Frieler S, Geßmann J, Jettkant B, Ronge J M, Köller M, Schildhauer T A, Baecker H
Chirurgische Klinik und Poliklinik, BG Universitätsklinikum Bergmannsheil Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
Hochschule für angewandte Wissenschaften, Fachhochschule Südwestfalen, 58644, Iserlohn, Deutschland.
Orthopade. 2019 Feb;48(2):130-135. doi: 10.1007/s00132-018-3654-0.
In two-stage septic revision arthroplasty of the knee, a temporary intramedullary fixation with an antibiotic-containing polymethyl methacrylate (PMMA) spacer is often performed in cases of extensive bone defects after endoprosthesis explantation. A common method is the use of conventional steel or carbon fiber rods, which are connected via a tube-to-tube connector and finally reinforced near the joint with bone cement.
As the surface of foreign materials plays a critical role in the colonization and biofilm formation in the treatment of periprosthetic joint infections (PJI), the steel and carbon fiber rods were examined and compared with respect to bacterial surface adhesions.
Carbon fiber and steel rods of external fixator systems were used for this experimental study. The sample material was placed in a substrate enriched with S. aureus. The adherent bacteria were examined both by fluorescence microscopy and quantitatively after ultrasonic detachment (sonication) in a smear preparation. In addition, scanning electron micrograph (SEM) images were taken to analyze the topography of bacterial adhesions.
The fluorescence microscopy revealed a uniform surface distribution for both materials. The observation of the SEM images showed that for carbon fiber rods the growth of bacteria ran in unison with the direction of the fiber, while for the steel rods an arbitrary arrangement was found. With the help of sonication a significant difference in the number of adherent micro-organisms between the two materials could not be determined using the Wilcoxon test (significance level p < 0.05).
Both materials can be used to perform PMMA-reinforced intramedullary fixation without fear of sacrificing therapeutic success. From an economic point of view, the use of steel rods seems reasonable as the material costs are significantly lower.
在膝关节二期感染性翻修关节成形术中，对于假体取出后出现广泛骨缺损的病例，常采用含抗生素的聚甲基丙烯酸甲酯（PMMA）间隔物进行临时髓内固定。一种常见的方法是使用传统的钢棒或碳纤维棒，它们通过管对管连接器连接，最后在关节附近用骨水泥加固。
由于异物表面在假体周围关节感染（PJI）治疗中的定植和生物膜形成中起关键作用，因此对钢棒和碳纤维棒的细菌表面粘附情况进行了检查和比较。
本实验研究使用外固定系统的碳纤维棒和钢棒。将样本材料置于富含金黄色葡萄球菌的基质中。通过荧光显微镜检查粘附细菌，并在涂片制备中超声分离（超声处理）后进行定量分析。此外，拍摄扫描电子显微镜（SEM）图像以分析细菌粘附的形貌。
荧光显微镜显示两种材料的表面分布均匀。SEM图像观察表明，对于碳纤维棒，细菌生长与纤维方向一致，而对于钢棒，则发现细菌呈任意排列。借助超声处理，使用Wilcoxon检验无法确定两种材料之间粘附微生物数量的显著差异（显著性水平p < 0.05）。
两种材料均可用于进行PMMA加固的髓内固定，而无需担心牺牲治疗效果。从经济角度来看，使用钢棒似乎是合理的，因为材料成本显著更低。
