viability and proliferation after 3 days compared with all other treatment groups. Mineralization was also significantly decreased with higher doses of vancomycin.
At high concentrations, vancomycin may impair hMSC viability and osteogenic differentiation.
Surgeons should exercise caution and consider the limited soft tissue envelope when applying vancomycin locally during foot and ankle surgery, especially during arthrodesis procedures.
万古霉素常用于足踝手术的术区局部给药，以帮助预防感染。虽然局部应用万古霉素在脊柱手术中已被证实有效，但在足踝手术中，其剂量和适应证尚未达成共识。人骨髓间充质干细胞（hMSCs）的成骨分化对于骨折和关节融合的愈合至关重要。本研究旨在确定万古霉素在 hMSCs 成骨分化过程中的影响。
hMSCs 在成骨分化培养基中培养以促进成骨分化。细胞用不同浓度的万古霉素（0、50、500 和 5000μg/ml）处理。在万古霉素处理 1、3 和 7 天后，通过 LIVE/DEAD 活力/细胞毒性试剂盒（Invitrogen，沃尔瑟姆，MA）评估细胞活力和细胞生长。在处理 21 天后，通过茜素红染色评估分化和矿化。使用单因素方差分析和 Tukey-Kramer 法进行事后两两比较，比较不同处理组之间的平均细胞活力、细胞数量和矿化。
在最高浓度的万古霉素下，与所有其他处理组相比，细胞活力和增殖在第 3 天显著降低。高剂量的万古霉素也显著降低了矿化。
高浓度的万古霉素可能会损害 hMSC 的活力和成骨分化。
外科医生在进行足踝手术时，尤其是在进行关节融合术时，应谨慎使用局部万古霉素，并考虑到有限的软组织包埋。
